Exercise leads to faster postural reflexes, improved balance and mobility, and fewer falls in older persons with chronic stroke

Abstract

Objectives: To determine the effect of two different community-based group exercise programs on functional balance, mobility, postural reflexes, and falls in older adults with chronic stroke.

Design: A randomized, clinical trial.

Setting: Community center.

Participants: Sixty-one community-dwelling older adults with chronic stroke.

Intervention: Participants were randomly assigned to an agility (n=30) or stretching/weight-shifting (n=31) exercise group. Both groups exercised three times a week for 10 weeks.

Measurements: Participants were assessed before, immediately after, and 1 month after the intervention for Berg Balance, Timed Up and Go, step reaction time, Activities-specific Balance Confidence, and Nottingham Health Profile. Testing of standing postural reflexes and induced falls evoked by a translating platform was also performed. In addition, falls in the community were tracked for 1 year from the start of the interventions.

Results: Although exercise led to improvements in all clinical outcome measures for both groups, the agility group demonstrated greater improvement in step reaction time and paretic rectus femoris postural reflex onset latency than the stretching/weight-shifting group. In addition, the agility group experienced fewer induced falls on the platform.

Conclusion: Group exercise programs that include agility or stretching/weight shifting exercises improve postural reflexes, functional balance, and mobility and may lead to a reduction of falls in older adults with stroke.

Figure 1

Trial Profile.

Figure 2

Typical postural reflexes evoked during platform translations at baseline (solid lines) and post-intervention (dashed lines) assessments. Sample postural reflexes of a person with stroke during forward platform translations for the (A) paretic TA and (B) paretic RF. