Speed-Dependent Treadmill Training in Ambulatory Hemiparetic Stroke Patients: A Randomized Controlled Trial Analysis and Comparison of the Psychometric Properties of Three Balance Measures for Stroke Patients Circuit Class Therapy or Seven-Day Week Therapy for Increasing Rehabilitation Intensity of Therapy after Stroke (CIRCIT): A Randomized Controlled Trial Responsiveness and predictability of gait speed and other disability measures in acute stroke. Inactive and Alone: Physical Activity Within the First 14 Days of Acute Stroke Unit Care People with stroke spend more time in active task practice, but similar time in walking practice, when physiotherapy rehabilitation is provided in circuit classes compared to individual therapy sessions: an observational study. Effects of a high-intensity task-oriented training on gait performance early after stroke: a pilot study Water-based exercise for cardiovascular fitness in people with chronic stroke: a randomized controlled trial. Exercise to Enhance Mobility and Prevent Falls After Stroke Controlled comparison of retention and adherence in home- vs center-initiated exercise interventions in women ages 40-65 years: The S.W.E.A.T. Study (Sedentary Women Exercise Adherence Trial). Effects of circuit training as alternative to usual physiotherapy after stroke: randomised controlled trial A task-orientated intervention enhances walking distance and speed in the first year post stroke: a randomized controlled trial Muscle strengthening and physical conditioning to reduce impairment and disability in chronic stroke survivors. Technology-assisted stroke rehabilitation in Mexico: a pilot randomized trial comparing traditional therapy to circuit training in a Robot/technology-assisted therapy gym Exercise-Induced Changes in Cardiovascular Function after Stroke: A Randomized Controlled Trial Meaningful change and responsiveness in common physical performance measures in older adults. Time dependency of walking classification in stroke. Cost-effectiveness of a structured progressive task-oriented circuit class training programme to enhance walking competency after stroke: The protocol of the FIT-Stroke trial A randomized controlled trial of supervised versus unsupervised exercise programs for ambulatory stroke survivors. Clinical application of circuit training for subacute stroke patients: a preliminary study Exercise intervention to prevent falls and enhance mobility in community dwellers after stroke: a protocol for a randomised controlled trial Effects of individualized versus group task-oriented circuit training on balance ability and gait endurance in chronic stroke inpatients What is the benefit of a high-intensive exercise program on health-related quality of life and depression after stroke? A randomized controlled trial Exercise leads to faster postural reflexes, improved balance and mobility, and fewer falls in older persons with chronic stroke. Physical fitness training in Subacute Stroke (PHYS-STROKE) - study protocol for a randomised controlled trial Effectiveness of a structured circuit class therapy model in stroke rehabilitation: a protocol for a randomised controlled trial Additional task-related practice improves mobility and upper limb function early after stroke: a randomised controlled trial. Psychometric evaluation of the original and Canadian French version of the activities-specific balance confidence scale among people with stroke. Effect of the a circuit training program using obstacles on the walking and balance abilities of stroke patients Circuit class therapy versus individual physiotherapy sessions during inpatient stroke rehabilitation: a controlled trial. Balance and stability-focused exercise program improves stability and balance in patients after acute stroke in a resource-poor setting. Task-related circuit training improves performance of locomotor tasks in chronic stroke: a randomized, controlled pilot trial. Effects of Combined Aerobic and Resistance Exercise on Central Arterial Stiffness and Gait Velocity in Patients with Chronic Poststroke Hemiparesis Balance self-efficacy and its relevance to physical function and perceived health status after stroke. A multidisciplinary group programme in rural settings for community-dwelling chronic stroke survivors and their carers: a pilot randomized controlled trial Circuit Class or Seven-Day Therapy for Increasing Intensity of Rehabilitation after Stroke: Protocol of the CIRCIT Trial Exercise and health-related quality of life during the first year following acute stroke. A randomized controlled trial A Home- and Community-Based Physical Activity Program Can Improve the Cardiorespiratory Fitness and Walking Capacity of Stroke Survivors. Empirical evaluation of very large treatment effects of medical interventions. Effect of Strengthening Exercise in Addition to Task-Specific Gait Training after Stroke: a Randomised Trial The long-term effect of exercise on vascular risk factors and aerobic fitness in those with transient ischaemic attack: a randomized controlled trial A community-based fitness and mobility exercise program for older adults with chronic stroke: a randomized, controlled trial. Submaximal exercise in persons with stroke: test-retest reliability and concurrent validity with maximal oxygen consumption. Community walking training program improves walking function and social participation in chronic stroke patients. Detecting change in patients with stroke using the Berg Balance Scale. Group exercise can improve participants' mobility in an outpatient rehabilitation setting: a randomized controlled trial Circuit-based rehabilitation improves gait endurance but not usual walking activity in chronic stroke: a randomized controlled trial. Upper-extremity functional electric stimulation-assisted exercises on a workstation in the subacute phase of stroke recovery. A community-based upper-extremity group exercise program improves motor function and performance of functional activities in chronic stroke: a randomized controlled trial. Aerobic Exercise Improves Cognition and Motor Function Poststroke Stroke: a randomized trial of exercise or relaxation. Effects of Task-Specific Locomotor and Strength Training in Adults Who Were Ambulatory After Stroke: Results of the STEPS Randomized Clinical Trial Task-oriented progressive resistance strength training improves muscle strength and functional performance in individuals with stroke Randomized Controlled Trial of Truncal Exercises Early After Stroke to Improve Balance and Mobility Task-Oriented Circuit Class Training Program with Motor Imagery for Gait Rehabilitation in Poststroke Patients: A Randomized Controlled Trial Meaningful Task-Specific Training (MTST) for Stroke Rehabilitation: A Randomized Controlled Trial Safety and feasibility of post-stroke care and exercise after minor ischemic stroke or transient ischemic attack: MotiveS & MoveIT.
Background and Purpose — A new gait training strategy for patients with stroke seeks to increase walking speed through treadmill training . This study compares the effects of structured speed-dependent treadmill training ( STT ) ( with the use of an interval paradigm to increase the treadmill speed stepwise according to principles of sport physiology ) with limited progressive treadmill training ( LTT ) and conventional gait training ( CGT ) on clinical outcome measures for patients with hemiparesis . Methods — Sixty ambulatory poststroke patients were each r and omly selected to receive 1 of the 3 different gait therapies : 20 subjects were treated with STT , 20 subjects were trained to walk on a treadmill with a 20 % increase of belt speed over the treatment period ( LTT ) , and 20 subjects were treated with CGT . Treatment outcomes were assessed on the basis of overground walking speed , cadence , stride length , and Functional Ambulation Category scores . Results — After a 4-week training period , the STT group scored significantly higher than the LTT and CGT groups for overground walking speed ( STT versus LTT , P < 0.001 ; STT versus CGT , P < 0.001 ) , cadence ( STT versus LTT , P = 0.007 ; STT versus CGT , P < 0.001 ) , stride length ( STT versus LTT , P < 0.001 ; STT versus CGT , P < 0.001 ) , and Functional Ambulation Category scores ( STT versus LTT , P = 0.007 ; STT versus CGT , P < 0.001 ) . Conclusions — Structured STT in poststroke patients result ed in better walking abilities than LTT or CGT . This gait training strategy provides a dynamic and integrative approach for the treatment of gait dysfunction after stroke Background and Purpose — This study compared the psychometric properties of 3 clinical balance measures , the  Berg Balance Scale ( BBS ) , the Balance subscale of the Fugl-Meyer test ( FM-B ) , and the Postural Assessment Scale for Stroke Patients ( PASS ) , in stroke patients with a broad range of neurological and functional impairment from the acute stage up to 180 days after onset . Methods — One hundred twenty-three stroke patients were followed up prospect ively with the 3 balance measures 14 , 30 , 90 , and 180 days after stroke onset ( DAS ) . Reliability ( interrater reliability and internal consistency ) and validity ( concurrent validity , convergent validity , and predictive validity ) of each measure were examined . A comparison of the responsiveness of each of the 3 measures was made on the basis of the entire group of patients and 3 separate groups classified by degree of neurological severity . Results — The FM-B and BBS showed a significant floor or ceiling effect at some DAS points , whereas the PASS did not show these effects . The BBS , FM-B , and PASS all had good reliability and validity for patients at different recovery stages after stroke . The results of effect size demonstrated fair to good responsiveness of all 3 measures within the first 90 DAS but , as expected , only a low level of responsiveness at 90 to 180 DAS . The PASS was more responsive to changes in severe stroke patients at the earliest period after stroke onset , 14 to 30 DAS . Conclusions — All 3 measures tested showed very acceptable levels of reliability , validity , and responsiveness for both clinicians and research ers . The PASS showed slightly better psychometric characteristics than the other 2 measures Background Increased therapy has been linked to improvements in functional ability of people with stroke . Aim To determine the effectiveness of two alternative models of increased physiotherapy service delivery ( seven-day week therapy or group circuit class therapy five days a week ) to usual care . Method Three-armed r and omized controlled trial with blinded assessment of outcome . People admitted with a diagnosis of stroke , previously independently ambulant and with a moderate level of disability were recruited .  ‘ Usual care ’ was individual physiotherapy provided five-days a week . Seven-day week therapy was usual care physiotherapy provided seven-days a week . Participants in the circuit class therapy arm of the trial received physiotherapy in group circuit classes in two 90-min sessions , five-days a week . Primary outcome was distance walked on the six-minute walk test at four-weeks post-r and omization . Results Two hundred eighty-three participants were r and omized ; primary outcome data were available for 259 ( 92 % ) . In the seven-day arm participants received an additional three hours of physiotherapy and thosein the circuit class armanadditional 22 h. There were no significant between-group differences at four-weeks in walking distance ( P = 0·72 ) . Length of stay was shorter for seven-day ( mean difference −2·9 days , 95 % confidence interval −17·9 to 12·0 ) and circuit class participants ( mean difference −9·2 days , 95 % confidence interval −24·2 to 5·8 ) compared to usual care , but this was not significant . Conclusions Both seven-day therapy and group circuit class therapy increased physiotherapy time , but walking outcomes were equivalent to usual care OBJECTIVES To identify the most responsive method of measuring gait speed , to estimate the responsiveness of other outcome measures , and to determine whether gait speed predicts discharge destination in acute stroke . DESIGN A prospect i ve cohort study . SETTING Five acute-care hospitals . PATIENTS Fifty subjects with residual gait deficits after a first-time stroke . INTERVENTIONS Five- ( 5mWT ) and 10-meter walk tests ( 10mWT ) at comfortable and maximum speeds , with 2 evaluations conducted an average + /- st and ard deviation ( SD ) of 8 + /- 3 and 38 + /- 5 days poststroke . MAIN OUTCOME MEASURE St and ardized response mean ( SRM = mean change/SD of change ) was used to estimate responsiveness for each walk test , the Berg Balance Scale , the Barthel Index , the Stroke Rehabilitation Assessment of Movement ( STREAM ) , and the Timed Up and Go ( TUG ) . RESULTS The SRMs were 1.22 and 1.00 for the 5mWT , and .92 and .83 for the 10mWT performed at a comfortable and maximum pace , respectively . The SRMs for the Berg Balance Scale , the Barthel Index , the STREAM , and the TUG were 1.04,.99,.89 , and .73 , respectively . The probability of discharge to a rehabilitation center for persons walking at < or = 0.3 m/s or > 0.6 m/s at the first evaluation was.95 and .22 , respectively . CONCLUSIONS The 5mWT at a comfortable pace is recommended as the measure of choice for clinicians and research ers who need to detect longitudinal change in walking disability in the first 5 weeks poststroke Background and Purpose — One way that stroke units may improve outcome is by reducing complications of immobility through early mobilization ; however , this intervention needs testing . The purpose of this study was to determine