Family-Mediated Exercise Intervention (FAME): Evaluation of a Novel Form of Exercise Delivery After Stroke Body-weight-supported treadmill rehabilitation after stroke. Repetitive locomotor training and physiotherapy improve walking and basic activities of daily living after stroke: a single-blind, randomized multicentre trial (DEutsche GAngtrainerStudie, DEGAS) A randomised controlled trial evaluating family mediated exercise (FAME) therapy following stroke Exercise to Enhance Mobility and Prevent Falls After Stroke Randomised controlled trial of an occupational therapy intervention to increase outdoor mobility after stroke Effects of circuit training as alternative to usual physiotherapy after stroke: randomised controlled trial Randomized Trial of Treadmill Training to Improve Walking in Community-Dwelling People after Stroke: The AMBULATE Trial Effects of Task-Specific and Impairment-Based Training Compared With Usual Care on Functional Walking Ability After Inpatient Stroke Rehabilitation Use of Accelerometer-Based Feedback of Walking Activity for Appraising Progress With Walking-Related Goals in Inpatient Stroke Rehabilitation Protocol for the Locomotor Experience Applied Post-stroke (LEAPS) trial: a randomized controlled trial Using wireless technology in clinical practice: does feedback of daily walking activity improve walking outcomes of individuals receiving rehabilitation post-stroke? Study protocol for a randomized controlled trial Combined analysis of two randomized trials of community physiotherapy for patients more than one year post stroke Physiotherapy intervention late after stroke and mobility. A community-based fitness and mobility exercise program for older adults with chronic stroke: a randomized, controlled trial. Circuit-based rehabilitation improves gait endurance but not usual walking activity in chronic stroke: a randomized controlled trial.
Background and Purpose — Additional exercise therapy has been shown to have a positive impact on function after acute stroke and research is now focusing on methods to increase the amount of therapy that is delivered . This r and omized controlled trial examined the impact of additional family-mediated exercise ( FAME ) therapy on outcome after acute stroke . Methods — Forty participants with acute stroke were r and omly assigned to either a control group who received routine therapy with no formal input from their family members or a FAME group , who received routine therapy and additional lower limb FAME therapy for 8 weeks . The primary outcome measure used was the lower limb section of the Fugl-Meyer Assessment modified by Lindmark . Other measures of impairment , activity , and participation were completed at baseline , postintervention , and at a 3-month follow-up . Results — Statistically significant differences in favor of the FAME group were noted on all measures of impairment and activity postintervention ( P<0.05 ) . These improvements persisted at the 3-month follow-up but only walking was statistically significant ( P<0.05 ) . Participants in the FAME group were also significantly more integrated into their community at follow-up ( P<0.05 ) . Family members in the FAME group reported a significant decrease in their levels of caregiver strain at the follow-up when compared with those in the control group ( P<0.01 ) . Conclusions — This evidence -based FAME intervention can serve to optimize patient recovery and family involvement after acute stroke at the same time as being mindful of available re sources BACKGROUND Locomotor training , including the use of body-weight support in treadmill stepping , is a physical therapy intervention used to improve recovery of the ability to walk after stroke . The effectiveness and appropriate timing of this intervention have not been established . METHODS We stratified 408 participants who had had a stroke 2 months earlier according to the extent of walking impairment -- moderate ( able to walk 0.4 to < 0.8 m per second ) or severe ( able to walk < 0.4 m per second)-- and r and omly assigned them to one of three training groups . One group received training on a treadmill with the use of body-weight support 2 months after the stroke had occurred ( early locomotor training ) , the second group received this training 6 months after the stroke had occurred ( late locomotor training ) , and the third group participated in an exercise program at home managed by a physical therapist 2 months after the stroke ( home-exercise program ) . Each intervention included 36 sessions of 90 minutes each for 12 to 16 weeks . The primary outcome was the proportion of participants in each group who had an improvement in functional walking ability 1 year after the stroke . RESULTS At 1 year , 52.0 % of all participants had increased functional walking ability . No significant differences in improvement were found between early locomotor training and home exercise ( adjusted odds ratio for the primary outcome , 0.83 ; 95 % confidence interval [ CI ] , 0.50 to 1.39 ) or between late locomotor training and home exercise ( adjusted odds ratio , 1.19 ; 95 % CI , 0.72 to 1.99 ) . All