Comparison of effect of aerobic cycle training and progressive resistance training on walking ability after stroke: a randomized sham exercise-controlled study. Progressive resistance training increases strength after stroke but this may not carry over to activity: a systematic review. Progressive resistance training after stroke: effects on muscle strength, muscle tone, gait performance and perceived participation. Comparison of Two Techniques of Robot-Aided Upper Limb Exercise Training After Stroke A predominantly home-based progressive resistance exercise program increases knee extensor strength in the short-term in people with chronic obstructive pulmonary disease: a randomised controlled trial. Effects of Task-Specific and Impairment-Based Training Compared With Usual Care on Functional Walking Ability After Inpatient Stroke Rehabilitation Task-oriented progressive resistance strength training improves muscle strength and functional performance in individuals with stroke High intensity strength training improves strength and functional performance after stroke. Benefits of intensive resistance training in patients with chronic polymyositis or dermatomyositis. Delayed Onset Muscle Soreness and Perceived Exertion After Blood Flow Restriction Exercise Muscle strength after resistance training is inversely correlated with baseline levels of soluble tumor necrosis factor receptors in the oldest old. Gait Parameters Associated With Responsiveness to Treadmill Training With Body-Weight Support After Stroke: An Exploratory Study High intensity interval training does not impair strength gains in response to resistance training in premenopausal women Effects of Task-Specific Locomotor and Strength Training in Adults Who Were Ambulatory After Stroke: Results of the STEPS Randomized Clinical Trial Exercise training for rehabilitation and secondary prevention of falls in geriatric patients with a history of injurious falls. Effects of Resistance Training and Aerobic Training on Ambulation in Chronic Stroke Paretic Upper-Limb Strength Best Explains Arm Activity in People With Stroke Effect of progressive resistance training on muscle performance after chronic stroke. Understanding physical factors associated with participation in community ambulation following stroke Rehabilitation for post-stroke cognitive impairment: an overview of recommendations arising from systematic reviews of current evidence Progressive Resistance Muscle Strength Training of Hospitalized Frail Elderly Tai chi and postural stability in patients with Parkinson's disease. Impairments, activity limitations and participation restrictions 6 and 12 months after breast cancer operation.
OBJECTIVES To determine whether changes in strength or cardiorespiratory fitness after exercise training improve walking ability in individuals who have had a stroke . DESIGN A sham exercise-controlled , r and omized two-by-two factorial design , in which the two factors investigated were cycle training ( AEROBIC ) and resistance training ( STRENGTH ) . SETTING University exercise laboratory . PARTICIPANTS Fifty-two individuals with a history of stroke ( aged 63+/-9 ; time since stroke , 57+/-54 months ) . INTERVENTION Participants undertook 30 exercise sessions over 10 to 12 weeks . Depending on group allocation , individuals underwent aerobic cycling plus sham progressive resistance training ( PRT ) ( n=13 ) , sham cycling plus PRT ( n=13 ) , aerobic cycling plus PRT ( n=14 ) , or sham cycling plus sham PRT ( n=12 ) . MEASUREMENTS Primary outcomes were 6-minute walk distance , habitual and fast gait velocities , and stair climbing power . Secondary outcomes included measures of cardiorespiratory fitness ; muscle strength , power , and endurance ; and psychosocial attributes . RESULTS Neither AEROBIC nor STRENGTH improved walking distance or gait velocity significantly more than sham exercise , although STRENGTH significantly improved participants ' stair climbing power by 17 % ( P=.009 ) , as well as their muscle strength , power , and endurance ; cycling peak power output ; and self-efficacy . Conversely , AEROBIC improved indicators of cardiorespiratory fitness only . Cycling plus PRT produced larger effects than either single modality for mobility and impairment outcomes . CONCLUSION Single-modality exercises targeted at existing impairments do not optimally address the functional deficits of walking but do ameliorate the underlying impairments . The underlying cardiovascular and musculoskeletal impairments are significantly modifiable years after stroke with targeted robust exercise QUESTION Does progressive resistance training improve strength and activity after stroke ? Does any increase in strength carry over to activity ? DESIGN Systematic review of r and omised trials with meta- analysis . PARTICIPANTS Adults who have had a stroke . INTERVENTION Progressive resistance training compared with no intervention or placebo . OUTCOME MEASURES The primary outcome was change in strength . This measurement had to be of maximum voluntary force production and performed in muscles congruent with the muscles trained in the intervention . The secondary outcome was change in activity . This measurement had to be a direct measure of performance that produced continuous or ordinal data , or with scales that produced ordinal data . RESULTS Eleven studies involving 370 participants were included in this systematic review . The overall effect of progressive resistance training on strength was examined by pooling change scores from six studies with a mean PEDro score of 5.8 , representing medium quality . The effect