the physical activity patterns of stroke patients managed within acute stroke units as a first step in developing an early mobilization protocol . Methods — We recruited 64 patients within 14 days after stroke from 5 metropolitan stroke units and observed them for 2 consecutive days at 10-minute intervals between the hours of 8 am and 5 pm . At each observation , we ascertained physical activity , location , and other person(s ) present . Therapists recorded therapy details . Results — The 58 patients who completed the study had a mean age of 71.3 years . Stroke severity ranged from mild ( National Institutes of Health Stroke Scale score , 1 ) to severe ( score , 27 ) , and mean time after stroke at observation was 5.6 days ( range , 0 to 13 days ) . Only 9 patients were restricted to bed . During the therapeutic day , patients spent > 50 % resting in bed , 28 % sitting out of bed , and only 13 % engaged in activities with the potential to prevent complications and improve recovery of mobility . Patients were alone > 60 % of the time . Conclusions — This is the first multicenter study of physical activity early after stroke . We believe the next step is to conduct a r and omized controlled trial to evaluate the effect of increased levels of  physical activity  early after stroke compared with current st and ards of care QUESTION Do people with stroke spend more time in active task practice during circuit class therapy sessions versus individual physiotherapy sessions ? Do people with stroke practise different tasks during circuit class therapy sessions versus individual physiotherapy sessions ? DESIGN Prospect i ve , observational study . PARTICIPANTS Twenty-nine people with stroke in inpatient rehabilitation setting s. INTERVENTIONS Individual therapy sessions and circuit class therapy sessions provided within a larger r and omised controlled trial . OUTCOME MEASURES Seventy-nine therapy sessions were video-recorded and the footage was analysed for time spent engaged in various categories of activity . In a sub sample of 28 videos , the number of steps taken by people with stroke per therapy session was counted . RESULTS Circuit class therapy sessions were of a longer duration ( mean difference 38.0minutes , 95 % CI 29.9 to 46.1 ) , and participants spent more time engaged in active task practice ( mean difference 23.8minutes , 95 % CI 16.1 to 31.4 ) compared with individual sessions . A greater percentage of time in circuit class therapy sessions was spent practising tasks in sitting ( mean difference 5.3 % , 95 % CI 2.4 to 8.2 ) and in sit-to-st and practice ( mean difference 2.7 % , 95 % CI 1.4 to 4.1 ) , and a lower percentage of time in walking practice ( mean difference 19.1 % , 95 % CI 10.0 to 28.1 ) compared with individual sessions . PARTICIPANTS took an average of 371 steps ( SD 418 ) during therapy sessions and this did not differ significantly between group and individual sessions . CONCLUSION People with stroke spent more time in active task practice , but a similar amount of time in walking practice when physiotherapy was offered in circuit class therapy sessions versus individual therapy sessions . There is a need for effective strategies to increase the amount of walking practice during physiotherapy sessions for people after stroke Objective : To investigate the feasibility and the effects on gait of a high intensity task-oriented training , incorporating a high cardiovascular workload and large number of repetitions , in patients with subacute stroke , when compared to a low intensity physiotherapy-programme . Design and subjects : R and omized controlled clinical trial : Forty-four patients with stroke were recruited at 2 to 8 weeks after stroke onset . Measures : Maximal gait speed assessed with the 10-metre timed walking test ( 10MTWT ) , walking capacity assessed with the six-minute walk test ( 6MWT ) . Control of st and ing balance assessed with the Berg Balance Scale and the Functional Reach test . Group differences were analysed using a Mann — Whitney U-test . Results : Between-group analysis showed a statistically significant difference in favour of the high intensity task-oriented training in performance on the 10MTWT ( Z = -2.13 , P = 0.03 ) and the 6MWT ( Z = -2.26 , P = 0.02 ) . No between-group difference were found for the Berg Balance Scale ( Z = —0.07 , P = 0.45 ) and the Functional Reach test ( Z = —0.21 , P = 0.84 ) . Conclusion : A high-intensity task-oriented training programme design ed to improve hemiplegic gait and physical fitness was feasible in the present study and the effectiveness exceeds a low intensity physiotherapy-programme in terms of gait speed and walking capacity in patients with subacute stroke . In a future study , it seems appropriate to additionally use measures to evaluate physical fitness and energy expenditure while walking OBJECTIVE To evaluate the effect of an 8-week , water-based exercise program ( experimental group ) with that of an upper-extremity function program ( control group ) to increase cardiovascular fitness within a community setting for people with stroke . DESIGN Single-blind r and omized controlled trial . SETTING Public community center . PARTICIPANTS A volunteer sample of 12 community-dwelling people with stroke with mild to moderate residual motor deficits . INTERVENTION Study subjects participated in group exercise programs for 1 hour , 3 times a week for 8 weeks . The experimental group exercised in chest-deep water at targeted heart rates . The control group performed arm and h and exercises while sitting . Main outcome measures The primary outcome measure was cardiovascular fitness ( V(O2)max ) . Secondary measures were maximal workload , muscle strength , gait speed , and the Berg Balance Scale score . RESULTS The experimental group attained significant improvements over the control group in cardiovascular fitness , maximal workload , gait speed , and paretic lower-extremity muscle strength . The relatively short program ( 8 wk ) of water-based exercise result ed in a 22 % improvement in cardiovascular fitness in a small group of people with stroke who had relatively high function . CONCLUSIONS A water-based exercise program undertaken as a group program may be an effective way to promote fitness in people with stroke Background . Exercise interventions can enhance mobility after stroke as well as prevent falls in elderly persons . Objective . Investigate whether an exercise intervention can enhance mobility , prevent falls , and increase physical activity among community-dwelling people after stroke . Method . A r and omized trial with blinding of physical outcome assessment was conducted through local stroke clubs . Both groups , on average 5.9 years poststroke , received exercise classes , advice , and a home program for 12 months . The experimental group ( EG ) program ( n = 76 ) aim ed to improve walking , prevent falls and increase physical activity . The control group ( CG ) program ( n = 75 ) aim ed to improve upper-limb and cognitive functions . The primary outcomes were walking capacity , walking speed measured before and after the intervention , and fall rates monitored monthly . Results . At 12 months , the EG walked 34 m further in 6 minutes ( 95 % confidence interval [ CI ] = 19 - 50 ; P < .001 ) and 0.07 m/s faster over 10 m ( 95 % CI = 0.01 - 0.14 ; P = .03 ) than the CG . The EG had 129 falls , and the CG had 133 . There were no differences in proportion of fallers ( relative risk = 1.22 ; 95 % CI = 0.91 - 1.62 ; P = .19 ) or the rate of falls between groups ( incidence rate ratio = 0.96 ; 95 % CI = 0.59 - 1.51 ; P = .88 ) . Conclusion . The experimental intervention delivered through stroke clubs enhanced aspects of mobility but had no effect on falls BACKGROUND In an 18-month exercise intervention in previously sedentary older women ( 40 - 65 years ) , we examined whether an initial 6 months of supervised exercise leads to greater long-term retention and adherence to regular physical activity than an unsupervised home-based program and whether these outcomes are influenced by the exercise intensity . METHODS Women ( N = 126 ) were recruited from the community and r and omly assigned to either center-based or home-based exercise three times/week . The center-based group attended supervised sessions for 6 months , while after 10 initial sessions the home-based group exercised at home . After 6 months both groups were home-based for a further 12 months . Within each arm , subjects were further r and omized to exercise at either moderate or vigorous intensity . RESULTS The center-based group had higher retention than the home-based ( 97 , 94 , 81 versus 87 , 76 , and 61 % ) at 6 , 12 , and 18 months , respectively ( P < 0.05 ) . At 6 months , adherence was higher in the center-based group ( 84 versus 63 % , P < 0.001 ) and energy expenditure was higher at 6 ( P < 0.05 ) and 12 ( P < 0.01 ) months . At 18 months , retention was higher with moderate exercise ( P < 0.05 ) , while adherence was similar with both intensities . CONCLUSION An initial 6 months of center-based exercise enhanced retention in both the short and the long term and promoted short-term adherence and energy expenditure . Long-term , moderate exercise retained more subjects , but had little influence on adherence Objective To analyse the effect of task oriented circuit training compared with usual physiotherapy in terms of self reported walking competency for patients with stroke discharged from a rehabilitation centre to their own home . Design R and omised controlled trial with follow-up to 24 weeks . Setting Multicentre trial in nine outpatient rehabilitation centres in the Netherl and s Participants Patients with stroke who were able to walk a minimum of 10 m without physical assistance and were discharged from inpatient rehabilitation to an outpatient rehabilitation clinic . Patients were r and omly allocated to circuit training or usual physiotherapy , after stratification by rehabilitation centre , with an online r and omisation procedure . Intervention Patients in the intervention group received circuit training in 90 minute sessions twice a week for 12 weeks . The training included eight different workstations in a gym and was intended to improve performance in tasks relating to walking competency . The control group received usual outpatient physiotherapy . Main outcome measures The primary outcome was the mobility domain of the stroke impact scale ( SIS , version 3.0 ) . Secondary outcomes were st and ing balance , self reported abilities , gait speed , walking distance , stair climbing , instrumental activities of daily living , fatigue , anxiety , and depression . Differences between groups were analysed according to the intention to treat principle . All outcomes were assessed by blinded observers in a repeated measurement design lasting 24 weeks . Results 126 patients were included in the circuit training group and 124 in the usual care group ( control ) , with data from 125 and 117 , respectively , available for analysis . One patient from the circuit training  group and seven from the control group dropped out . Circuit training was a safe intervention , and no serious adverse events were reported . There were no significant differences between groups for the stroke impact scale mobility domain ( β=0.05 ( SE 0.68 ) , P=0.943 ) at 12 weeks . Circuit training was associated with significantly higher scores in terms of gait speed ( 0.09 m/s ( SE 0.02 ) , P<0.001 ) , walking distance ( 20.0 m ( SE 7.4 ) , P=0.007 ) , and modified stairs test ( −1.6 s ( SE 0.7 ) , P=0.015 ) . There were no significant differences between groups for the other secondary outcomes , except for the leisure domain of the Nottingham extended activities of daily living and the memory and thinking domain of the stroke impact scale . With the exception of gait speed ( −0.04 m/s ( SE 0.02 ) , P=0.040 ) , there were no significant differences between groups at follow-up . Conclusion Task oriented circuit training can safely replace usual physiotherapy for patients with stroke who are discharged from inpatient rehabilitation to the community and need further training in gait and gait related activities as an outpatient . Trial registration Dutch Trial Register ( NTR1534 ) Objective : To evaluate the efficacy of a task-orientated intervention in enhancing competence in walking in people with stroke . Design : Two-centre observer-blinded stratified block-r and omized controlled trial . Setting : General community . Subjects : Between May 2000 and February 2003 , 91 individuals with a residual walking deficit within one year of a first or recurrent stroke consented to participate . Interventions : The experimental intervention comprised 10 functional tasks design ed to strengthen the lower extremities and enhance walking balance , speed and distance . The control intervention involved the practice of upper extremity activities . Subjects in both groups attended sessions three times a week for six weeks . Main measures : Six-minute walk test ( SMWT ) , 5-m walk ( comfortable and maximum pace ) , Berg Balance Scale , timed ‘ up and go ’ . Results : At baseline , subjects in the experimental ( n = 44 ) and control ( n = 47 ) groups walked an average distance of 209 m ( SD = 126 ) and 204 m ( SD = 131 ) , respectively , on the SMWT . Mean improvements of 40 m ( SD = 72 ) , and 5 m ( SD = 66 ) were observed following the experimental and control interventions , respectively . The between-group difference was 35 m ( 95 % confidence interval ( CI ) 7 , 64 ) . Significant between-group effects of 0.21 m/s ( 95 % CI 0.12 , 0.30 ) and of 0.11 m/s ( 95 % CI 0.03 , 0.19 ) in maximum