Circuit training benefits stroke survivors
MedWire News: Task-oriented circuit training is a good alternative to standard physiotherapy for stroke survivors who need to improve their walking ability, show results from a randomized trial.
"The present study stems from the recommendations of the American Heart Association, issued to promote the investigation of innovative methods to increase duration of practice with minimum use of resources," say Gert Kwakkel and colleagues from University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, in the Netherlands.
They observe: "The lower ratio of staff to patients suggests that circuit training can be cheaper and a valuable treatment to intensify physiotherapy for patients with stroke."
The staff-to-patient ratio was 1:1.8 for circuit training and 1:1.3 for physiotherapy. Patients in the circuit-training group worked in pairs on tasks designed to improve walking ability, in groups of two to eight. Sessions took place twice a week for 12 weeks and lasted an average of 72 minutes, whereas the control physiotherapy sessions lasted an average of 34 minutes.
Adverse events, which were mostly falls, occurred to a similar extent among the 126 patients assigned to circuit training and the 124 assigned to receive physiotherapy. One patient developed arrhythmia during a circuit-training session, but was cleared to continue after a medical check up.
Compliance with the intervention was generally good, the team reports in the BMJ. Just one patient withdrew from circuit training; the other patients attended 83% of the sessions, on average.
After 12 weeks of treatment, the primary outcome of self-reported change on the mobility domain of the stroke impact scale was similar for both groups, yet the circuit-training group did better than the physiotherapy group on several secondary outcomes.
Specifically, circuit-training patients improved by 0.09 m/s more on the 5-meter comfortable walking speed test than did physiotherapy patients, by 20 m more on the 6-minute walk test, and by 1.61 s more on the modified stairs test.
This "suggests that small gains in walking speed and walking distance are insufficient to result in significant improvements in patients' perception of gait performance," say the researchers. "Nor can they be generalised to improvements in patients' ability to walk outdoors."
They note that the primary outcome may also have been subject to ceiling effects, because most patients had fairly high scores at the outset. In addition, time had a large impact on patients' functional gains, irrespective of the intervention.
"The significant effect of time alone could reflect spontaneous neurological recovery, which might be considerable up to 12 weeks after stroke, as almost half of our patients were discharged within 3 months after stroke," says the team.
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By Eleanor McDermid