What is the benefit of a high intensive exercise program? A randomized controlled trial

Abstract

The aim of the study was to evaluate a high intensive exercise program in stroke subjects with risk of falls regarding balance, activities of daily life, falls efficacy, number of falls and lifestyle activities. The intervention program contained high intensity functional exercises (HIFE) implemented to real-life situations together with education on falls and security aspects. This was a single-center, single-blinded, randomized controlled trial. Consecutive >55-year-old patients with risk of falls were enrolled and randomized 3–6 months after first or recurrent stroke to the intervention group (IG, n=15) or to the control group (CG, n=19) who received group discussions about hidden dysfunctions after stroke. Outcomes were Berg Balance Scale (BBS) primarily, Barthel Index (BI), Falls Efficacy Scale – International (FES-I) and number of falls secondarily and Frenchay Activities Index last 3 months (FAI-3) tertially. Assessments were done at baseline, post-intervention, 3- and 6-month follow-up by two physiotherapists and one nurse blinded to group allocation. Generalized Estimating Equations with Repeated-measure statistics were used to analyze the data. There were no significant differences between the IG and the CG regarding balance (BBS). BI at 6 months and FES-I post-intervention and 3 months follow-up showed significant improvement in the IG compared with the CG (p<0.05). Number of falls and FAI-3 were without significant change. This study suggests that our program consisting of HIFE implemented in real-life situations together with educational discussions may improve performance of everyday life activities and improve falls efficacy in stroke subjects with risk of falls.

Key words::

• Accidental falls
• activities of daily life
• cerebrovascular disorders
• exercise
• rehabilitation

Acknowledgments

The study is registered at www.clinicaltrials.gov (NCT00377689).

This study was supported by grants from Vårdalinstitutet, the Swedish Institute for Health Sciences, the Swedish Stroke Foundation, the Swedish Heart and Lung Foundation, the Northern Swedish Stroke fund, the “Spjutspetsprojekt” at the County of Västerbotten, the Medical Faculty of Umeå University, Umeå University Hospital and the Erik and Anne-Marie Detlof Foundation at Umeå University.

We thank the Clinical Research Center at the University Hospital of Umeå for use of their facilities for our assessments. We also thank the following staff for help with the study: Rolf Backlund; Maria Hällgren; Monica Edström; Annelie Selling; Mats Bergström; Lena Sjölund; Stina Olofsson; Josefin Croxatto and Katarina Klingberg. We also thank the subjects and caregivers for their contributions and Anders Lundquist for assistance with the statistical analyses.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.