High Frequency and Intensity Rehabilitation in 641 Subacute Ischemic Stroke Patients

Abstract

Objectives: To determine the effects of exergaming on quality of life (QoL), motor, and clinicalsymptoms in subacute stroke patients.Design: A pseudorandomized controlled trial, using a before-after test design.Setting: University hospital.Participants: Subacute, ischemic stroke outpatients (NZ3857), 680 of whom were randomized and 641completed the study.Interventions: We determined the effects of 5 times a week twice daily (EX2; 50 sessions; nZ286)and once daily (EX1; 25 sessions; nZ272) exergaming and low-intensity standard care (control [CON];25 sessions; nZ83) on clinical, mobility, blood pressure (BP), and QoL outcomes. Main OutcomeMeasures: The primary outcome was Modified Rankin Scale. Secondary outcomes were activities ofdaily living, 5 aspects of health-related QoL, Beck Depression Inventory, 6-minute walk test(6MWT), Berg Balance Scale (BBS), and static balance (center of pressure). Results: Duringexercise, the peak heart rate was 134, 134, and 126 beats per minute in the EX2, EX1, and CONgroups, respectively. mRS improved similarly in the EX2 (e1.8; effect size, dZe4.0) and EX1 (e1.4;dZe2.6) groups, but more than in the CON group (e0.7; dZe0.6). QoL, Barthel Index, BBS, 6MWT, andstanding posturography improved more in the EX2 group and the same in the EX1 and CON groups.Systolic and diastolic resting BP decreased more in the EX2 and EX1 groups than in the CON group.The intervention effects did not differ between men (nZ349) and women (nZ292).Conclusions: Twice daily compared with once daily high-intensity exergaming or once daily lowerintensity standard care produced superior and motor symptoms, BP, and QoL in male and femalesubacute ischemic stroke participants.