groups had similar improvements in walking speed , motor recovery , balance , functional status , and quality of life . Neither the delay in initiating the late locomotor training  nor the severity of the initial impairment affected the outcome at 1 year . Ten related serious adverse events were reported ( occurring in 2.2 % of participants undergoing early locomotor training , 3.5 % of those undergoing late locomotor training , and 1.6 % of those engaging in home exercise ) . As compared with the home-exercise group , each of the groups receiving locomotor training had a higher frequency of dizziness or faintness during treatment ( P=0.008 ) . Among patients with severe walking impairment , multiple falls were more common in the group receiving early locomotor training than in the other two groups ( P=0.02 ) . CONCLUSIONS Locomotor training , including the use of body-weight support in stepping on a treadmill , was not shown to be superior to progressive exercise at home managed by a physical therapist . ( Funded by the National Institute of Neurological Disorders and Stroke and the National Center for Medical Rehabilitation Research ; LEAPS Clinical Trials.gov number , NCT00243919 . ) Objective : To evaluate the effect of repetitive locomotor training on an electromechanical gait trainer plus physiotherapy in subacute stroke patients . Design : R and omized controlled trial . Setting : Four German neurological rehabilitation centres . Subjects : One hundred and fifty-five non-ambulatory patients ( first-time stroke < 60 days ) . Intervention : Group A received 20 min locomotor training and 25 min physiotherapy ; group B had 45 min physiotherapy every week day for four weeks . Main outcome measures : Primary variables were gait ability ( Functional Ambulation Category , 0 - 5 ) and the Barthel Index ( 0 - 100 ) , blindly assessed at study onset , end , and six months later for follow-up . Responders to the therapy had to become ambulatory ( Functional Ambulation Category 4 or 5 ) or reach a Barthel Index of ≥ 75 . Secondary variables were walking velocity , endurance , mobility and leg power . Results : The intention-to-treat analysis revealed that significantly greater number of patients in group A could walk independently : 41 of 77 versus 17 of 78 in group B ( P B < 0.0001 ) at treatment end . Also , significantly more group A patients had reached a Barthel Index ≥ 75 : 44 of 77 versus 21 of 78 ( P B < 0.0001 ) . At six-month follow-up , the superior gait ability in group A persisted ( 54 of 77 versus 28 of 78 , P B < 0.0001 ) , while the Barthel Index responder rate did not differ . For all secondary variables , group A patients had improved significantly more ( P B < 0.0001 ) during the treatment period , but not during follow-up . Conclusions : Intensive locomotor training plus physiotherapy result ed in a significantly better gait ability and daily living competence in subacute stroke patients  compared with physiotherapy alone Background Stroke is a leading cause of disability among adults worldwide . Evidence suggests that increased duration of exercise therapy following stroke has a positive impact on functional outcome following stroke . The main objective of this r and omised controlled trial is to evaluate the impact of additional family assisted exercise therapy in people with acute stroke . Methods / Design A prospect i ve multi-centre single blind r and omised controlled trial will be conducted . Forty patients with acute stroke will be r and omised into either an experimental or control group . The experimental group will receive routine therapy and additional lower limb exercise therapy in the form of family assisted exercises . The control group will receive routine therapy with no additional formal input from their family members . Participants will be assessed at baseline , post intervention and followed up at three months using a series of st and ardised outcome measures . A secondary aim of the project is to evaluate the impact of the family mediated exercise programme on the person with stroke and the individual(s ) assisting in the delivery of exercises using a qualitative methodology . The study has gained ethical approval from the Research Ethics Committees of each of the clinical sites involved in the study . Discussion This study will evaluate a structured programme of exercises that can be delivered to people with stroke by their ' family members/friends ' . Given that the progressive increase in the population of older people is likely to lead to an increased prevalence of stroke in the future , it is important to reduce the burden of this illness on the individual , the family and society . Family mediated exercises can maximise the carry over outside formal physiotherapy sessions , giving patients the opportunity for informal practice .Trial Registration The protocol for this study is registered with the US NIH Clinical trials registry ( NCT00666744 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 Abstract Objective To evaluate an occupational therapy intervention to improve outdoor mobility after stroke . Design R and omised controlled