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Effects of twice-weekly intense aerobic exercise in early subacute stroke: a randomized controlled trial
Sandberg K, Kleist M, Falk L, Enthoven P
Archives of Physical Medicine and Rehabilitation 2016 Aug;97(8):1244-1253
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To examine the effects of 12 weeks of twice-weekly intensive aerobic exercise on physical function and quality of life after subacute stroke. DESIGN: Randomized controlled trial. SETTING: Ambulatory care. PARTICIPANTS: Fifty-six patients (28 women) aged >= 50 years who had a mild stroke (98% ischemic) and were discharged to independent living and enrolled 20 days (median) after stroke onset. INTERVENTIONS: Sixty minutes of group aerobic exercise, including 2x8 minutes of exercise with intensity up to exertion level 14 to 15/20 on the Borg rating of perceived exertion scale, twice weekly for 12 weeks (n = 29). Controls (n = 27) received no organized rehabilitation or scheduled physical exercise. MAIN OUTCOME MEASURES: Primary outcome measures: aerobic capacity: standard ergometer exercise stress test (peak work rate (WR)). Walking distance: 6-Minute Walk Test (6MWT). Secondary outcomes measures: maximum walking speed 10 meters (MWS10m). Balance: Timed Up and Go (TUG), Single Leg Stance (SLS). Health-related quality of life: Euroqol-5D (EQ-5D). Participation and recovery after stroke: Stroke Impact Scale 2.0 (SIS) domains 8 and 9. Participants were evaluated pre-intervention and post-intervention; patient-reported measures were also evaluated at a 6-month follow-up. RESULTS: The following improved significantly more in the intervention group (pre- to post-intervention): peak WR (group x time interaction p = 0.006), 6MWT (p = 0.011), MWS10m (p < 0.001), TUG (p < 0.001), SLS right and left (eyes open) (p < 0.001 and p = 0.022 respectively), and SLS right (eyes closed) (p = 0.019). Aerobic exercise was associated with improved EQ-5D VAS; p = 0.008) and perceived recovery (SIS domain 9; p = 0.002). These patient-reported improvements persisted at the 6-month follow-up. CONCLUSIONS: Intensive aerobic exercise twice weekly early in subacute mild stroke improved aerobic capacity, walking, balance, health-related quality of life, and patient-reported recovery.

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