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Community-Based Adaptive Physical Activity Program for Chronic Stroke: Feasibility, Safety, and Efficacy of the Empoli Model

Health Administration and Policy Program, University of Maryland, Baltimore County, Baltimore, Maryland, stuart{at}umbc.edu

Francesco Benvenuti, MD

Dipartimento della Riabilitazione e delle Fragilità, Azienda Unità Sanitaria Locale 11 di Empoli, Empoli, Italy

Richard Macko, MD

Department of Neurology and Medicine, Division of Gerontology, and Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland

Antonio Taviani, MD

Dipartimento della Riabilitazione e delle Fragilità, Azienda Unità Sanitaria Locale 11 di Empoli, Empoli, Italy

Lucianna Segenni, MD

Unità Operativa di Recupero e Riabilitazione Funzionale, Azienda Unità Sanitaria Locale 5 di Pisa, Pisa, Italy

Federico Mayer, MD

Unità Operativa di Riabilitazione, Casa di Cura Ulivella e Glicini, Firenze, Italy

John D. Sorkin, MD, PhD

University of Maryland School of Medicine, Claude D. Pepper Older Americans Independence Center, Baltimore, Maryland

Steven J. Stanhope, PhD

Department of Health, Nutrition, and Exercise Sciences, University of Delaware, Newark, Delaware

Velio Macellari, PhD

Dipartimento Tecnologie e Salute, Istituto Superiore di Sanità, Roma, Italy

Michael Weinrich, MD

National Center for Medical Rehabilitation Research, NICHD, National Institutes of Health, Bethesda, Maryland

Objective. To determine whether Adaptive Physical Activity (APA-stroke), a community-based exercise program for participants with hemiparetic stroke, improves function in the community. Methods. Nonrandomized controlled study in Tuscany, Italy, of participants with mild to moderate hemiparesis at least 9 months after stroke. Forty-nine participants in a geographic health authority (Empoli) were offered APA-stroke (40 completed the study). Forty-four control participants in neighboring health authorities (Florence and Pisa) received usual care (38 completed the study). The APA intervention was a community-based progressive group exercise regimen that included walking, strength, and balance training for 1 hour, thrice a week, in local gyms, supervised by gym instructors. No serious adverse clinical events occurred during the exercise intervention. Outcome measures included the following: 6-month change in gait velocity (6-Minute Timed Walk), Short Physical Performance Battery (SPPB), Berg Balance Scale, Stroke Impact Scale (SIS), Barthel Index, Hamilton Rating Scale for Depression, and Index of Caregivers Strain. Results. After 6 months, the intervention group improved whereas controls declined in gait velocity, balance, SPPB, and SIS social participation domains. These between-group comparisons were statistically significant at P < .00015. Individuals with depressive symptoms at baseline improved whereas controls were unchanged (P < .003). Oral glucose tolerance tests were performed on a subset of participants in the intervention group. For these individuals, insulin secretion declined 29% after 6 months (P = .01). Conclusion. APA-stroke appears to be safe, feasible, and efficacious in a community setting.

Key Words: Stroke • Exercise • Community • Rehabilitation

This version was published on September 1, 2009

Neurorehabilitation and Neural Repair, Vol. 23, No. 7, 726-734 (2009)
DOI: 10.1177/1545968309332734


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