size of  progressive resistance training on strength was 0.98 ( 95 % CI 0.67 to 1.29 , I2=0 % ) . The overall effect of progressive resistance training on activity was examined by pooling change scores from the same six studies . The effect size of progressive resistance training on activity was 0.42 ( 95 % CI -0.08 to 0.91 , I2=54 % ) . CONCLUSION After stroke , progressive resistance training has a large effect on strength compared with no intervention or placebo . There is uncertainty about whether these large increases in strength carry over to improvements in activity . REVIEW REGISTRATION PROSPERO CRD42015025401 . [ Dorsch S , Ada L , Alloggia D ( 2018 ) Progressive resistance training increases strength after stroke but this may not carry over to activity : a systematic review . Journal of Physiotherapy 64 : 84 - 90 ] OBJECTIVE To evaluate the effects of progressive resistance training on muscle strength , muscle tone , gait performance and perceived participation after stroke . DESIGN A r and omized controlled trial . SUBJECTS Twenty-four subjects ( mean age 61 years ( st and ard deviation 5 ) ) 6 - 48 months post-stroke . METHODS The training group ( n = 15 ) participated in supervised progressive resistance training of the knee muscles ( 80 % of maximum ) twice weekly for 10 weeks , and the control group ( n = 9 ) continued their usual daily activities . Both groups were assessed before and after the intervention and at follow-up after 5 months . Muscle strength was evaluated dynamically and isokinetically ( 60 degrees /sec ) and muscle tone by the Modified Ashworth Scale . Gait performance was evaluated by Timed " Up & Go " , Fast Gait Speed and 6-Minute Walk tests , and perceived participation by Stroke Impact Scale . RESULTS Muscle strength increased significantly after progressive resistance training with no increase in muscle tone and improvements were maintained at follow-up . Both groups improved in gait performance , but at follow-up only Timed " Up & Go " and perceived participation were significantly better for the training group . CONCLUSIONS Progressive resistance training is an effective intervention to improve muscle strength in chronic stroke . There appear to be long-term benefits , but further studies are needed to clarify the effects , specifically of progressive resistance training on gait performance and participation Stein J , Krebs HI , Frontera WR , Fasoli SE , Hughes R , Hogan N : Comparison of two techniques of robot-aided upper limb exercise training after stroke . Am J Phys Med Rehabil 2004;83:720–728 . Objective : This study examined whether incorporating progressive resistive training into robot-aided exercise training provides incremental benefits over active-assisted robot-aided exercise for the upper limb after stroke . Design : A total of 47 individuals at least 1 yr poststroke were enrolled in this 6-wk training protocol . Paretic upper limb motor abilities were evaluated using clinical measures and a robot-based assessment to determine eligibility for robot-aided progressive resistive training at study entry . Subjects capable of participating in resistance training were r and omized to receive either active-assisted robot-aided exercises or robot-aided progressive resistance training . Subjects who were incapable of participating in resistance training underwent active-assisted robotic therapy and were again screened for eligibility after 3 wks of robotic therapy . Those subjects capable of participating in resistance training at 3 wks were then r and omized to receive either robot-aided resistance training or to continue with robot-aided active-assisted training . Results : One subject withdrew due to unrelated medical issues , and data for the remaining 46 subjects were analyzed . Subjects in all groups showed improvement in measures of motor control ( mean increase in Fugl-Meyer of 3.3 ; 95 % confidence interval , 2.2–4.4 ) and maximal force ( mean increase in maximal force of 3.5 N , P = 0.027 ) over the course of robot-aided exercise training . No differences in outcome measures were observed between the resistance training groups and the matched active-assisted training groups . Subjects ’ ability to perform the robotic task at the time of group assignment predicted the magnitude of the gain in motor control . Conclusion : The incorporation of robot-aided progressive resistance exercises into a program of robot-aided exercise did not favorably or negatively affect the gains in motor control or strength associated with this training , though interpretation of these results is limited by sample size . Individuals with better motor control at baseline experienced greater increases in motor control with robotic training QUESTIONS Does a 12-week , predominantly home-based program of progressive resistance exercises reduce impairments , activity limitations , and participation restrictions in people with chronic obstructive pulmonary disease ? Are any gains maintained 12 weeks after the cessation of the program ? DESIGN R and omised controlled trial with concealed allocation , assessor blinding , and intention-to-treat analysis . PARTICIPANTS 54 people with moderately severe chronic obstructive pulmonary disease not undergoing pulmonary rehabilitation . INTERVENTION The experimental group performed six progressive resistance exercises three times per week ( once a week hospital-based , twice a week home-based ) for 12 weeks . Exercise intensity was three sets of 8 to 12 repetition maximum progressed against elasticised b and s of increasing resistance . The control group received no intervention . OUTCOME MEASURES Primary outcomes were strength ( knee extensor , hip abductor , shoulder horizontal flexor , shoulder flexor ) measured using h and -held dynamometry , and walking capacity measured by the 6-minute Walk Test performed before and after intervention and again at 12 weeks after the cessation of intervention . RESULTS The experimental group increased their knee extensor strength by 4.9 kg ( 95 % CI 1.1 to 8.7 ) more than the control group by Week 12 . However , this gain was not maintained at Week 24 . No difference between the groups was found for any of the other primary outcomes . CONCLUSIONS A predominantly home-based progressive resistance exercise program led to modest improvements in knee extensor strength in people with chronic obstructive pulmonary disease . However , 44 % of the experimental group were unable to complete the exercise program , highlighting the need to underst and factors influencing adherence to exercise in this population Background . After inpatient stroke rehabilitation , many people still can not participate in community activities because of limited walking ability . Objective . To compare the effectiveness of 2 conceptually different , early physical therapy ( PT ) interventions to usual care ( UC ) in improving walking 6 months after stroke . Methods . The Locomotor Experience Applied Post-Stroke ( LEAPS ) study was a single-blind , r and omized controlled trial conducted in 408 adults with disabling hemiparetic stroke . Participants were stratified at baseline ( 2 months ) by impairment in walking speed : severe ( < 0.4 m/s ) or moderate ( 0.4 to < 0.8 m/s ) . Between 2 and 6 months , they received either only UC ( n = 143 ) or UC plus 36 therapist-provided sessions of either ( 1 ) walking training on a treadmill using body-weight support and practice overground at clinics ( locomotor training program [ LTP ] , n = 139 ) or ( 2 ) impairment-based strength and balance exercise at home ( home exercise program [ HEP ] , n = 126 ) . Results . LTP participants were 18 % more likely to transition to a higher functional walking level : severe to > 0.4 m/s and moderate to > 0.8 m/s than UC participants ( 95 % confidence interval [ CI ] = 7%-29 % ) , and HEP participants were 17 % more likely to transition ( 95 % CI = 5%-29 % ) . Mean gain in walking speed in LTP participants was 0.13 m/s greater ( 95 % CI = 0.09 - 0.18 ) and in HEP participants , 0.10 m/s greater ( 95 % CI = 0.05 - 0.14 ) than in UC participants . Conclusions . Progressive PT , using either walking training on a treadmill and overground , conducted in a clinic , or strength and balance exercises conducted at home , was superior to UC in improving walking , regardless of severity of initial impairment Objective : To examine the effectiveness of task-oriented progressive resistance strength training on lower extremity strength and functional performance in chronic stroke subjects . Design : Single-blind , r and omized controlled trial . Setting : Medical centre and district hospital . Subjects : Forty-eight subjects at least one year post stroke . Interventions : Participants r and omly allocated to two groups , control  ( n-/24 ) and experimental  ( n-/24 ) . Subjects in the control group did not receive any rehabilitation training . Subjects in the experimental group were put on a four-week task-oriented progressive resistance strength training . Main measures : Lower extremity muscle strength , gait velocity , cadence , stride length , six-minute walk test , step test , and timed up and go test . Results : Muscle strength significantly improved in the experimental group for strong side muscle groups ( ranged from 23.9 % to 36.5 % ) and paretic side muscle groups ( ranged from 10.1 % to 77.9 % ) . In the control group muscle strength changes ranged from 6.7 % gain to 11.2 % decline . The experimental group showed significant improvement in all selected measures of functional performance except for the step test . In the control group , the number of repetitions of the step test significantly decreased ( -20.3 % ) with no change in other functional tests . There was a significant difference between groups for muscle strength and all functional measures . The strength gain was significantly associated with gain in the functional tests . Conclusions : The task-oriented progressive resistance strength training programme could improve lower extremity muscle strength in individuals with chronic stroke and could carry over into improvement in functional abilities OBJECTIVE To evaluate the effects of a progressive resistance strength training program on changes in muscle strength , gait , and balance in older individuals 1 yr after stroke , seven individuals were recruited who were greater than 60-yr-old , 1 yr after stroke , living at home , and able to follow verbal comm and s. DESIGN Subjects participated in a 12-wk 2x per wk resistance training program at 70 % of 1 repetition maximum . RESULTS Lower limb strength improved 68 % on the affected side and 48 % on the intact side during training , with the largest increases observed for hip extension ( affected side : 88 % , P < 0.01 ; intact side : 103 % , P < 0.001 ) . Repeated chair st and time decreased 21 % ( P < 0.02 ) . Motor performance assessed by the Motor Assessment Scale improved 9 % ( P < 0.04 ) and static and dynamic balance ( Berg balance scale ) improved 12 % ( P < 0.004 ) . Progressive resistance training in individuals 1 yr after stroke improves affected and intact side lower limb strength and was associated with gains in chair st and time , balance , and motor performance . CONCLUSIONS