trial . Setting General practice registers , social services departments , a primary care rehabilitation service , and a geriatric day hospital . Participants 168 community dwelling people with a clinical diagnosis of stroke in previous 36 months : 86 were allocated to the intervention group and 82 to the control group . Interventions Leaflets describing local transport services for disabled people ( control group ) and leaflets with assessment and up to seven intervention sessions by an occupational therapist ( intervention group ) . Main outcome measures Responses to postal question naires at four and 10 months : primary outcome measure was response to whether participant got out of the house as much as he or she would like , and secondary outcome measures were response to how many journeys outdoors had been made in the past month and scores on the Nottingham extended activities of daily living scale , Nottingham leisure question naire , and general health question naire . Results Participants in the treatment group were more likely to get out of the house as often as they wanted at both four months ( relative risk 1.72 , 95 % confidence interval 1.25 to 2.37 ) and 10 months ( 1.74 , 1.24 to 2.44 ) . The treatment group reported more journeys outdoors in the month before assessment at both four months ( median 37 in intervention group , 14 in control group : P < 0.01 ) and 10 months ( median 42 in intervention group , 14 in control group : P < 0.01 ) . At four months the mobility scores on the Nottingham extended activities of daily living scale were significantly higher in the intervention group , but there were no significant differences in the other secondary outcomes . No significant differences were observed in these measures at 10 months . Conclusion A targeted occupational therapy intervention at home increases outdoor mobility in people after stroke 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 ) Background Residual walking deficits are common in community-dwelling people after stroke . Aims The aim of this study was to determine if a four-month treadmill and overground walking program is more effective than a two-month program , compared with control , at improving walking in community-dwelling people with stroke who walk slowly . Method A three-arm r and omized trial with concealed allocation , assessor blinding , and intention-to-treat analysis involving 102 people with stroke living in the community who walked slowly was undertaken . Experimental group 1 undertook 30 min of treadmill and overground walking thrice per week for four-months , experimental group 2 undertook training for two-months , while the control group had no intervention . The primary outcome was walking measured as the distance covered during the six-min walk test . Other outcomes were walking speed , step length and cadence , health status , community participation , self-efficacy and falls . Results By two-months , the experimental groups , who were both undergoing training , had improved their six-min walk distance compared with the control group . The four-month training group continued training beyond two-months and improved further so that by four months they walked 38 m ( 95 % confidence interval 15–60 ) more than the control group and 29 m ( 95 % confidence interval 4–53 ) more than the two-month training group . However , by 12 months , well after the cessation of training , both experimental groups had returned to near baseline levels , and there was no difference between the groups . Conclusion Four months of treadmill training results in better walking . However , these effects disappear once training ceases . Therefore , training should be ongoing Background . After inpatient stroke rehabilitation , many people still can not participate in community activities because of limited walking ability . Objective . To compare the effectiveness of 2 conceptually different , early physical therapy ( PT ) interventions to usual care ( UC ) in improving walking 6 months after stroke . Methods . The Locomotor Experience Applied Post-Stroke ( LEAPS ) study was a single-blind , r and omized controlled trial conducted in 408 adults with disabling hemiparetic stroke . Participants were stratified at baseline ( 2 months ) by impairment in walking speed : severe ( < 0.4 m/s ) or moderate ( 0.4 to < 0.8 m/s ) . Between 2 and 6 months , they received either only UC ( n = 143 ) or UC plus 36 therapist-provided sessions of either ( 1 ) walking training on a treadmill using body-weight support and practice overground at clinics ( locomotor training program [ LTP ] , n = 139 ) or ( 2 ) impairment-based strength and balance exercise at home ( home exercise program [ HEP ] , n = 126 ) . Results . LTP participants were 18 % more likely to transition to a higher functional walking level : severe to > 0.4 m/s and moderate to > 0.8 m/s than UC participants ( 95 % confidence interval [ CI ] = 7%-29 % ) , and HEP participants were 17 % more likely to transition ( 95 % CI = 5%-29 % ) . Mean gain in walking speed in LTP participants was 0.13 m/s greater ( 95 % CI = 0.09 - 0.18 ) and in HEP participants , 0.10 m/s greater ( 95 % CI = 0.05 - 0.14 ) than in UC participants . Conclusions . Progressive PT , using either walking training on a treadmill and overground , conducted in a clinic , or strength and balance exercises conducted at home , was superior to UC in improving walking , regardless of severity of initial impairment Background . Regaining independent ambulation is important to those with stroke . Increased walking practice during “ down time ” in rehabilitation could improve walking function for individuals with stroke . Objective . To determine the effect of providing physiotherapists with accelerometer-based feedback on patient activity and walking-related goals during inpatient stroke rehabilitation . Methods . Participants with stroke wore accelerometers around both ankles every weekday during inpatient rehabilitation . Participants were r and omly assigned to receive daily feedback about walking activity via their physiotherapists  ( n = 29 )  or to receive no feedback  ( n = 28 ) . Changes in measures of daily walking ( walking time , number of steps , average cadence , longest bout duration , and number of “ long ” walking bouts ) and changes in gait control and function assessed in-laboratory were compared between groups . Results . There was no significant increase in walking time , number of steps , longest bout duration , or number of long walking bouts for the feedback group compared with the control group ( P values > .20 ) . However , individuals who received feedback significantly increased cadence of daily walking more than the control group ( P = .013 ) . From the in-laboratory gait assessment , individuals who received feedback had a greater increase in walking speed and decrease in step time variability than the control group ( P values < .030 ) . Conclusion . Feedback did not increase the amount of walking completed by individuals with stroke . However , there was a significant increase in cadence , indicating that intensity of daily walking was greater for those who received feedback than the control group . Additionally , more intense daily walking activity appeared to translate to greater improvements in walking speed Background Locomotor training using body weight support and a treadmill as a therapeutic modality for rehabilitation of walking post-stroke  is being rapidly adopted into clinical practice . There is an urgent need for a well- design ed trial to determine the effectiveness of this intervention . The objective of the Locomotor Experience Applied Post-Stroke ( LEAPS ) trial is to determine if there is a difference in the proportion of participants who recover walking ability at one year post-stroke when r and omized to a specialized locomotor training program ( LTP ) , conducted at 2- or 6-months post-stroke , or those r and omized to a home based non-specific , low intensity exercise intervention ( HEP ) provided 2 months post-stroke . We will determine if the timing of LTP delivery affects gait speed at 1 year and whether initial impairment severity interacts with the timing of LTP . The effect of number of treatment sessions will be determined by changes in gait speed taken pre-treatment and post-12 , -24 , and -36 sessions . Methods / Design We will recruit 400 adults with moderate or severe walking limitations within 30 days of stroke onset . At two months post stroke , participants are stratified by locomotor impairment severity as determined by overground walking speed and r and omly assigned to one of three groups : ( a ) LTP-Early ; ( b ) LTP-Late or ( c ) Home Exercise Program -Early . The LTP program includes body weight support on a treadmill and overground training . The LTP and HEP interventions are delivered for 36 sessions over 12 weeks . Primary outcome measure include successful walking recovery defined as the achievement of a 0.4 m/s gait speed or greater by persons with initial severe gait impairment or the achievement of a 0.8 m/s gait speed or greater by persons with initial moderate gait impairment . LEAPS is powered to detect a 20 % difference in the proportion of participants achieving successful locomotor recovery between the LTP groups and the HEP group , and a 0.1 m/s mean difference in gait speed change between the two LTP groups . Discussion The goal of this single-blinded , phase III r and omized clinical trial is to provide evidence to guide post-stroke walking recovery programs . Trial registration NCT00243919 Background Regaining independent ambulation is the top priority for individuals recovering from stroke . Thus , physical rehabilitation post-stroke should focus on improving walking function and endurance . However , the amount of walking completed by individuals with stroke attending rehabilitation is far below that required for independent community ambulation . There has been increased interest in accelerometer-based monitoring of walking post-stroke .  