and comfortable walking speed , respectively , were observed . People with a mild , moderate or severe walking deficit at baseline improved an average of 36 ( SD = 96 ) , 55 ( SD = 56 ) and 18 m ( SD = 23 ) , respectively , in SMWT performance following the experimental intervention . Conclusions : Study findings support the efficacy of a task-orientated intervention in enhancing walking distance and speed in the first year post stroke , particularly in people with moderate walking deficits OBJECTIVE To evaluate the impact of a program of muscle strengthening and physical conditioning on  impairment and disability in chronic stroke subjects . DESIGN A r and omized pretest and posttest control group , followed by a single-group pretest and posttest design . SUBJECTS Thirteen community-dwelling stroke survivors of at least 9 months . INTERVENTION A 10-week ( 3 days/week ) program consisting of a warm-up , aerobic exercises , lower extremity muscle strengthening , and a cool-down . MAIN OUTCOME MEASURES Peak isokinetic torque of the major muscle groups of the affected lower limb , quadriceps and ankle plantarflexor spasticity , gait speed , rate of stair climbing , the Human Activity Profile ( HAP ) , and the Nottingham Health Profile ( NHP ) were recorded twice for the treatment group and three times for the control group . RESULTS Significant improvements were found for all the selected outcome measures ( HAP , NHP , and gait speed ) for the treatment group ( p < .001 ) . In terms of overall training effects , the 13 subjects demonstrated increases in strength of the affected major muscle groups , in HAP and NHP profiles , and in gait speed and rate of stair climbing without concomitant increases in either quadriceps or ankle plantarflexor spasticity . CONCLUSIONS The 10-week combined program of muscle strengthening and physical conditioning result ed in gains in all measures of impairment and disability . These gains were not associated with measurable changes of spasticity in either quadriceps or ankle plantarflexors Background Stroke rehabilitation in low- and middle-income countries , such as Mexico , is often hampered by lack of clinical re sources and funding . To provide a cost-effective solution for comprehensive post-stroke rehabilitation that can alleviate the need for one-on-one physical or occupational therapy , in lower and upper extremities , we proposed and implemented a technology-assisted rehabilitation gymnasium in Chihuahua , Mexico . The Gymnasium for Robotic Rehabilitation ( Robot Gym ) consisted of low- and high-tech systems for upper and lower limb rehabilitation . Our hypothesis is that the Robot Gym can provide a cost- and labor-efficient alternative for post-stroke rehabilitation , while being more or as effective as traditional physical and occupational therapy approaches . Methods A typical group of stroke patients was r and omly allocated to an  intervention ( n = 10 ) or a  control group ( n = 10 ) . The intervention group received rehabilitation using the devices in the Robot Gym , whereas the control group  ( n = 10 ) received time-matched st and ard care . All of the study subjects were subjected to 24 two-hour therapy sessions over a period of 6 to 8 weeks . Several clinical assessment s tests for upper and lower extremities were used to evaluate motor function pre- and post-intervention . A cost analysis was done to compare the cost effectiveness for both therapies . Results No significant differences were observed when comparing the results of the pre-intervention Mini-mental , Brunnstrom Test , and Geriatric Depression Scale Test , showing that both groups were functionally similar prior to the intervention . Although , both training groups were functionally equivalent , they had a significant age difference . The results of all of the upper extremity tests showed an improvement in function in both groups with no statistically significant differences between the groups . The Fugl-Meyer and the 10 Meters Walk lower extremity tests showed greater improvement in the intervention group compared to the control group . On the Time Up and Go Test , no statistically significant differences were observed pre- and post-intervention when comparing the control and the intervention groups . For the 6 Minute Walk Test , both groups presented a statistically significant difference pre- and post-intervention , showing progress in their performance . The robot gym therapy was more cost-effective than the traditional one-to-one therapy used during this study in that it enabled therapist to train up to 1.5 to 6 times more patients for the approximately same cost in the long term . Conclusions The results of this study showed that the patients that received therapy using the Robot Gym had enhanced functionality in the upper extremity tests similar to patients in the control group . In the lower extremity tests , the intervention patients showed more improvement than those subjected to traditional therapy . These results support that the Robot Gym can be as effective as traditional therapy for stroke patients , presenting a more cost- and labor-efficient option for countries with scarce clinical re sources and funding .Trial registration IS RCT N98578807 Background and aims Cardiovascular co-morbidities are prevalent after stroke , with heart disease , hypertension and impaired glucose tolerance present in the majority of cases . Exercise has the potential to mediate cardiovascular risk factors commonly present in people with stroke . This single-blinded r and omized controlled trial compared the effects of high versus low intensity exercise on fitness , cardiovascular risk factors , and cardiac function after stroke . Methods Fifty participants ( age 50–80 y , > 1 y post-stroke ) were r and omized to a high-intensity Aerobic Exercise ( AE ) or low-intensity non-aerobic Balance/Flexibility ( BF ) program ( 6 months , 3 60-min sessions/week ) . Outcomes assessed by VO2peak ( primary outcome ) , arterial stiffness , ambulatory capacity , hemodynamics and cardiac function using echocardiography , and lipid , glucose and homocysteine levels . Assessors were blinded to group allocation . Results Twenty-three ( 92 % ) of 25 AE group participants ( withdrawals unrelated to the intervention ) and all BF group participants completed the program . One BF group participant experienced 2 non-injurious falls during class . No other adverse events occurred . There were no changes in VO2peak in either group ( AE 16·9 ±7 to 17·4 ± 7 ml•kg−1•min−1 vs. BF 16·9 ±6 to 16·6 ± 5 ml•kg−1•min−1 , P = 0·45 ) , but AE group demonstrated greater improvement in right atrial emptying fraction ( AE 30 ± 22 to 37 ± 22 % vs. BF 35 ± 20 to 31 ± 20 % , P = 0·04 ) . Both groups demonstrated improvements in lipid profiles , glucose and homocysteine levels , and ambulatory capacity ( P < 0·04 ) . Conclusions This was the first study to examine the effects of aerobic exercise after stroke on cardiovascular hemodynamics . High-intensity exercise improved right-sided function and early myocardial relaxation . Low-intensity exercise may also benefit plasma lipid , glucose and inflammatory markers , and ambulatory capacity . This study is an important step towards underst and ing mechanisms by which exercise may reduce cardiovascular risk and function OBJECTIVES To estimate the magnitude of small meaningful and substantial individual change in physical performance measures and evaluate their responsiveness . DESIGN Secondary data analyses using distribution- and anchor-based methods to determine meaningful change . SETTING Secondary analysis of data from an observational study and clinical trials of community-dwelling older people and subacute stroke survivors . PARTICIPANTS Older adults with mobility disabilities in a strength training trial ( n=100 ) , subacute stroke survivors in an intervention trial ( n=100 ) , and a prospect i ve cohort of community-dwelling older people ( n=492 ) . MEASUREMENTS  Gait speed , Short Physical Performance Battery ( SPPB ) , 6-minute-walk distance ( 6MWD ) , and self-reported mobility . RESULTS Most small meaningful change estimates ranged from 0.04 to 0.06 m/s for gait speed , 0.27 to 0.55 points for SPPB , and 19 to 22 m for 6MWD . Most substantial change estimates ranged from 0.08 to 0.14 m/s for gait speed , 0.99 to 1.34 points for SPPB , and 47 to 49 m for 6MWD . Based on responsiveness indices , per-group sample sizes for clinical trials ranged from 13 to 42 for substantial change and 71 to 161 for small meaningful change . CONCLUSION Best initial estimates of small meaningful change are near 0.05 m/s for gait speed , 0.5 points for SPPB , and 20 m for 6MWD and of substantial change are near 0.10 m/s for gait speed , 1.0 point for SPPB , and 50 m for 6MWD . For clinical use , substantial change in these measures and small change in gait speed and 6MWD , but not SPPB , are detectable . For research use , these measures yield feasible sample sizes for detecting meaningful change BACKGROUND AND PURPOSE To facilitate optimal stroke rehabilitation , valid interpretation of observed functional recovery is required . The purpose of this study was to examine the longitudinal relationship between comfortable walking speed and  Functional Ambulation Categories ( FAC ) scores for physically independent gait . SUBJECTS This study was a prospect i ve cohort study with 73 subjects who were severely affected by acute stroke . METHODS Functional Ambulation Categories classification and walking speed were measured between weeks 4 and 26 after stroke . The responsiveness of walking speed  measurements for detecting clinical ly important speed changes was determined , and the longitudinal association between walking speed and FAC scores and its time dependency were established . This relationship subsequently was scrutinized for possible speed changes occurring within specific FAC scores . Responsiveness ratios , r and om coefficient analysis , paired Student t tests , and the Cohen kappa statistic were used for statistical analyses . RESULTS Responsiveness ratios exceeded the smallest detectable differences . R and om coefficient analysis demonstrated a significant between- and within-subject coefficient and a significant negative interaction between timing of measurements and FAC scores . Paired Student t tests revealed mostly significant pretest-posttest differences in walking speeds , and all kappa values for pretest-posttest FAC scores were significant . DISCUSSION AND CONCLUSION Walking speed measurements are sensitive for detecting clinical ly important changes . Functional Ambulation Categories scores are dependent on the timing of comfortable walking speed measurements after stroke . Moreover , there are indications that , in this relationship , repeated FAC appraisal s are not only based on steady walking speeds , but that the walking speeds related to a specific FAC appraisal also change and , over time , may shift gradually from higher to lower speeds Background Most patients who suffer a stroke experience reduced walking competency and health-related quality of life ( HRQoL ) . A key factor in effective stroke rehabilitation is intensive , task-specific training . Recent studies suggest that intensive , patient-tailored training can be organized as a circuit with a series of task-oriented workstations . Primary aim of the FIT-Stroke trial is to evaluate the effects and cost-effectiveness of a structured , progressive task-oriented circuit class training ( CCT ) programme , compared to usual physiotherapeutic care during outpatient rehabilitation in a rehabilitation centre . The task-oriented CCT will be applied in groups of 4 to 6 patients . Outcome will be defined in terms of gait and gait-related ADLs after stroke . The trial will also investigate the generalizability of treatment effects of task-oriented CCT in terms of perceived fatigue , anxiety , depression and perceived HRQoL. Methods / design The multicentre single-blinded r and omized trial will include 220 stroke patients discharged to the community from inpatient rehabilitation , who are able to communicate and walk at least 10 m without physical , h and s-on assistance . After discharge from inpatient rehabilitation , patients in the experimental group will receive task-oriented CCT two times a week for 12 weeks at the physiotherapy department of the rehabilitation centre . Control group patients will receive usual individual , face-to-face , physiotherapy . Costs will be evaluated by having each patient keep a cost diary for the first 24 weeks after r and omisation . Primary outcomes are the mobility part of the Stroke Impact Scale ( SIS-3.0 ) and the EuroQol . Secondary outcomes are the other domains of SIS-3.0 , lower limb muscle strength , walking endurance , gait speed , balance , confidence not to fall , instrumental ADL , fatigue , anxiety , depression and HRQoL. Discussion Based on assumptions about the effect of intensity of practice and specificity of treatment effects , FIT-Stroke will address two key aims . The first aim is to investigate the effects of task-oriented CCT on walking competency and HRQoL compared to usual face-to-face physiotherapy . The second aim is to reveal the cost-effectiveness of task-oriented CCT in the first 6 months post stroke . Both aims were recently recommended as priorities by the American Hearth Association and Stroke Council . Trial registration This study is registered in the Dutch Trial Register as NTR1534 BACKGROUND AND PURPOSE Little is known about the relative efficacy of supervised versus unsupervised community exercise programs for stroke survivors . This study compared the effectiveness of a 10-week