These results support the concept that strength training is an appropriate intervention to improve the quality of physical function in older community dwelling stroke survivors OBJECTIVE To investigate the benefits and safety of an intensive muscular training program in patients with chronic polymyositis ( PM ) and dermatomyositis ( DM ) . METHODS Nine patients with chronic PM or DM ( median age 53 years , range 44 - 61 ) were included . Assessment s of impairment ( 10 - 15 voluntary repetition maximum [ VRM ] , the Functional Index 2 [ FI-2 ] , the Grippit , and pain rated on the Borg CR-10 scale ) , activity limitation ( Myositis Activities Profile ) , and participation restriction ( patients ' disease impact on well-being ) were performed 4 weeks prior to baseline , at baseline , and after 7 weeks of exercise . A 6-item core set of disease activity measures was administered and muscle biopsy sample s of vastus lateralis were obtained at baseline and after 7 weeks of exercise . Response criteria at an individual level were set for disability and disease activity . The patients exercised 3 days per week for 7 weeks on loads allowing 10 VRM . RESULTS On a group level there were no significant differences between assessment s at 4 weeks before baseline compared with baseline . The group improved significantly regarding 10 - 15 VRM and FI-2 at 7 weeks compared with baseline ( P < 0.05 ) . All patients were responders with respect to impairment and 2 were activity limitation responders whereas participation restriction remained unchanged in all . Two patients were responders with reduced disease activity and no patient had signs of increased muscle inflammation in the muscle biopsy sample after 7 weeks of exercise .  CONCLUSION Patients with chronic , stable PM and DM can perform this intensive resistive exercise program with beneficial effects on impairment and activity limitation without increased muscle inflammation Abstract Br and ner , CR , and Warmington , SA . Delayed onset muscle soreness and perceived exertion after blood flow restriction exercise . J Strength Cond Res 31(11 ) : 3101–3108 , 2017—The purpose of this study was to determine the perceptual responses to resistance exercise with heavy loads ( 80 % 1 repetition maximum [ 1RM ] ) , light loads ( 20 % 1RM ) , or light loads in combination with blood flow restriction ( BFR ) . Despite the use of light loads , it has been suggested that the adoption of BFR resistance exercise may be limited because of increases in delayed onset muscle soreness ( DOMS ) and perceived exertion .  Seventeen healthy untrained males participated in this balanced , r and omized cross-over study . After 4 sets of elbow-flexion exercise , participants reported ratings of perceived exertion ( RPE ) , with DOMS also recorded for 7 days after each trial . Delayed onset muscle soreness was significantly greater for low-pressure continuous BFR ( until 48 hours postexercise ) and high-pressure intermittent BFR ( until 72 hours postexercise ) than for traditional heavy-load resistance exercise and light-load resistance exercise . In addition , RPE was higher for heavy-load resistance exercise and high-pressure intermittent BFR than for low-pressure continuous BFR , with all trials greater than light-load resistance exercise . For practitioners working with untrained participants , this study provides evidence to suggest that to minimize the perception of effort and postexercise muscle soreness associated with BFR resistance exercise , continuous low-pressure application may be more preferential than intermittent high-pressure application . Importantly , these perceptual responses are relatively short-lived ( ∼2 days ) and have previously been shown to subside after a few exercise sessions . Combined with smaller initial training volumes ( set × repetitions ) , this may limit RPE and DOMS to strengthen uptake and adherence and assist in program progression for muscle hypertrophy and gains in strength OBJECTIVES To test the hypothesis that physical exercise induces an antiinflammatory response that is associated with reduced chronic activation of the tumor necrosis factor (TNF)-alpha system in frail elders and that the increase in muscle strength after resistance training is limited by systemic low- grade inflammation . DESIGN A 12-week controlled resistance-training study . SETTING Nursing homes in Copenhagen , Denmark . PARTICIPANTS Twenty-one frail nursing home residents aged 86 to 95 completed the study . INTERVENTION Ten participants were r and omized to a program of resistance training of knee extensors and flexors three times a week for 12 weeks ; the remaining 11 participants served as a control group who joined social activities supervised by an occupation therapist . MEASUREMENTS Muscle strength , plasma levels of TNF-alpha , soluble TNF receptor (sTNFR)-1 , and interleukin (IL)-6 were measured before and at the end of the intervention period . RESULTS The training program improved muscle strength but did not affect plasma levels of TNF-alpha and sTNFR-I or IL-6 . However , plasma levels of sTNFR-I at baseline were inversely correlated with the increase in muscle strength . CONCLUSION Low- grade activation of the TNF system could limit the increase in muscle strength after resistance training in the oldest old . Furthermore , data suggest that the antiinflammatory response induced by 12 weeks of resistance training is not sufficient to reduce chronic activation of the TNF system , but the small sample size limited this interpretation Background Task-specific training programs  after stroke improve walking function , but it is not clear which biomechanical parameters of gait are most associated with improved walking speed . Objective The purpose of this study was to identify gait parameters associated with improved walking speed after a locomotor training program that included body-weight – supported treadmill training ( BWSTT ) . Design A prospect i ve , between-subjects design was used . Methods Fifteen people , ranging from approximately 9 months to 5 years after stroke , completed 1 of 3 different 6-week training regimens . These regimens consisted of 12 sessions of BWSTT alternated with 12 sessions of : lower-extremity resistive cycling ; lower-extremity progressive , resistive strengthening ; or a sham condition of arm ergometry .  