Stroke is one of the most common chronic conditions affecting older adults, and an increasing number of stroke survivors are choosing to return home instead of going to inpatient rehabilitation programs. However, there are currently very few community-based alternatives to inpatient rehabilitation programs. This study examines the effects of a community-based group exercise program for older individuals with chronic stroke. Participants who received the fitness and mobility exercise program as opposed to the control group showed significant improvement in cardiorespiratory fitness, mobility, and paretic leg muscle strength. This study is useful in demonstrating the efficacy of a community-based fitness and mobility exercise program for rehabilitating older individuals with chronic stroke. Unfortunately, no information is provided about the cost of the intervention, so conclusions about the cost-effectiveness of this program await further research.

Background: Stroke is one of the most common chronic conditions affecting older adults, and the number of stroke survivors in the community is on the rise as more choose to return home instead of going to inpatient rehabilitation programs. Most stroke survivors continue to live with residual physical impairments that often result in health complications such as cardiac events, recurrent stroke, poor balance, and hip fracture. It is recognized that rehabilitation and physical activity are critical to improving the functional status and quality of life of stroke survivors. Currently, there are very few alternatives to inpatient rehabilitation programs, and there is a lack of accessible community-based programs. This study compares the effects of a community-based group exercise programs for older individuals with chronic stroke to a standard outpatient rehabilitation program.

Methods: Participants were recruited from a local rehabilitation hospital, community stroke clubs, and local advertisements. A total of 63 older individuals with chronic stroke met the selection criteria (e.g., aged ≥ 50, chronic stroke sustained one or more years previously, physically able to ride a bike) participated in the study. Participants were randomly assigned to an intervention (n=32) or control group (n=31). The intervention group underwent a fitness and mobility exercise (FAME) program designed to improve cardiorespiratory fitness, mobility, leg muscle strength, balance, and hip bone mineral density. The control group underwent a seated upper extremity program without aerobic exercise, leg strengthening or balance training. The intervention and control programs took place in a room in a community hall, and consisted of 1-hour sessions, three times per week, for 19 weeks. A physical therapist, an occupational therapist, and an exercise instructor coordinated and supervised the sessions.

Findings: At the end of the study, participants who received the FAME program showed significant improvement in cardiorespiratory fitness, mobility, and stroke-affected leg muscle strength when compared to those receiving only the upper extremity rehabilitation program. This study provides the first evidence that regular exercise is beneficial for hipbone health in chronic stroke population. Femoral neck bone mineral density was maintained in the intervention group, whereas a 2.5% decline occurred in the control group.

Conclusions: Study results suggest that the FAME program has the potential to improve some of the secondary health complications resulting from physical inactivity in older adults living with chronic stroke. Individuals suffering from chronic stroke showed significant improvement in cardiorespiratory fitness, mobility, and stroke-affected leg muscle strength, and maintained hipbone mineral density compared to the control group. While this study demonstrates the efficacy of the FAME communitybased fitness program for older individuals with chronic stroke, decision makers will be interested in whether the FAME program is a cost-effective use of resources compared to traditional rehabilitation and exercise programs for these populations. Unfortunately, this study does not provide evidence pertaining to the cost of the intervention, so conclusions about the cost-effectiveness await further research.

Reference: Pang MYC, Eng JJ, Dawson AS, McKay HA, JE Harris. "A Community-based Fitness and Mobility Exercise Program for Older Adults with Chronic Stroke: A Randomized Controlled Trial". Journal of American Geriatrics Society, 2005; 53: 1667-1674

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