supervised strengthening and conditioning program ( supervised ) with a 1-week supervised instruction program followed by a 9-week unsupervised home program ( unsupervised ) and evaluated retention of changes at 6 months and 1 year after program completion . METHODS Seventy-two subjects retained at baseline ( 27 women , 45 men ; mean+/-SD age , 64.6+/-11.8 years ) were r and omly allocated to receive the supervised or unsupervised program . The primary outcome was walking speed over 6 minutes , and secondary outcome measures were Human Activity Profile , Medical Outcome Study 36-Item Short-Form survey ( SF-36 ) , Physiological Cost Index , and lower extremity muscle strength . RESULTS The 6-minute walking speed increased significantly in both groups and remained significantly improved by 1 year . The Human Activity Profile demonstrated an increasing trend only in the supervised group that was significant by 1 year . The SF-36 Physical Component summary score increased significantly in the supervised group and remained improved by 1 year ; the unsupervised group showed significant improvement at 1 year . Women made greater gains in supervised programs , but men made greater gains in unsupervised programs . CONCLUSIONS Supervised exercise programs and unsupervised programs after initial supervised instruction were both associated with physical benefits that were retained for 1 year , although supervised programs showed trends to greater improvements in self-reported gains . Gender differences require further research [ Purpose ] To investigate how task-oriented circuit training for the recovery motor control of the lower-extremity , balance and walking endurance could be clinical ly applied to subacute stroke inpatient group therapy . [ Subjects and Methods ] Twenty subacute stroke patients were r and omly assigned to the intervention group ( n=10 ) or the control group ( n=10 ) . The intervention consisted of a structured , progressive , inpatient circuit training program focused on mobility and gait training as well as physical fitness training that was performed for 90 minutes , 5 days a week for 4 weeks . The control group received individual physiotherapy of neurodevelopmental treatment for 60 minutes , 5 days a week for 4 weeks . Outcome measures were lower-extremity motor control , balance , gait endurance and activities of daily living before and after 4 weeks . [ Results ] There were no significant differences at baseline between the two groups . After 4 weeks , both groups showed significant improvements in all outcome measures , but there were no significant differences between the two groups during the invention period . [ Conclusion ] In spite of the small sample size , these findings suggest that task-oriented circuit training might be used as a cost-effective and alternative method of individual physiotherapy for the motor recovery of lower-extremity , balance and walking endurance of subacute stroke patients Background Stroke is the most common disabling neurological condition in adults . Falls and poor mobility are major contributors to stroke-related disability . Falls are more frequent and more likely to result in injury among stroke survivors than among the general older population . Currently there is good evidence that exercise can enhance mobility after stroke , yet ongoing exercise programs for general community-based stroke survivors are not routinely available . This r and omised controlled trial will investigate whether exercise can reduce fall rates and increase mobility and physical activity levels in stroke survivors . Methods and design Three hundred and fifty community dwelling stroke survivors will be recruited . Participants will have no medical contradictions to exercise and be cognitively and physically able to complete the assessment s and exercise program .  After the completion of the pre-test assessment , participants will be r and omly allocated to one of two intervention groups . Both intervention groups will participate in weekly group-based exercises and a home program for twelve months . In the lower limb intervention group , individualised programs of weight-bearing balance and strengthening exercises will be prescribed . The upper limb/cognition group will receive exercises aim ed at management and improvement of function of the affected upper limb and cognition carried out in the seated position . The primary outcome measures will be falls ( measured with 12 month calendars ) and mobility . Secondary outcome measures will be risk of falling , physical activity levels , community participation , quality of life , health service utilisation , upper limb function and cognition . Discussion This study aims to establish and evaluate community-based sustainable exercise programs for stroke survivors . We will determine the effects of the exercise programs in preventing falls and enhancing mobility among people following stroke . This program , if found to be effective , has the potential to be implemented within existing community services . Trial registration The protocol for this study is registered with the Australian New Zeal and Clinical Trials Registry ( ACTRN12606000479505 ) [ Purpose ] The purpose of this study was to analyze the effects of task-oriented circuit training on the balance ability and gait endurance of chronic stroke in patients . [ Subjects and Methods ] The participants were 30 patients who had stroke > 6 months previously , result ing in a disability such as hemiparesis . The participants were r and omly divided into the group task-oriented circuit training group and the individual task-oriented circuit-training group . They performed eight types of modified task-oriented training .  Balance ability and gait endurance were measured by using the Berg balance scale question naire and the 6-min walk test , respectively , before and after the experiment . [ Results ] Significant differences were observed between before and after the intervention in all variables . There was a significant difference between groups in Berg balance scale scores ; however , no significant differences were seen in the timed up and go test and the 6-min walk test . [ Conclusion ] The results of this study indicated that group exercise can better improve the balance ability of chronic stroke in patients after stroke than can individualized exercise intervention Abstract The aim of the study was to evaluate the impact of a high-intensive exercise program containing high-intensive functional exercises implemented to real-life situations together with group discussion s on falls and security aspects in stroke subjects with risk of falls . This was a pre-specified secondary outcome for this study . For evaluation , Short Form-36 ( SF-36 ) health-related quality of life ( HRQoL ) and the Geriatric Depression Scale-15 ( GDS-15 ) were used . This was a single-center , single-blinded , r and omized , controlled trial . Consecutive ≥55 years old stroke patients with risk of falls at 3–6 months after first or recurrent stroke were r and omized to the  intervention group ( IG , n=15 ) or to the control group ( CG , n=19 ) who received group discussion with focus on hidden dysfunctions but no physical fitness training . The 5-week high-intensive exercise program was related to an improvement in the CG in the SF-36 Mental Component Scale and the Mental Health subscale at 3 months follow-up compared with baseline values while no improvement was seen in the IG at this time . For the SF-36 Physical Component Scale , there was an improvement in the whole study group at 3 and 6 months follow-up compared with baseline values without any significant changes between the IG and CG . The GDS-15 was unchanged throughout the follow-up period for both groups . Based on these data , it is concluded that high-intensive functional exercises implemented in real-life situations should also include education on hidden dysfunctions after stroke instead of solely focus on falls and safety aspects to have a favorable impact on OBJECTIVES To determine the effect of two different community-based group exercise programs on functional balance , mobility , postural reflexes , and falls in older adults with chronic stroke . DESIGN A r and omized , clinical trial . SETTING Community center . PARTICIPANTS Sixty-one community-dwelling older adults with chronic stroke . INTERVENTION Participants were r and omly assigned to an agility ( n=30 ) or stretching/weight-shifting ( n=31 ) exercise group . Both groups exercised three times a week for 10 weeks . MEASUREMENTS Participants were assessed before , immediately after , and 1 month after the intervention for Berg Balance , Timed Up and Go , step reaction time , Activities-specific Balance Confidence , and Nottingham Health Profile . Testing of st and ing postural reflexes and induced falls evoked by a translating platform was also performed . In addition , falls in the community were tracked for 1 year from the start of the interventions . RESULTS Although exercise led to improvements in all clinical outcome measures for both groups , the agility group demonstrated greater improvement in step reaction time and paretic rectus femoris postural reflex onset latency than the stretching/weight-shifting group . In addition , the agility group experienced fewer induced falls on the platform . CONCLUSION Group exercise programs that include agility or stretching/weight shifting exercises improve postural reflexes , functional balance , and mobility and may lead to a reduction of falls in older adults with stroke Background Given the rising number of strokes worldwide , and the large number of individuals left with disabilities after stroke , novel strategies to reduce disability , increase functions in the motor and the cognitive domains , and improve quality of life are of major importance . Physical activity is a promising intervention to address these challenges but , as yet , there is no study demonstrating definite outcomes . Our objective is to assess whether additional treatment in the form of physical fitness-based training for patients early after stroke will provide benefits in terms of functional outcomes , in particular gait speed and the Barthel Index ( co- primary outcome measures ) reflecting activities of daily living ( ADL ) . We will gather secondary functional outcomes as well as mechanistic parameters in an exploratory approach . Methods / Design Our phase III r and omised controlled trial will recruit 215 adults with moderate to severe limitations of walking and ADL 5 to 45 days after stroke onset . Participants will be stratified for the prognostic variables of “ centre ” , “ age ” , and “ stroke severity ” , and r and omly assigned to one of two groups . The interventional group receives physical fitness training delivered as supported or unsupported treadmill training ( cardiovascular active aerobic training ; five times per week , over 4 weeks ; each session 50 minutes ; total of 20 additional physical fitness training sessions ) in addition to st and ard rehabilitation treatment . The control intervention consists of relaxation sessions ( non-cardiovascular active ; five times per week week , over 4 weeks ; each session 50 minutes ) in addition to st and ard rehabilitation treatment . Co- primary efficacy endpoints will be gait speed ( in m/s , 10 m walk ) and the Barthel Index ( 100 points total ) at 3 months post-stroke , compared to baseline measurements . Secondary outcomes include st and ard measures of quality of life , sleep and mood , cognition , arm function , maximal oxygen uptake , and cardiovascular risk factors including blood pressure , pulse , waist-to-hip ratio , markers of inflammation , immunity and the insulin-glucose pathway , lipid profile , and others . Discussion The goal of this endpoint-blinded , phase III r and omised controlled trial is to provide evidence to guide post-stroke physical fitness-based rehabilitation programmes , and to eluci date the mechanisms underlying this intervention . Trial registration Registered in Clinical Trials.gov with the Identifier NCT01953549 Background Currently , the key advocacy in neuroscientific studies for stroke rehabilitation is that therapy should be directed towards task specificity performed with multiple repetitions . Circuit Class Therapy ( CCT ) is well suited to accomplish multiple task-specific activities . However , while repetitive task practice is achievable with circuit class therapy , in stroke survivors repetitive activities may be affected by poor neurologic inputs to motor units , result ing in decreases in discharging rates which consequently may reduce the efficiency of muscular contraction . To accomplish multiple repetitions , stroke survivors may require augmented duration of practice . To date , no study has examined the effect of augmented duration of CCT in stroke rehabilitation , and specifically what duration of CCT is more effective in influencing functional capacity among stroke survivors . Methods / design Using a r and omised controlled trial with blinded outcome assessment , this study is aim ed at determining the effectiveness of structured augmented CCT in stroke rehabilitation . Sixty-eight stroke survivors ( to be recruited from a tertiary health institution in Kano , Northwest , Nigeria ) will be r and omised into one of four groups : three intervention groups of differing CCT duration s namely : 60 min , 90 min , and 120minuntes respectively , and a control group . Participants will take part in an 8-week structured intensive CCT intervention . Participants will be assessed at baseline , post-intervention , and six-month follow-up for the effectiveness of the