Gait analysis was conducted before and after the 6-week intervention program . Kinematics , kinetics , and electromyographic ( EMG ) activity were recorded from the hemiparetic lower extremity while participants walked at a self-selected pace . Changes in gait parameters were compared in participants who showed an increase in self-selected walking speed of greater than 0.08 m/s ( high-response group ) and in those with less improvement ( low-response group ) . Results Compared with participants in the low-response group , those in the high-response group displayed greater increases in terminal stance hip extension angle and hip flexion power ( product of net joint moment and angular velocity ) after the intervention . The intensity of soleus muscle EMG activity during walking also was significantly higher in participants in the high-response group after the intervention . Limitations Only sagittal-plane parameters were assessed , and the sample size was small . Conclusions Task-specific locomotor training alternated with strength training result ed in kinematic , kinetic , and muscle activation adaptations that were strongly associated with improved walking speed . Changes in both hip and ankle biomechanics during late stance were associated with greater increases in gait speed Purpose To compare the increases in upper- and lower-body muscle strength in premenopausal women performing resistance training ( RT ) alone or alongside concurrent high-intensity interval training ( CT ) .  Methods Sixteen women ( 26–40 years ) were r and omly assigned into two groups that performed either RT or CT . Both groups performed the same RT program ; however , CT performed additional high-intensity interval training ( HIIT ) on a bicycle ergometer before RT . The study lasted 8 weeks and the participants were tested for ten repetition maximum ( 10RM ) load in elbow flexion ( barbell biceps curl ) and knee extension exercises pre- and post-intervention . RT was performed with 10–12 repetitions to self-determined repetition maximum in the first four weeks and then progressed to 8–10 . During CT , HIIT was performed before RT with six 1-min bouts at 7–8 of perceived subjective exertion ( RPE ) and then progressed to eight bouts at 9–10 RPE . Results Analysis of variance revealed significant increases in upper and lower body strength for both the RT and CT  groups . Biceps barbell curl 10RM load increased from 12.9 ± 3.2 kg to 14 ± 1.5 kg in CT ( p < 0.05 ) and from 13 ± 1.8 kg to 15.9 ± 2.5 kg in RT ( p < 0.05 ) , with no significant between-groups differences . Knee extension 10RM increase from 31.9 ± 11.6 kg to 37.5 ± 8.5 kg for CT ( p < 0.05 ) and from 30.6 ± 8.6 kg to 41.2 ± 7.4 kg for RT ( p < 0.05 ) . Conclusion In conclusion , performing HIIT on a cycle ergometer before resistance training does not seem to impair muscle strength increases in the knee extensors or elbow flexors of pre-menopausal women . This information should be considered when prescribing exercise sessions , since both activities may be combined without negative effects in muscle strength Background and Purpose : A phase II , single-blinded , r and omized clinical trial was conducted to determine the effects of combined task-specific and lower-extremity ( LE ) strength training to improve walking ability after stroke . Subjects : The participants were 80 adults who were ambulatory 4 months to 5 years after a unilateral stroke . Method : The exercise interventions consisted of body-weight – supported treadmill training ( BWSTT ) , limb-loaded resistive leg cycling ( CYCLE ) , LE muscle-specific progressive-resistive exercise ( LE-EX ) , and upper-extremity ergometry ( UE-EX ) . After baseline assessment s , participants were r and omly assigned to a combined exercise program that included an exercise pair . The exercise pairs were : BWSTT/UE-EX , CYCLE/UE-EX , BWSTT/CYCLE , and BWSTT/LE-EX . Exercise sessions were 4 times per week for 6 weeks ( total of 24 sessions ) , with exercise type completed on alternate days . Outcomes were self-selected walking speed , fast walking speed , and 6-minute walk distance measured before and after intervention and at a 6-month follow-up . Results : The BWSTT/UE-EX group had significantly greater walking speed increases compared with the CYCLE/UE-EX group ; both groups improved in distance walked . All BWSTT groups increased walking speed and distance whether BWSTT was combined with LE strength training or not . Discussion and Conclusion : After chronic stroke , task-specific training during treadmill walking with body-weight support is more effective in improving walking speed and maintaining these gains at 6 months than resisted leg cycling alone . Consistent with the overtraining literature , LE strength training alternated daily with BWSTT walking did not provide an added benefit to walking outcomes OBJECTIVE To