Walking monitoring could be integrated within the goal - setting process for those with ambulation goals in rehabilitation . The feedback from these devices can be downloaded to a computer to produce reports . The purpose of this study is to determine the effect of accelerometer-based feedback of daily walking activity during rehabilitation on the frequency and duration of walking post-stroke . Methods Participants will be r and omly assigned to one of two groups : feedback or no feedback . Participants will wear accelerometers daily during in- and out-patient rehabilitation and , for participants in the feedback group , the participants ’ treating physiotherapist will receive regular reports of walking activity . The primary outcome measures are the amount of daily walking completed , as measured using the accelerometers , and spatio-temporal characteristics of walking ( e.g. walking speed ) . We will also examine goal attainment , satisfaction with progress towards goals , stroke self-efficacy , and community-integration . Discussion Increased walking activity during rehabilitation is expected to improve walking function and community re-integration following discharge . In addition , a focus on altering walking behaviour within the rehabilitation setting may lead to altered behaviour and increased activity patterns after discharge . Trial registration Clinical Trials.gov Background : Some patients continue to have mobility problems as a long-term consequence of stroke and it is unclear whether routine , further contact with a physiotherapy service is beneficial . Two single-centre , r and omized controlled trials of physiotherapy for patients more than one year post stroke have been undertaken in Oxford and Bradford in the UK and the results from these two trials have been combined to give a more precise estimate of effectiveness . Method : The computerized data bases from both trials were combined for a joint analysis . Outcome measures common to both trials were : Rivermead Mobility Index ; gait speed measured over 10 metres ; Barthel Index ; Frenchay Activities Index ; Hospital Anxiety and Depression Scale . Results : There were 264 patients available for the combined analysis ( Oxford= 94 ; Bradford= 170 ) . There was a significant but clinical ly small improvement in mobility at three months in the combined treatment group measured by the Rivermead Mobility Index ( median of the differences= 0 ( 95 % confidence interval ( CI ) 0 , 1 ) ; interpolated values= 0.43 ( 95 % CI 0.08 , 0.80 ) ) and gait speed ( treatment effect 2.7 m/min ( 95 % CI 0.94 , 4.46 ) ) . There were no other significant differences . Intervention given in both studies was at the discretion of the physiotherapists and was of similar and low intensity ( mean visits Oxford= 4 ( SD 2.5 ) ; Bradford= 5 ( SD 4.5 ) ) . Conclusion : A more effective physiotherapy intervention is required for stroke patients with persisting mobility problems after stroke OBJECTIVE --To determine whether the intervention of a physiotherapist improved mobility in patients seen more than one year after stroke . DESIGN --R and omised crossover trial comparing two groups offered intervention by a physiotherapist , one immediately after entry into the trial and the other after a delay of three months . The intervention consisted of identifying problems and offering advice and help to solve the problems . SETTING -- Patients ' homes in Oxfordshire . SUBJECTS-- Patients who had reduced mobility due to a stroke more than one year before entry ; 60 were recruited from a community stroke register and 34 in other ways . MAIN OUTCOME MEASURES --St and ard measures of mobility including gait speed , functional ambulation categories , the Nottingham extended activities of daily living index , and individual items from the Barthel activities of daily living index and the Frenchay activities index . Measures of manual dexterity , depression , and anxiety were used as controls . RESULTS --94 patients entered the trial and 49 were r and omised to immediate and 45 to delayed physiotherapy ; 89 were compared at the crossover point . At r and omisation the two groups were comparable . At three months the group given early therapy showed an improvement in gait speed whereas the untreated group had declined ( differences of -3.9 v 6.4 s to walk 10 m ; p less than 0.01 ) ; between three and six months the group given delayed therapy showed improvement and the previously treated group declined ( differences of 6.5 v -3.9 s to walk 10 m ; p less than 0.01 ) . A 9 % ( 95 % confidence interval 0 % to 18 % ) decrease in time taken to walk 10 m was associated with treatment and a 12 % ( 2 % to 19 % ) increase when patients were untreated . Other measures did not change significantly . CONCLUSION --Intervention of an experienced physiotherapist late after stroke specifically improves mobility , albeit by a small amount , but the effects do not seem to be maintained , perhaps because there is an underlying decline in mobility in these patients . Gait speed offers a simple and sensitive measure of outcome 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 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 : This study aim ed to determine the effectiveness of current interventions to improve real-world walking for people with stroke and specifically whether benefits are sustained .