varied duration s of therapy , using st and ardised tools . Based on the WHO-ICF model , the outcomes are body structure/function , activity limitation , and participation restriction measures . Discussion It is expected that the outcome of this study will clarify whether increasing CCT duration leads to better recovery of motor function in stroke survivors . Trial registration Pan African Clinical Trial Registry ( PACTR ) : The purpose of this study was to investigate whether additional practice of either upper limb or mobility tasks improved functional outcome during inpatient stroke rehabilitation . This prospect i ve , r and omised , single blind clinical trial recruited 30 stroke subjects into either an Upper Limb or a Mobility Group . All subjects received their usual rehabilitation and an additional session of task-related practice using a circuit class format . Independent assessors , blinded to group allocation , tested all subjects . Outcome measures used were three items of the Jebsen Taylor H and Function Test ( JTHFT ) , two  arm items  of the Motor Assessment Scale ( MAS ) , and three mobility measures , the Timed Up and Go Test ( TUGT ) , Step Test , and Six Minute Walk Test ( 6MWT ) . Both groups improved significantly between pre- and post-tests on all of the mobility measures , however only the Upper Limb Group made a significant improvement on the JTHFT and MAS upper arm items . Following four weeks training , the Mobility Group had better locomotor ability than the Upper Limb Group ( between-group differences in the 6MWT of 116.4 m , 95 % CI 31.4 to 201.3 m , Step Test 2.6 repetitions , 95 % CI -1.0 to 6.2 repetitions , and TUGT -7.6 sec , 95 % CI -15.5 to 0.2 sec ) . The JTHFT dexterity scores in the Upper Limb Group were 6.5 sec ( 95 % CI -7.4 to 20.4 sec ) faster than the Mobility Group . Our findings support the use of additional task-related practice during inpatient stroke rehabilitation . The circuit class format was a practical and effective means to provide supervised additional practice that led to significant and meaningful functional gains OBJECTIVE To evaluate the internal and absolute reliability and construct validity of the Activities-Specific Balance Confidence ( ABC ) scale and a new Canadian French version ( ABC-CF ) of it among people with stroke . DESIGN Cross-sectional data from a r and omized controlled trial . SETTING Community . PARTICIPANTS Ninety-one people with a residual walking deficit between 57 and 386 days poststroke . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES The ABC and ABC-CF scales , Berg Balance Scale ( BBS ) , comfortable and maximum gait speeds , Timed Up & Go ( TUG ) test , 6-minute walk test ( 6MWT ) , Barthel Index , physical function scale of the Medical Outcomes Study 36-Item Short-Form Health Survey , Geriatric Depression Scale ( GDS ) , and the EQ-5D visual analog scale ( EQ VAS ) . RESULTS Internal consistency ( Cronbach alpha ) was .94 and .93 and the st and ard error of measurement was 5.05 and 5.13 for the ABC ( n=51 ) and the ABC-CF ( n=35 ) scales , respectively . Spearman rho values ranged from .30 to .60 for the ABC scale and from .45 to .68 on the ABC-CF scale for associations with scores on the BBS , comfortable and maximum gait speeds , TUG , 6MWT , Barthel Index , physical function scale , GDS , and EQ VAS . CONCLUSIONS Evidence of internal and absolute reliability and of construct validity of the ABC and the ABC-CF scales supports their use for cross-sectional measurements of balance self-efficacy among community-dwelling people in the first year poststroke [ Purpose ] The aim of this study was to investigate the impact of a circuit training program on the walking and balance abilities of stroke patients using an up-to- date walking analysis device . [ Subjects and Methods ] The subjects of this study were 12 adults who were diagnosed with stroke . Evaluation was conducted using the Smart Step test for walking ability ; ( BBS ) for balance ability ; and the Timed Up and Go test ( TUG ) for functional mobility and movement ability . The 12 stroke patients were r and omly recruited and divided into two groups ; an experimental group which performed circuit training with obstacles , and a control group which performed flat gait training ) . [ Results ] Between-group comparison of the change in the 10-m walking speed found a statistically significant difference between the two groups . Between-group comparison of the changes in BBS and TUG found statistically significant differences between the two groups . [ Conclusion ] The circuit training program using obstacles had a positive effect on the gait and balance abilities of the stroke patients OBJECTIVE To compare the effectiveness of circuit class therapy and individual physiotherapy ( PT ) sessions in improving walking ability and functional balance for people recovering from stroke . DESIGN Nonr and omized , single-blind controlled trial . SETTING Medical rehabilitation ward of a rehabilitation hospital . PARTICIPANTS Sixty-eight persons receiving inpatient rehabilitation after a stroke . INTERVENTIONS Subjects received group circuit class therapy or individual treatment sessions as the sole method of PT service delivery for the duration of their inpatient stay . MAIN OUTCOME MEASURES Five-meter walk test ( 5MWT ) , two-minute walk test ( 2MWT ) , and the Berg Balance Scale ( BBS ) measured 4 weeks after admission . Secondary outcome measures included the Iowa Level of Assistance Scale , Motor Assessment Scale upper-limb items , and patient satisfaction . Measures were taken on admission and 4 weeks later . RESULTS Subjects in both groups showed significant improvements between admission and week 4 in all primary outcome measures . There were no significant between group differences in the primary outcome measures at week 4 ( 5MWT mean difference , .07 m/s ; 2MWT mean difference , 1.8 m ; BBS mean difference , 3.9 points ) . A significantly higher proportion of subjects in the circuit class therapy group were able to walk independently at discharge ( P=.01 ) and were satisfied with the amount of therapy received ( P=.007 ) . CONCLUSIONS Circuit class therapy appeared as effective as individual PT sessions for this sample of subjects receiving inpatient rehabilitation poststroke . Favorable results for circuit classes in terms of increased walking independence and patient satisfaction suggest this model of service delivery warrants further investigation OBJECTIVE To compare the effect of a balance and stability-focused outpatient community-based rehabilitation and a regular physiotherapy program on balance , stability , and perceptions of improvement  after acute stroke . DESIGN A r and omized controlled trial in a community-based therapy center . PARTICIPANTS Fifty consecutive patients with a first stroke , who reported to a community-based therapy center over a 7-month period were allocated to the control group ( regular physiotherapy ) or the experimental group ( balance and stability-focused rehabilitation ) . INTERVENTION A program of physiotherapy focused on balance and stability exercises . The control group received the regular physiotherapy program . MAIN OUTCOME MEASUREMENTS The Postural Assessment Scale for Stroke Patients ( PASS ) and the Berg Balance Scale ( BBS ) monitored stability and balance . The normalized data ( PASS and BBS ) were analyzed by using analysis of covariance . Qualitative data were thematically described . RESULTS Internal consistency of baseline PASS and BBS scores was high ( Cronbach α , .964 and .974 , respectively ) . PASS overall pretest scores increased from 21.96 ± 21.41 ( mean ± st and ard deviation ) and 21.52 ± 8.43 to 67.67 ± 28.42 and 80.16 ± 22.60 posttest in the control and experimental groups , respectively . Posttest scores were significantly different ( P = .004 ) . The effect size was medium ( .490 ) . The overall BBS scores showed overall mean ( st and ard deviation ) increases from 44.71 ± 22.24 and 43.43 ± 17.11 pretest to 48.71 ± 23.18 and 59.71 ± 18.20 posttest for the control and experimental groups , respectively . The effect size was considered medium ( .532 ) . CONCLUSION The balance and stability-focused community-based rehabilitation program was more effective in improving stability and balance in patients with stroke compared with the regular physiotherapy program in re source -poor setting OBJECTIVE To evaluate the immediate and retention effects of a 4-week training program on the performance of locomotor-related tasks in chronic stroke . DESIGN R and omized , controlled pilot study with 2-month follow-up . SETTING Rehabilitation center . SUBJECTS A convenience sample consisting of 12 chronic stroke subjects was used . Subjects were r and omly assigned to the experimental or the control group . Three subjects withdrew from the study . INTERVENTION Both experimental and control groups participated in exercise classes three times a week for 4 weeks . The exercise class for the experimental group focused on strengthening the affected lower limb and practicing functional tasks involving the lower limbs , while the control group practice d upper-limb tasks . MAIN OUTCOME MEASURES Lower-limb function was evaluated by measuring walking speed and endurance , peak vertical ground reaction force through the affected foot during sit-to-st and , and the step test . RESULTS The experimental group demonstrated significant immediate and retained ( 2-month follow-up ) improvement ( p < or = .05 ) compared with the control group in walking speed and endurance , force production through the affected leg during sit-to-st and , and the number of repetitions of the step test . CONCLUSION The pilot study provides evidence for the efficacy of a task-related circuit class at improving locomotor function in chronic stroke Objective The effects of combined aerobic and resistance exercise training on central arterial stiffness and gait velocity in patients with chronic poststroke hemiparesis were investigated . Design Twenty-six patients with chronic poststroke hemiparesis were r and omly assigned to either the combined aerobic and resistance exercise group ( n = 14 ) or the control group ( n = 12 ) . The exercise intervention group received a combined aerobic and resistance exercise training ( 1 hr/day , three times/week for 16 wks ) , whereas the control group received usual care .  Central arterial stiffness was determined by pulse wave velocity and augmentation index . Gait velocity was assessed using the 6-min walk test , 10-m walk test , and the Timed Up- and -Go test . Results Patients in the exercise intervention group had greater improvement of mean pulse wave velocity ( P < 0.001 ) , augmentation index ( P = 0.048 ) , and gait velocity ( 6-min walk test , P < 0.001 ; 10-m walk test , P < 0.001 ) than did patients in the control group . Patients in the exercise intervention group also had greater improvements in physical fitness component ( grip strength , P < 0.001 ; muscular strength of upper and lower limbs , P < 0.027 ; flexibility , P < 0.001 ) when compared with control patients . Conclusions The combined aerobic and resistance exercise program significantly reduced central arterial stiffness and increased gait velocity in patients with chronic poststroke hemiparesis OBJECTIVES To estimate the level of balance self-efficacy among community-dwelling subjects with stroke and to determine the relative importance of balance self-efficacy compared with functional walking capacity in predicting physical function and perceived health status . DESIGN Secondary analysis of baseline , postintervention , and 6-month follow-up data from a r and omized trial . SETTING General community . PARTICIPANTS Ninety-one subjects with a first or recurrent stroke , discharged from rehabilitation therapy with a residual walking deficit . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES The Activities-Specific Balance Confidence ( ABC ) Scale , Medical Outcomes Study 36-Item Short-Form Health Survey physical function scale , and the EQ-5D visual analog scale of perceived health status . RESULTS Average balance self-efficacy was 59 out of 100 points on the ABC scale ( 95 % confidence interval , 55 - 64 ; n=89 ) . After adjusting for age and sex , functional walking capacity explained 32 % and 0 % of the respective variability in physical function and perceived health status scores obtained 6 months later . After adjustment for age , sex , and functional walking capacity , balance self-efficacy explained 3 % and 19 % of variation in 6-month physical function and perceived health status scores , respectively . CONCLUSIONS Subjects living in the community after stroke experience impaired balance self-efficacy . Enhancing balance self-efficacy in addition to functional walking capacity may lead to greater improvement , primarily in perceived health status , but also in physical function , than the enhancement of functional walking capacity alone Objectives : To explore whether a group programme for community-dwelling chronic stroke survivors and their carers is feasible in rural setting s ; to measure the impact of the programme on health-related quality of life and functional performance ; and to determine if any benefits gained are maintained . Design : R and omized , assessor blind , cross-over , controlled trial . Setting : Rural outpatient . Subjects : Twenty-five community-dwelling , chronic stroke survivors and 17 carers of participant stroke survivors . Intervention : The intervention group undertook a once-a-week , seven-week group programme combining physical activity , education , self-management principles and a ‘ healthy options ’ morning tea . At completion , the control group crossed over to receive the intervention . Main measures : Stroke Impact Scale ( stroke survivors ) , Health Impact Scale ( carers ) , Six Minute Walk Test , Timed Up and Go , Caregiver Strain Index . Results : There were insufficient participants for results to reach statistical significance . However between-group trends favoured the intervention group in the majority of outcome measures for stroke survivors and carers . The majority of measures remained above baseline at 12 weeks post programme for stroke survivor participants . The programme was well attended . Of the seven sessions all participants attended four or more and 88 % attended six or seven sessions . Conclusions : This novel programme incorporating physical activity , education and social interaction proved feasible to undertake by a stroke-specific multidisciplinary team in three rural Australian setting s. This programme may improve and maintain health-related quality of life and physical functioning for chronic stroke survivors and their carers and warrants further investigation Rationale There is strong evidence for a dose – response relationship between physical therapy early after stroke and recovery of function . The optimal method of maximizing physical therapy within finite health care re sources is unknown . Aims To determine the effectiveness and cost-effectiveness of two alternative models of physical therapy service delivery ( seven-days per week therapy services or group circuit class therapy over five-days a week ) to usual care for people receiving inpatient rehabilitation after stroke . Design Multicenter , three-armed r and omized controlled trial with blinded assessment of outcomes . Study A total of 282 people admitted to inpatient rehabilitation facilities after stroke with an admission functional independence measure ( FIM ) score within the moderate range ( total 40–80 points or motor 38–62 points ) will be r and omized to receive one of three interventions : • usual care therapy over five-days a week • st and ard care therapy over seven-days a week , or • group circuit class therapy over five-days a week . Participants will receive the allocated intervention for the length of their hospital stay . Analysis will be by intention-to-treat . Outcomes The primary outcome measure is walking ability ( six-minute walk test ) at four-week postintervention with three- and six-month follow-up . Economic analysis will include a costing analysis based on length of hospital stay and staffing/re source costs and a cost-utility analysis ( incremental quality of life per incremental cost , relative to usual care ) . Secondary outcomes include walking speed and independence , ability to perform activities of daily living , arm function , quality of life and participant satisfaction Purpose : To evaluate the impact of two different physiotherapy exercise regimes in patients after acute stroke on  health-related quality of life ( HRQoL )  and to investigate how the degree of motor and balance function , gait capacity , activities of daily living and instrumental activities of daily living influenced HRQoL. Methods : A longitudinal r and omized controlled stratified trial of two interventions : the intensive exercise groups with scheduled intensive training during four periods of the first year after stroke and the regular exercise group with self-initiated training . Results : There was a tendency of better HRQoL in the regular exercise group on NHP total score ( p= 0.05 ) . Patients with low scores in activities of daily living , balance and motor function and inability to perform 6-minute walk test on admission , scored lower on self-perceived health than patients with high scores and ability to perform the walking test . At 1 year post-stroke , total scores on NHP were moderately associated with motor function ( r= −0.63 ) , balance ( r= −0.56 ) , gait ( r= −0.57 ) , activities of daily living ( r= −0.57 ) and instrumental activities of daily living ( r= −0.49–0.58 ) . The physical mobility sub-scale of NHP had the strongest association ranging from r= −0.47–0.82 . Conclusion : The regular exercise group with self-initiated training seemed to enhance HRQoL more than the intensive exercise group with scheduled intensive training . The degree of motor function , balance , walking capacity and independence in activities of daily living is of importance for perceived BACKGROUND The cardiorespiratory fitness of stroke survivors is low . Center-based exercise programs that include an aerobic component have been shown to improve poststroke cardiorespiratory fitness . This pilot study aims to determine the feasibility , safety , and preliminary efficacy of an individually tailored home- and community-based exercise program to improve cardiorespiratory fitness and walking capacity in stroke survivors . METHODS Independently ambulant , community-dwelling stroke survivors were recruited . The control  ( n = 10 ) and intervention ( n = 10 ) groups both received usual care . In addition the intervention group undertook a 12-week , individually tailored , home- and community-based exercise program , including once-weekly telephone or e-mail support . Assessment s were conducted at baseline and at 12 weeks . Feasibility was determined by retention and program participation , and safety by adverse events . Efficacy measures included change in cardiorespiratory fitness ( peak oxygen consumption [ VO2peak ] ) and distance walked during the Six-Minute Walk Test ( 6MWT ) . Analysis of covariance was used for data analysis . RESULTS All participants completed the study with no adverse events . All intervention participants reported undertaking their prescribed program . VO2peak improved more in the intervention group ( 1.17 ± .29 L/min to 1.35 ± .33 L/min ) than the control group ( 1.24 ± .23 L/min to 1.24 ± .33 L/min , between-group difference = .18 L/min , 95 % confidence interval [ CI ] : .01-.36 ) . Distance walked improved more in the intervention group ( 427 ± 123 m to 494 ± 67 m ) compared to the control group ( 456 ± 101 m to 470 ± 106 m , between-group difference = 45 m , 95 % CI : .3 - 90 ) . CONCLUSIONS Our individually tailored approach with once-weekly telephone or e-mail support was feasible and effective in selected stroke survivors . The 16 % greater improvement in VO2peak during the 6MWT achieved in the intervention versus control group is comparable to improvements attained in supervised , center-based programs CONTEXT Most medical interventions have modest effects , but occasionally some clinical trials may find very large effects for benefits or harms . OBJECTIVE To evaluate the frequency and features of very large effects in medicine . DATA SOURCES Cochrane Data base of Systematic Review s ( CDSR , 2010 , issue 7 ) . STUDY SELECTION We separated all binary- outcome CDSR forest plots with comparisons of interventions according to whether the first published trial , a subsequent trial ( not the first ) , or no trial had a nominally statistically significant ( P < .05 ) very large effect ( odds ratio [ OR ] , ≥5 ) . We also sample d r and omly 250 topics from each group for further in-depth evaluation . DATA EXTRACTION We assessed the types of treatments and outcomes in trials with very large effects , examined how often large-effect trials were followed up by other trials on the same topic , and how these effects compared against the effects of the respective meta-analyses . RESULTS Among 85,002 forest plots ( from 3082 review s ) , 8239 ( 9.7 % ) had a significant very large effect in the first published trial , 5158 ( 6.1 % ) only after the first published trial , and 71,605 ( 84.2 % ) had no trials with significant very large effects . Nominally significant very large effects typically appeared in small trials with median number of events : 18 in first trials and 15 in subsequent trials . Topics with very large effects were less likely than other topics to address mortality ( 3.6 % in first trials , 3.2 % in subsequent trials , and 11.6 % in no trials with significant very large effects ) and were more likely to address laboratory-defined efficacy ( 10 % in first trials,10.8 % in subsequent , and 3.2 % in no trials with significant very large effects ) . First trials with very large effects were as likely as trials with no very large effects to have subsequent published trials . Ninety percent and 98 % of the very large effects observed in first and subsequently published trials , respectively , became smaller in meta-analyses that included other trials ; the median odds ratio decreased from 11.88 to 4.20 for first trials , and from 10.02 to 2.60 for subsequent trials . For 46 of the 500 selected topics ( 9.2 % ; first and subsequent trials ) with a very large-effect trial , the meta- analysis maintained very large effects with P < .001 when additional trials were included , but none pertained to mortality-related outcomes . Across the whole CDSR , there was only 1 intervention with large beneficial effects on mortality , P < .001 , and no major concerns about the quality of the evidence ( for a trial on extracorporeal oxygenation for severe respiratory failure in newborns ) . CONCLUSIONS Most large treatment effects emerge from small studies , and when additional trials are performed , the effect sizes become typically much smaller . Well-vali date d large effects are uncommon and pertain to nonfatal outcomes Rationale Gait deficits contribute considerably to functional disability after stroke , and the regaining of walking ability is a major goal in most stroke rehabilitation programmes . Evidence suggests that muscular strengthening exercises after stroke can improve strength and activity . Additionally , task-related practice performed at high intensities may enhance walking competency in people with stroke . However , there is insufficient evidence to conclude which approach is most effective . Aim This study will test the hypothesis that task-specific walking training plus targeted strength training is superior to task-specific walking training alone in improving strength , motor co-ordination , quality of independent walking , and participation in acute stroke patients . Design This trial is a prospect i ve , r and omised clinical trial . People after stroke who are living at home and attending outpatient clinics will be r and omly allocated into either an experimental or a control group . The experimental group will undertake task-specific walking training , plus targeted strength training three times per week over 10 weeks , while the control group will only undertake task-specific walking training . At baseline , after 10 weeks of intervention and 4 weeks after the cessation of the interventions , allocation-blinded research ers will collect outcome measures . Study outcomes Primary outcomes will be measured for levels of impairment ( strength and co-ordination ) , activity ( quality of walking ) , and participation ( quality of life ) . Secondary outcomes will be the minimal clinical ly important differences of lower limb strength , motor co-ordination , and gait speed Objective : Exercise has beneficial effects on vascular risk factors in transient ischaemic attack ( TIA ) patients within the sub-acute phase . This study examined whether TIA patients r and omized to an early exercise and education programme within 2 weeks of TIA diagnosis would demonstrate improvements in cardiovascular risk factors and aerobic fitness 12 months post-diagnosis compared with control patients . Methods : A single-centre , r and omized , parallel-group clinical trial . Sixty TIA patients ( 69 ± 11 years ) completed a vascular risk stratification baseline assessment and a physical fitness examination . Individuals were r and omized to either an 8-week early exercise and education group or control group . Fifty-one patients attended post-intervention assessment s that were completed immediately ( post-intervention ) and 12 months after ( 12PI ) . Results : A significantly greater improvement in resting SBP was observed between baseline and post-intervention for EX than for CON ( –11 mmHg cf . –1 mmHg , respectively ; P < 0.05 ) . The improvement in SBP was maintained between post-intervention and 12PI ( P > 0.05 ) . Similar findings were demonstrated for BMI , bodyweight and peak oxygen uptake ( P < 0.05 ) . Exercise blood pressure , pulse pressure and double product ( SBP x heart rate ; an indication of myocardial workload ) were significantly lower at post-intervention and 12PI for EX than for CON ( all P < 0.05 ) . Conclusion : An 8-week exercise programme soon after TIA result ed in beneficial changes in resting and exercise blood pressure that were maintained for 12 months . Clinical trial registration : http://www.anzctr.org.au/ Trial Registration Number : OBJECTIVES To examine the effects of a community-based group exercise program for older individuals with chronic stroke . DESIGN Prospect i ve , single-blind , r and omized , controlled intervention trial . SETTING Intervention was community-based . Data collection was performed in a research laboratory located in a rehabilitation hospital . PARTICIPANTS Sixty-three older individuals ( aged > or = 50 ) with chronic stroke ( poststroke duration > or = 1 year ) who were living in the community . INTERVENTION Participants were r and omized into intervention group ( n=32 ) or control group ( n=31 ) . The intervention group underwent a fitness and mobility exercise ( FAME ) program design ed to improve cardiorespiratory fitness , mobility , leg muscle strength , balance , and hip bone mineral density ( BMD ) ( 1-hour sessions , three sessions/week , for 19 weeks ) . The control group underwent a seated upper extremity program . MEASUREMENTS Cardiorespiratory fitness ( maximal oxygen consumption ) , mobility ( 6-minute walk test ) , leg muscle strength ( isometric knee extension ) , balance ( Berg Balance Scale ) , activity and participation ( Physical Activity Scale for Individuals with Physical Disabilities ) , and femoral neck BMD ( using dual-energy x-ray absorptiometry ) . RESULTS The intervention group had significantly more gains in cardiorespiratory fitness , mobility , and paretic leg muscle strength than controls . Femoral neck BMD of the paretic leg was maintained in the intervention group , whereas a significant decline of the same occurred in controls . There was no significant time-by-group interaction for balance , activity and participation , nonparetic leg muscle strength , or nonparetic femoral neck BMD . CONCLUSION The FAME program is feasible and beneficial for improving some of the secondary complications result ing from physical inactivity in older adults living with stroke . It may serve as a good model of a community-based fitness program for preventing secondary diseases in older adults living with chronic conditions OBJECTIVE To establish the test-retest reliability and concurrent validity with maximum oxygen consumption ( VO2max ) for 3 submaximal exercise tests in persons with chronic stroke : ( 1 ) submaximal treadmill test , ( 2 ) submaximal cycle ergometer test , and ( 3 ) 6-minute walk test ( 6MWT ) . DESIGN Prospect i ve study using a convenience sample . SETTING Free-st and ing tertiary rehabilitation center . PARTICIPANTS A volunteer sample of 12 community-dwelling individuals who had a stroke with moderate motor deficits . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Heart rate , blood pressure , and oxygen consumption ( VO2 ) were assessed during the exercise tests . RESULTS Test-retest reliability was good to excellent for the exercise tests ( maximal and submaximal tests ) . VO2 for all submaximal measures related to VO2max ( r range , .66-.80 ) . Neither the 6MWT distance , self-selected gait speed , nor hemodynamic measures related to VO2max . CONCLUSION The VO2 measures of the submaximal exercise tests had excellent reliability and good concurrent validity with VO2max . Submaximal exercise tests may be a method by which to monitor the effects of interventions after a screening test ( eg , symptom-limited grade d exercise test , dobutamine stress echocardiograph ) Stroke patients live with balance and walking dysfunction .  Walking is the most important factor for independent community activities . The purpose of this study was to investigate the effect of a community walking training program ( CWTP ) within the real environment on walking function and social participation in chronic stroke patients . Twenty-two stroke patients ( 13 male , 50.45 years old , post stroke duration 231.64 days ) were r and omly assigned to either the CWTP group or the control group . All subjects participated in the same st and ard rehabilitation program consisting of physical and occupational therapy for 60 min per day , five times a week , for four weeks . In addition , the CWTP group participated in CWTP for 30 min per day , five times a week , for four weeks . Walking function was assessed using the 10-m walk test ( measurement for 10-meter walking speed ) , 6-min walk assessment ( measurement of gait length for 6-minutes ) , and community gait assessment . Social participation was assessed using a social participation domain of stroke impact scale . In walking function , greater improvement was observed in the CWTP group compared with the control group ( P < 0.05 ) . In addition , social participation improved more in the CWTP group compared with the control group ( P < 0.05 ) . These findings demonstrate the efficacy of  CWTP  on walking function and social participation in chronic stroke patients . Therefore , we suggest that CWTP within the real environment may be an effective method for improving walking function and social participation of chronic stroke patients when added to st and ard rehabilitation The  Berg Balance Scale ( BBS ) was design ed to help determine change in functional st and ing balance over time . The purpose of this paper was to estimate the minimum detectable change score ( MDC ) using the st and ard error of measure ( SEM ) , thereby providing a means to decide if genuine change had occurred . Calculation of the agreement regarding the presence of change as determined by the MDC and clinicians ' perceptions was performed to give an indication of the validity of this criterion value . Forty-eight subjects who were receiving inpatient rehabilitation after stroke were assessed on consecutive days by two raters using the BBS . The MDC analysis suggests that a change of + /- 6 BBS points is necessary to be 90 % confident of genuine change . Only 25/45 subjects showed agreement between the statistically derived presence of change and clinicians ' perceptions of change . The lack of agreement may relate to the validity of the SEM/MDC methodology to determine the criterion BBS value , the heterogeneity of the subjects , or the use of clinician gestalt impressions of change Objective : To establish the effects of group exercise on mobility and strength . Design : R and omized controlled trial . Setting : Two public hospital outpatient rehabilitation services . Participants : One hundred and seventy-three people ( mean age 74.9 years , SD 10.8 ) with impaired mobility were r and omized and 159 people ( 92 % ) completed the trial . Interventions : Five-week , twice-weekly ` circuit-style ' group exercise programme run by a physiotherapist ( n = 85 ) and a no-intervention waiting list control group ( n = 88 ) . Main outcome measures : Three aspects of mobility : balance while st and ing and stepping ( Step Test , semi-t and em and t and em stance times ) ; sit-to-st and ability ( rate and minimum height ) and gait ( 6-metre and 6-minute walk tests ) . Lower limb muscle strength ( knee flexion and extension ) . Results : At retest , exercise participants had improved significantly more than their control counterparts on measures of balance while stepping , sit to st and and gait . Exercise participants averaged 1.6 more steps on the 15-second Step Test ( 95 % confidence interval ( CI ) 0.5 to 2.8 , P=0.005 ) , walked an average of 0.12 m/s faster ( 95 % CI 0.05 to 0.2 , P=0.002 ) and took 2.5 fewer steps in 6 metres ( 95 % CI —4.2 to —0.8 , P=0.004 ) . Exercise participants also averaged 0.04 more sit-to-st and s/second , ( 95 % CI 0.003 to 0.08 , P=0.037 ) and walked an average of 30.9 metres further in 6 minutes ( 95 % CI 9.4 to 52.4 , P=0.005 ) . There were no clinical ly important or statistically significant between-group differences at retest for the measures of strength ( knee extension and flexion ) , balance while st and ing or minimal sit-to-st and height . Conclusion : This short- duration circuit class programme improved mobility , but not strength UNLABELLED Mudge S , Barber PA , Stott NS . Circuit-based rehabilitation improves gait endurance but not usual walking activity in chronic stroke : a r and omized controlled trial . OBJECTIVE To determine whether circuit-based rehabilitation would increase the amount and rate that individuals with stroke walk in their usual environments . DESIGN Single-blind r and omized controlled trial . SETTING Rehabilitation clinic . PARTICIPANTS Sixty participants with a residual gait deficit at least 6 months after stroke originally enrolled in the study . Two withdrew in the initial phase , leaving 58 participants ( median age , 71.5y ; range , 39.0 - 89.0y ) who were r and omized to the 2 intervention groups . INTERVENTIONS The exercise group had 12 sessions of clinic-based rehabilitation delivered in a circuit class design ed to improve walking . The control group received a comparable duration of group social and educational classes . MAIN OUTCOME MEASURES Usual walking performance was assessed using the StepWatch Activity Monitor . Clinical tests were gait speed ( timed 10-meter walk ) and endurance ( six-minute walk test [ 6MWT ] ) , confidence ( Activities-Based Confidence Scale ) , self-reported mobility ( Rivermead Mobility Index [ RMI ] ) , and self-reported physical activity ( Physical Activity and Disability Scale ) . RESULTS Intention-to-treat analysis revealed that the exercise group showed a significantly greater distance for the 6MWT than the control group immediately after the intervention ( P=.030 ) but that this effect was not retained 3 months later . There were no changes in the StepWatch measures of usual walking performance for either group . The exercise and control groups had significantly different gait speed ( P=.038 ) and scores on the RMI ( P=.025 ) at the 3-month follow-up . These differences represented a greater decline in the control group compared with the exercise group for both outcome measures . CONCLUSIONS Circuit-based rehabilitation leads to improvements in gait endurance but does not change the amount or rate of walking performance in usual environments . Clinical gains made by the exercise group were lost 3 months later . Future studies should consider whether rehabilitation needs to occur in usual environments to improve walking performance OBJECTIVE To test the efficacy of functional electric stimulation (FES)-assisted exercise therapy ( FES-ET ) on a workstation in the subacute phase of recovery from a stroke . DESIGN Single-blind , r and omly controlled comparison of high- and low-intensity treatment . SETTING Laboratory in a rehabilitation hospital . PARTICIPANTS Nineteen stroke survivors ( 10 men , 9 women ; mean age + /- st and ard deviation , 60.6+/-5.8y ) , with upper-extremity hemiplegia ( mean poststroke time , 48+/-17d ) . The main inclusion criteria were : stroke occurred within 3 months of onset of trial and result ed in severe upper-limb dysfunction , and FES produced adequate h and opening . INTERVENTION An FES stimulator and an exercise workstation with instrumented objects were used by 2 groups to perform specific motor tasks with their affected upper extremity . Ten subjects in the high-intensity FES-ET group received FES-ET for 1 hour a day on 15 to 20 consecutive workdays . Nine subjects in the low-intensity FES-ET group received 15 minutes of sensory electric stimulation 4 days a week and on the fifth day they received 1 hour of FES-ET . MAIN OUTCOME MEASURES Primary outcome measure included the Wolf Motor Function Test ( WMFT ) . Secondary outcome measures included the Motor Activity Log ( MAL ) , the upper-extremity portion of the Fugl-Meyer Assessment ( FMA ) , and the combined kinematic score ( CKS ) derived from workstation measurements . The WMFT , MAL , and FMA were used to assess function in the absence of FES whereas CKS was used to evaluate function assisted by FES . RESULTS Improvements in the WMFT and CKS were significantly greater in the high-intensity group ( post-treatment effect size , .95 ) than the low-intensity group ( post-treatment effect size , 1.3 ) . The differences in MAL and FMA were not statistically significant . CONCLUSIONS Subjects performing high-intensity FES-ET showed significantly greater improvements on the WMFT than those performing low-intensity FES-ET . However , this was not reflected in subjects ' self- assessment s ( MAL ) or in their FMA scores , so the clinical significance of the result is open to debate . The CKS data suggest that high-intensity FES-ET may be advantageous in neuroprosthetic applications OBJECTIVE To assess the effects of a community-based exercise program on motor recovery and functional abilities of the paretic upper extremity in persons with chronic stroke . DESIGN R and omized controlled trial . SETTING Rehabilitation research laboratory and a community hall . PARTICIPANTS A sample of 63 people ( > or = 50y ) with chronic deficits result ing from stroke ( onset > or = 1y ) . INTERVENTIONS The arm group underwent an exercise program design ed to improve upper-extremity function ( 1h/session , 3 sessions/wk for 19wk ) . The leg group underwent a lower-extremity exercise program . MAIN OUTCOME MEASURES The Wolf Motor Function Test ( WMFT ) , Fugl-Meyer Assessment ( FMA ) , h and -held dynamometry ( grip strength ) , and the Motor Activity Log . RESULTS Multivariate analysis showed a significant group by time interaction ( Wilks lambda=.726 , P=.017 ) , indicating that overall , the arm group had significantly more improvement than the leg group . Post hoc analysis demonstrated that gains in WMFT ( functional ability ) ( P=.001 ) and FMA ( P=.001 ) scores were significantly higher in the arm group . The amount of improvement was comparable to other novel treatment approaches such as constraint-induced movement therapy or robot-aided exercise training previously reported in chronic stroke . Participants with moderate arm impairment benefited more from the program . CONCLUSIONS The pilot study showed that a community-based exercise program can improve upper-extremity function in persons with chronic stroke . This outcome justifies a larger clinical trial to further assess efficacy and cost effectiveness Background . Cognitive deficits impede stroke recovery . Aerobic exercise ( AEX ) improves cognitive executive function ( EF ) processes in healthy individuals , although the learning benefits after stroke are unknown . Objective . To underst and AEX-induced improvements in EF , motor learning , and mobility poststroke . Methods . Following cardiorespiratory testing , 38 chronic stroke survivors were r and omized to 2 different groups that exercised 3 times a week ( 