determine the safety and efficacy of an exercise protocol design ed to improve strength , mobility , and balance and to reduce subsequent falls in geriatric patients with a history of injurious falls . DESIGN A r and omized controlled 3-month intervention trial , with an additional 3-month follow-up . SETTING Out-patient geriatric rehabilitation unit . PARTICIPANTS Fifty-seven female geriatric patients ( mean age 82 + /- 4.8 years ; range 75 - 90 ) admitted to acute care or inpatient rehabilitation with a history of recurrent or injurious falls including patients with acute fall-related fracture . INTERVENTION Ambulatory training of strength , functional performance , and balance 3 times per week for 3 months . Patients of the control group attended a placebo group 3 times a week for 3 months . Both groups received an identical physiotherapeutic treatment 2 times a week , in which strengthening and balance training were excluded . MEASUREMENTS Strength , functional ability , motor function , psychological parameters , and fall rates were assessed by st and ardized protocol s at the beginning ( T1 ) and the end ( T2 ) of intervention . Patients were followed up for 3 months after the intervention ( T3 ) . RESULTS No training-related medical problems occurred in the study group . Forty-five patients ( 79 % ) completed all assessment s after the intervention and follow-up period . Adherence was excellent in both groups ( intervention 85.4 + /- 27.8 % vs control 84.2 + /- 29.3 % ) . The patients in the intervention group increased strength , functional motor performance , and balance significantly . Fall-related behavioral and emotional restrictions were reduced significantly . Improvements persisted during the 3-month follow-up with only moderate losses . For patients of the control group , no change in strength , functional performance , or emotional status could be documented during intervention and follow-up . Fall incidence was reduced nonsignificantly by 25 % in the intervention group compared with the control group ( RR:0.753 CI:0.455 - 1.245 ) . CONCLUSIONS Progressive resistance training and progressive functional training are safe and effective methods of increasing strength and functional performance and reducing fall-related behavioral and emotional restrictions during ambulant rehabilitation in frail , high-risk geriatric patients with a history of injurious falls Objective The aim of this study was to directly compare the effects of aerobic training ( AT ) with progressive resistance training ( RT ) after stroke to determine whether AT-induced fitness gains or RT-induced strength gains translate into improved ambulation across a 12-wk intervention and whether gains are retained 1 yr after cessation of formal training . Design This study is a r and omized controlled 12-wk intervention trial with a 1-yr follow-up . Forty-three community-dwelling independent walkers with a chronic ischemic hemiparetic stroke were allocated to AT using a cycle ergometer ( n = 13 ) , RT using training machines ( n = 14 ) , or low-intensity sham training of the arms ( n = 16 ) . The main outcome measures were 6-min walk distance and fast 10-m walking speed . Results Comparisons between AT , RT , and sham training revealed no clinical ly relevant effects on walking velocity or walking distance . Muscle strength improved after RT ( P < 0.0001 ) and was preserved at 1-yr follow-up ( P < 0.001 ) . Aerobic capacity increased after AT ( P < 0.001 ) but was lost during the follow-up observation period . Conclusions Improvement of muscle strength or aerobic capacity using non – task-specific training methods does not result in improved ambulation in patients with chronic stroke .  Muscle strength gains were maintained at follow-up , whereas all improvements of aerobic capacity were lost , indicating a long-lasting effect of intensive RT even without maintenance training Background and Purpose The purpose of this study was to determine the relationship among variables of upper-limb impairment , upper-limb performance in activities of daily living ( activity ) , and engagement in life events and roles ( participation ) in people with chronic stroke . Subjects The subjects were 93 community-dwelling individuals with stroke ( ≥1 year ) . Methods This study , which was conducted in a tertiary rehabilitation center , used a cross-sectional design . The main measures of impairment were the Modified Ashworth Scale , h and held dynamometry , sensory testing ( monofilaments ) , and the Brief Pain Inventory .  The main measures of activity were the  Chedoke Arm and H and Activity Inventory ( CAHAI ) and the Motor Activity Log ( MAL ) . The main measure of participation was the Reintegration to Normal Living ( RNL ) Index . Results Paretic upper-limb strength ( force-generating capacity ) ( r=.89 , P<.01 ) , grip strength ( r=.69 , P<.01 ) , and tone ( resistance to passive movement ) ( r=−.80 , P<.01 ) were the impairment variables that were most strongly related to activity . Tone ( r=−.23 , P<.05 ) and CAHAI scores ( r=.22 , P<.05 ) had a significant , but weak , relationship to participation . Upper-limb strength accounted for 87 % of the variance of the CAHAI scores and 78 % of the variance of the MAL scores . In the participation models , tone and CAHAI scores accounted for 5 % of the variance of the RNL Index scores . Discussion and Conclusion Paretic upper-limb strength had the strongest relationship with variables of activity and best explained upper-limb performance in activities of daily living . Grip strength , tone , and sensation also were factors of upper-limb performance