Exercise Training in a Predominantly African-American Group of Stroke Survivors.

Exercise Training in a Predominantly African-American Group of Stroke Survivors Rimmer JH, Riley B, Creviston T, Nicola T (Department of Disability and Human Development and Department of Rehabilitation Medicine, University of Chicago, Chicago, IL), Med Sci Sports Exerc. 2000;32:1990-1996.

This study examined the effect of a 12-week exercise program on a group of 35 patients (9 men, 26 women; mean age=53.2 [+ or -] 8.3 years) with stroke and comorbidities who were predominantly African-American. All participants met the following inclusion criteria: 30 to 70 years of age, at least 6 months after stroke onset, ability to walk a minimum of 50 feet with or without an assistive device, and living within a 1-hour commute of the facility (transportation was provided for all sessions).

To provide a control group and also to provide training for all participants, this study used a pretest/posttest lag control group design. This design consisted of two 12-week exercise iterations. During the first iteration, 18 subjects received the exercise intervention, and the other 17 subjects served as lag controls. The lag control subjects received the exercise intervention during the second 12-week iteration. Both groups were examined before and after the first iteration, and the lag-control subjects were also examined after the second iteration. The exercise intervention, which was performed 3 days per week, consisted of 30 minutes of cardiovascular endurance, 20 minutes of strength training, and 10 minutes of flexibility training. Participants initially were instructed on how to judge perceived rates of exertion, recognize warning signs, and use equipment safely. For cardiovascular fitness training, participants chose from a variety of machines, including steppers and stationary bicycles. Strength training occurred on LifeFitness machines for upper- and lower-extremity muscle groups.

Cardiovascular fitness was assessed through peak [Vo.sub.2] testing on a stationary bicycle. Strength was assessed before and after exercise on bench press, leg press, and handgrip machines. Hamstring and lower back flexibility was assessed through a modified sit and reach test. Body composition was assessed through height, weight, skinfold measurements, and waist-to-hip ratios.

Ninety-three percent of all exercise sessions were attended, and no one dropped out of the program. The authors attributed this attendance record and lack of dropout to elimination of transportation and cost barriers. The results indicated that the exercise group improved significantly in peak [Vo.sub.2], time to exhaustion, muscular strength in the bench press and leg press exercises, hamstring flexibility, and skinfold measurements. These variables either remained unchanged or worsened in the lag control group during the first 12-week iteration. No significant differences were observed between the two groups in shoulder flexibility, handgrip strength, or waist-to-hip ratios.

The authors concluded that people with stroke can make significant fitness improvements with a supervised exercise program. They also suggested that greater efforts should be made to involve people with stroke in fitness and physical activity programs and that such programs may help reduce morbidity and disability in these people.

Carolyn Vaillancourt, PT, MS, NCS
Braintree, Mass