45-minute sessions ) for 8 weeks . The AEX group ( n = 19 ; 9 women ; 10 men ; 64.10 ± 12.30 years ) performed progressive resistive stationary bicycle training at 70 % maximal heart rate , whereas the Stretching Exercise ( SE ) group ( n = 19 ; 12 women ; 7 men ; 58.96 ± 14.68 years ) performed stretches at home . Between-group comparisons were performed on the change in performance at “ Post ” and “ Retention ” ( 8 weeks later ) for neuropsychological and motor function measures . Results . VO2max significantly improved at Post with AEX ( P = .04 ) . AEX also improved motor learning in the less-affected h and , with large effect sizes ( Cohen ’s d calculation ) . Specifically , AEX significantly improved information processing speed on the serial reaction time task ( SRTT ; ie , “ procedural motor learning ” ) compared with the SE group at Post ( P = .024 ) , but not at Retention . Also , at Post ( P = .038 ) , AEX significantly improved predictive force accuracy for a precision grip task requiring attention and conditional motor learning of visual cues . Ambulation and sit-to-st and transfers were significantly faster in the AEX group at Post ( P = .038 ) , with balance control significantly improved at Retention ( P = .041 ) . EF measurements were not significantly different for the AEX group . Conclusion . AEX  improved mobility and selected cognitive domains related to motor learning , which enhances sensorimotor control after stroke OBJECTIVES To determine the feasibility and effect of exercise training after stroke . DESIGN R and omized exploratory trial comparing exercise training ( including progressive endurance and resistance training ) with relaxation ( attention control ) . SETTING Interventions were performed in a rehabilitation hospital . PARTICIPANTS Sixty-six independently ambulatory patients ( mean age 72 , 36 men ) without significant dysphasia , confusion , or medical contraindications to exercise training who had completed their usual rehabilitation and had been discharged from hospital . INTERVENTION Both interventions were held three times a week for 12 weeks . Up to seven patients attended each session . MEASUREMENTS The Functional Independence Measure ; Nottingham Extended Activities of Daily Living ; Rivermead Mobility Index ; functional reach ; sit-to-st and ; elderly mobility score ; timed up- and -go ; Medical Outcomes Study 36-Item Short Form Question naire , version 2 ( SF-36 ) ; Hospital Anxiety and Depression Score ; aspects of physical fitness ( comfortable walking speed , walking economy , and explosive leg extensor power ) were measured at baseline , immediately after interventions ( 3 months ) , and 7 months after baseline . RESULTS The median number of intervention sessions attended was 36 ( interquartile range ( IQR ) 30.00 - 36.75 ) for exercise and 36 ( IQR 30.50 - 37.00 ) for relaxation .  Adherence to the individual exercises ranged from 94 % to 99 % . At 3 months , role-physical ( an item in SF-36 ) , timed up- and -go , and walking economy were significantly better in the exercise group ( analysis of covariance ) . At 7 months , role-physical was the only significant difference between groups . CONCLUSION Exercise training for ambulatory stroke patients was feasible and led to significantly greater benefits in aspects of physical function and perceived effect of physical health on daily life Background and Purpose : A phase II , single-blinded , r and omized clinical trial was conducted to determine the effects of combined task-specific and lower-extremity ( LE ) strength training to improve walking ability after stroke . Subjects : The participants were 80 adults who were ambulatory 4 months to 5 years after a unilateral stroke . Method : The exercise interventions consisted of body-weight – supported treadmill training ( BWSTT ) , limb-loaded resistive leg cycling ( CYCLE ) , LE muscle-specific progressive-resistive exercise ( LE-EX ) , and upper-extremity ergometry ( UE-EX ) . After baseline assessment s , participants were r and omly assigned to a combined exercise program that included an exercise pair . The exercise pairs were : BWSTT/UE-EX , CYCLE/UE-EX , BWSTT/CYCLE , and BWSTT/LE-EX . Exercise sessions were 4 times per week for 6 weeks ( total of 24 sessions ) , with exercise type completed on alternate days . Outcomes were self-selected walking speed , fast walking speed , and 6-minute walk distance measured before and after intervention and at a 6-month follow-up . Results : The BWSTT/UE-EX group had significantly greater walking speed increases compared with the CYCLE/UE-EX group ; both groups improved in distance walked . All BWSTT groups increased walking speed and distance whether BWSTT was combined with LE strength training or not . Discussion and Conclusion : After chronic stroke , task-specific training during treadmill walking with body-weight support is more effective in improving walking speed and maintaining these gains at 6 months than resisted leg cycling alone . Consistent with the overtraining literature , LE strength training alternated daily with BWSTT walking did not provide an added benefit to walking outcomes Objective : To examine the effectiveness of task-oriented progressive resistance strength training on lower extremity strength and functional performance in chronic stroke subjects . Design : Single-blind , r and omized controlled trial . Setting : Medical centre and district hospital . Subjects : Forty-eight subjects at least one year post stroke . Interventions : Participants r and omly allocated to two groups , control  ( n-/24 ) and experimental  ( n-/24 ) . Subjects in the control group did not receive any rehabilitation training . Subjects in the experimental group were put on a four-week task-oriented progressive resistance strength training . Main measures : Lower extremity muscle strength , gait velocity , cadence , stride length , six-minute walk test , step test , and timed up and go test . Results : Muscle strength significantly improved in the experimental group for strong side muscle groups ( ranged from 23.9 % to 36.5 % ) and paretic side muscle groups ( ranged from 10.1 % to 77.9 % ) . In the control group muscle strength changes ranged from 6.7 % gain to 11.2 % decline . The experimental group showed significant improvement in all selected measures of functional performance except for the step test . In the control group , the number of repetitions of the step test significantly decreased ( -20.3 % ) with no change in other functional tests . There was a significant difference between groups for muscle strength and all functional measures . The strength gain was significantly associated with gain in the functional tests . Conclusions : The task-oriented progressive resistance strength training programme could improve lower extremity muscle strength in individuals with chronic stroke and could carry over into improvement in functional abilities Background . Sitting balance and the ability to perform selective truncal movements are important predictors of functional outcome after stroke . However , few clinical trials have evaluated the effect of truncal exercises . Objective . The authors assessed the effect of additional truncal exercises on truncal function , st and ing balance , and mobility . Methods . An assessor-blinded r and omized controlled trial was carried out at a stroke rehabilitation hospital . A total of 33 participants ( mean 35 days post onset ) were r and omly assigned to an experimental group ( n = 18 ) or a  control group ( n = 15 ) . In addition to conventional therapy , the experimental group received 16 hours of truncal exercises . The control group received 16 hours of sham treatment .  Truncal function was evaluated by the Trunk Impairment Scale ( TIS ) and st and ing balance and mobility by the Tinetti Test . The Romberg with eyes open and eyes closed , Four Test Balance Scale ( FTBS ) , Berg Balance Scale ( BBS ) , Rivermead Motor Assessment Battery ( RMAB ) , Functional Ambulation Categories , and Dynamic Gait Index ( DGI ) were performed to eluci date the findings of the primary outcome measures . Results . A treatment effect was found for the experimental group on the TIS ( P < .001 ) , Tinetti Test ( P < .001 ) , FTBS ( P = .014 ) , BBS ( P = .007 ) , RMAB ( P < .001 ) , and DGI ( P = .006 ) . Conclusions . In addition to conventional therapy , truncal exercises have a beneficial effect on truncal function , st and ing balance , and mobility in people after stroke Abstract Background and Objective : The ability to walk is impaired in more than 80 % of poststroke patients . The objective of the present study was to evaluate the effectiveness of the task-oriented circuit class training ( TOCCT ) with motor imagery ( MI ) on the gait during the subacute phase after a stroke . Method : This was a r and omized , controlled , assessor-blinded trial in a neurology department of a university hospital . A convenience sample of 30 people , 4 to 12 weeks ( mean , 6.3 weeks ) after the stroke was r and omized into 2 groups ( the TOCCT with MI and st and ard training group ) of 15 people each . Twenty-nine participants completed the 6-week follow-up . Participants were assigned to receive either the TOCCT with MI or dose-matched st and ard training program based on the Bobath ’s neurodevelopmental technique , 7 days a week for 2 weeks , as out patients or in patients . Outcome measures were the Functional Ambulation Classification ( FAC ) , the Rivermead Visual Gait Assessment ( RVGA ) , step length asymmetry , walking speed , and 6-minute walk test ( 6MWT ) . Results : The TOCCT with MI group showed a positive improvement in the mean/median scores on most of the outcome measures at post and follow-up assessment s in comparison to the control group . However , statistically significant differences were observed in changes between the groups at post and follow-up assessment for FAC , RVGA , walking speed , and 6MWT ( ANOVA , P = .001 to .049 ; Mann-Whitney U test , P = .001 ) . Conclusion : Among the patients who had a stroke within the previous 4 to 12 weeks , the TOCCT with MI produced statistically significant and clinical ly relevant improvements in the gait and the gait-related activities Abstract Background / Objective : The upper extremity motor deficit is one of the functional challenges in post stroke patients . The objective of the present study was to evaluate the effectiveness of the meaningful task-specific training ( MTST ) on the upper extremity motor recovery during the subacute phase after a stroke . Method : This was a r and omized , controlled , double-blinded trial in the neurology department of a university hospital and occupational therapy unit of a rehabilitation institute . A convenience sample of 103 people , 4 to 24 weeks ( mean , 12.15 weeks ) after the stroke , was r and omized into 2 groups ( MTST , 51 ; st and ard training group , 52 ) . Subjects in the Brunnstrom stage of arm recovery of 2 to 5 were included in the study . Ninety-five participants completed the 8-week follow-up . Interventions : Participants were assigned to receive either the MTST or dose-matched st and ard training program based on the Brunnstrom stage and Bobath neurodevelopmental technique , 4 to 5 days a week for 4 weeks . Fugl-Meyer assessment ( FMA ) , Action Research Arm Test ( ARAT ) , Grade d Wolf Motor Function Test ( GWMFT ) , and Motor Activity Log ( MAL ) were outcome measures Results : The MTST group showed a positive improvement in the mean scores on the outcome measures at post and follow-up assessment s in comparison to the control group . Further , statistically significant differences were observed in changes between the groups at post and follow-up assessment for FMA , ARAT , GWMFT , and MAL . Conclusion : The MTST produced statistically significant and clinical ly relevant improvements in the upper extremity motor recovery of the patients who had a subacute stroke BACKGROUND Despite the beneficial effect of cardiac rehabilitation after myocardial infa rct ion , a rehabilitation program to improve cardiorespiratory fitness and influence secondary prevention has not been implemented for ischemic stroke and transient ischemic attack ( TIA ) . OBJECTIVE To investigate the safety and feasibility of a post-stroke care including an exercise program after minor ischemic stroke or TIA . METHODS In a r and omised controlled trial , 20 patients with a recent minor stroke or TIA without cardiac contraindications were r and omly assigned to one of the two interventions ; post-stroke care without exercise or post-stroke care with exercise . Patients were evaluated at baseline , 6 and 12 months . RESULTS Eighteen patients completed the intervention . In none of the patients cardiopulmonary contraindications for the maximal exercise test and exercise program were found . No cardiovascular events occurred during the maximal exercise tests and exercise program . After one year , significantly more patients in the post-stroke care with exercise group achieved the composite endpoint of optimal medical therapy . CONCLUSIONS Post-stroke care including an exercise program is safe and feasible in the acute phase after minor stroke or TIA and might be a way to increase effectiveness of secondary stroke prevention . We are currently conducting a larger trial to vali date these results
BACKGROUND Circuit class therapy ( CCT ) offers a supervised group forum for people after stroke to practise tasks , enabling increased practice time without increasing staffing .
This is an up date of the original review published in 2010 .
OBJECTIVES To examine the effectiveness and safety of  CCT  on mobility in adults with stroke .