in activities of daily living . Increased tone and upper-limb performance in activities of daily living had a weak relationship with participation PURPOSE This study investigated the effects of high-intensity progressive resistance training ( PRT ) and high-intensity cycling ( cycling ) on muscle performance and the time course of strength gains in a chronic stroke population . METHODS Forty-eight individuals with chronic stroke sequelae ( mean + /- SD ; age = 63 + /- 9 yr , time since stroke = 57 + /- 54 months ) were r and omly allocated to one of four treatment groups : PRT + cycling , PRT + sham cycling , sham PRT + cycling , or sham PRT + sham cycling groups in a fully factorial clinical trial . Thirty exercise sessions were conducted over a 10- to 12-wk period . The main outcomes investigated were measures of unilateral muscle strength , peak power , and muscle endurance . RESULTS Those undergoing PRT improved their lower limb muscle strength , peak power , and endurance compared with participants receiving sham PRT or cycling only ( P < 0.05 ) , and combined exercise was not superior to PRT alone . Strength improvements occurred primarily during the first 6 to 8 wk ( 98%-100 % of total gain ) and then reached a plateau during the final 2 to 4 wk . CONCLUSION We have shown for the first time in a direct comparison study that high-intensity PRT , but not cycling or sham exercise , can improve muscle strength , peak power , and muscle endurance in both affected and unaffected lower limbs after chronic stroke by a significant and clinical ly meaningful amount . Although strength gains plateaued earlier than anticipated , adherence to the intended continuous high-intensity progressive overload protocol was largely achieved ( average load of 84 % + /- 4 % of one repetition maximum ) Purpose . This study examined the association between impaired physical function and participation in  community ambulation  following stroke . We hypothesised that participation would be significantly less following stroke , and that physical impairments would be associated with participation . Method . Using a case – control design 30 survivors of stroke aged 45 and older and 30 controls provided health status information and a self-report of participation in community ambulation  ( number of trips and walking-related activities ( WRA ) reported prospect ively over a 12-day period ) . The association of physical impairments ( strength , range of motion , sensation , muscle tone , vision , and activity limitations ( gait speed and performance on complex walking tasks ) ) with level of participation was analysed using negative binomial regression and goodness of fit . Results . Participants included 30 individuals with and 30 without stroke , average age 68 years , majority were Caucasian women . Average time  since stroke was 40 months . Participation in survivors of stroke was characterised by fewer trips and WRA and lower satisfaction ( p < 0.001 ) . Usual gait speed , balance , muscle strength and muscle length were impaired ( p < 0.001 ) in stroke vs. controls , and associated with number of trips and WRA ( p < 0.05 ) . However , these factors explained less than very little of the variance in participation . Conclusions . While individual factors were associated with level of participation , results failed to accurately predict participation in community ambulation following stroke . Other factors , such as depression , cognition and self-efficacy may be stronger determinants of participation Background : Although cognitive impairments are common following stroke , there is considerable uncertainty about the types of interventions that can reduce activity restrictions and improve quality of life . Indeed , a recent project to identify priorities for research into life after stroke determined that the top priority for patients , carers and health professionals was how to improve cognitive impairments . Objective : To provide an overview of the evidence for the effectiveness of cognitive rehabilitation for patients with stroke and to determine the main gaps in the current evidence base . Methods : Evidence was synthesis ed for the six Cochrane review s relating to rehabilitation for post-stroke cognitive impairment and any subsequently published r and omized controlled trials to February 2012 . Results : Data arising from 44 trials involving over 1500 patients was identified . Though there was support for the effectiveness of  cognitive rehabilitation for some cognitive impairments , significant gaps were found in the current evidence base . All of the Cochrane review s identified major limitations within the evidence they identified . Conclusions : There is currently insufficient research evidence , or evidence of insufficient quality , to support clear recommendations for clinical practice . Recommendations are made as to the research required to strengthen the evidence base , and so facilitate the delivery of effective interventions to individuals with cognitive impairment after stroke Sullivan DH , Wall PT , Bariola JR , Bopp MM , Frost YM : Progressive resistance muscle strength training of hospitalized frail elderly . Am J Phys Med Rehabil 2001;80:503–509 . Objective To determine whether frail elderly patients recuperating from acute illnesses could safely participate in and gain appreciable improvement in muscle strength from progressive resistance muscle strength training . Design Muscle strength ( one repetition maximum ) , functional abilities ( sit-to-st and maneuver and 20-sec maximal safe gait speed ) , and body composition were measured before