Exercise as it relates to Disease/Effects of long-term exercise on post-stroke patients

This is a critical analysis on an article "Physiotherapy and physical functioning post-stroke: Exercise habits and functioning 4 years later? Long-term follow-up after a 1-year long-term intervention period: A randomized controlled trial" published by Langhammer, B., Lindmark, B., & Stanghelle, J. K. (2014)

What is the background to this research?
Strokes can occur suddenly in any individuals and it is one of the most common causes of death in Australia and in the world, and it is also a leading cause of disability. A study has shown that 65% of stroke survivors suffer some kinds of disability that requires assistance in their daily living activities. Those effects from stroke are different in each person, however in any conditions, it is highly recommended to do some exercise that meets their own capacity in order to maintain their physical functions such as motor function, tone, grip strength, balance, mobility and gait. The study conducted by Langhammer,B., Lindmark,B., and Stanghelle J.K. looked at the long-term outcome of exercise in stroke patients.

Where is the research from?
This study was conducted by researchers from Norway and Sweden. Two researchers were from Norway, and both of them belonged to universities. Another researcher was from a university hospital in Sweden. They were all from different faculties but within health area, which may give an advantage in reliability in this research because each person could have professional opinions or connections in each area. The authors have reported there was no conflicts of interest in this article.

What kind of research was this?
This was a single-blind, longitudinal randomised controlled trial. Stroke patients were divided into two groups, intervention and control, and asked to perform their exercises for one year. After the initial year, there were no scheduled exercises in either groups and the participants were responsible for their own exercise for three years period. 35 of 75 patients were eligible to participate in a follow-up study. They were randomly divided into two groups again, intensive and regular exercise, and got assessed on their physical functions.

What did the research involve?
All the participants of the study were voluntary and they have had satisfied the given criteria. For example, they had to be first-time-ever stroke patients, with no other particular illness or physical conditions. Average age of the participants was 75 years old. This study aimed to investigate how physical functions were maintained 4 years after the onset of stroke in two groups. One year of scheduled exercises were given to both groups and the same participants got tested across 4 years of the intervention (48 months post-onset of stroke).  Following tests were conducted:
 * Questionnaires: assessing the level of person’s performance in daily living activities and their physiological components using scales
 * Walking capacity test: 6-Minute Walk Test
 * Balance test: Berg Balance Scale
 * Functional mobility test: Timed-Up-and-Go
 * Grip strength
 * Measurement of muscle tone: Modified Ashworth Scale

What were the basic results?
There were some differences in the test results between two groups after the first year of intervention, however both groups improved their overall physical functions. Looking at their long-term results, both groups maintained their functions and had similar outcomes. They remained relatively active across 4 years after experiencing stroke. However, only 49% of the patients were eligible for the final test. People who withdrew from this research had reasons such as impossible to contact, too busy, development of illnesses and death, and this article does not indicate if there was any risk factors in this research that could affect the situation. Although every exercise has some potential risk, generally saying, long-term exercise can help maintaining physical functions in post-stroke patients. .

What conclusions can we take from this research?
This research showed the importance of exercise after an onset of stroke. In addition, it claimed the significance of regular exercise followed by the first year of the given program.

In fact, positive link between exercise and overall heath in stroke survivors has been established through many researches. It is generally said that rehabilitation exercises can help patients gain and maintain their independence as much as possible. Also, from the study conducted, subjects who were given scheduled exercise in their first year after their stroke incident; they were more likely to maintain their relatively active lives. Improvement or maintenance in physical functions can allow individuals to keep up with their social life and activities, which will lead them to have high quality of life.

Practical advice
This study indicated that long-term exercise can give positive effects in stroke survivors. It is important to give them an initial exercise program instead of just telling them to carry out any kinds of exercise. This is due to the fact that exercise for stroke patients can be a great challenge. Those challenges can include reduced functional capacity, activity intolerance and anxiety that might arise. However, the study showed that people who exercised in their first year after stroke incident were more likely to continue their exercise habits. Therefore, encouraging post-stroke patients to start exercising is largely important. One good way to provide them a chance to start exercising is to give them an initial exercise program with the consideration of their limitation.

Further information/resources
Stroke Foundation Australia

A Stroke Recovery Guideline - National Stroke Association