and at the conclusion of a 10-wk program of lower limb progressive resistance muscle strength training . The nonr and omized study was conducted in a 30-bed geriatric rehabilitation unit of a university-affiliated Veterans Affairs hospital and a 28-bed transitional care unit of a community nursing home . Participants included 19 recuperating elderly subjects ( 14 male , 5 female ; 13 ambulatory , 6 nonambulatory ) > 64 yr ( mean age , 82.8 ± 7.9 yr ) . Results The one repetition maximum increased an average of 74 % ± 49 % ( median , 70 % ; interquartile range , 38%–95 % , and an average of 20 ± 13 kg ( P = 0.0001 ) . Sit-to-st and maneuver times improved in 15 of 19 cases ( 79 % ) . Maximum safe gait speeds improved in 10 of 19 cases ( 53 % ) . Four of the six nonambulatory subjects progressed to ambulatory status . No subject experienced a complication . Conclusions A carefully monitored program of progressive resistance muscle strength training to regain muscle strength is a safe and possibly effective method for frail elderly recuperating from acute illnesses . A r and omized control study is needed to examine the degree to which progressive resistance muscle strength training offers advantages , if any , over routine posthospital care that includes traditional low-intensity physical therapy BACKGROUND Patients with Parkinson 's disease have substantially impaired balance , leading to diminished functional ability and an increased risk of falling . Although exercise is routinely encouraged by health care providers , few programs have been proven effective . METHODS We conducted a r and omized , controlled trial to determine whether a tailored tai chi program could improve postural control in patients with idiopathic Parkinson 's disease . We r and omly assigned 195 patients with stage 1 to 4 disease on the Hoehn and Yahr staging scale ( which ranges from 1 to 5 , with higher stages indicating more severe disease ) to one of three groups : tai chi , resistance training , or stretching . The patients participated in 60-minute exercise sessions twice weekly for 24 weeks . The primary outcomes were changes from baseline in the limits-of-stability test ( maximum excursion and directional control ; range , 0 to 100 % ) . Secondary outcomes included measures of gait and strength , scores on functional-reach and timed up- and -go tests , motor scores on the Unified Parkinson 's Disease Rating Scale , and number of falls . RESULTS The tai chi group performed consistently better than the resistance-training and stretching groups in maximum excursion ( between-group difference in the change from baseline , 5.55 percentage points ; 95 % confidence interval [ CI ] , 1.12 to 9.97 ; and 11.98 percentage points ; 95 % CI , 7.21 to 16.74 , respectively ) and in directional control ( 10.45 percentage points ; 95 % CI , 3.89 to 17.00 ; and 11.38 percentage points ; 95 % CI , 5.50 to 17.27 , respectively ) . The tai chi group also performed better than the stretching group in all secondary outcomes and outperformed the resistance-training group in stride length and functional reach .  Tai chi lowered the incidence of falls as compared with stretching but not as compared with resistance training . The effects of tai chi training were maintained at 3 months after the intervention . No serious adverse events were observed . CONCLUSIONS Tai chi training appears to reduce balance impairments in patients with mild-to-moderate Parkinson 's disease , with additional benefits of improved functional capacity and reduced falls . ( Funded by the National Institute of Neurological Disorders and Stroke ; Clinical Trials.gov number , NCT00611481 . ) OBJECTIVE To describe the impairments of upper body and limbs , activity limitations and participation restrictions 6 and 12 months after operation for breast cancer and to examine the impact of impairments on activity limitations . DESIGN A prospect i ve survey 6 and 12 months after operation . PATIENTS Ninety-six breast cancer patients . METHODS A question naire for assessing the impairments , activity limitations and participation restrictions was developed . RESULTS The most common impairments 6 months after operation were breast and axilla scar tightness , axilla oedema and neck-shoulder pain . At 12-month follow-up the breast scar tightness ( p=0.008 ) and axilla oedema ( p=0.023 ) decreased , and limb ache ( p=0.005 ) increased significantly . The most limiting impairments were axilla oedema and limb numbness 6 months after operation , and at 12-month follow-up axilla oedema . Lifting , carrying and reaching out caused worsening of impairments to more than half of the respondents at 6-month follow-up . Regression analysis showed that many impairments together were determinants of activity limitations and sleep impairment . Participation restrictions were constant . Respondents had not given up participation in activities in the home , but some had ab and oned leisure activities and felt that their work ability had decreased . CONCLUSION Impairments and their impact on activities were frequent and constant . There is an urgent need for developing rehabilitation protocol s for breast cancer patients
Conclusions : There is preliminary evidence that progressive resistance strength training programmes reduce musculoskeletal impairment after stroke .
Whether strengthening enhances the performance of functional activities or participation in societal roles remains unknown
Objective : To determine whether progressive resistance strength training reduces impairments , activity limitations and participation restrictions after stroke .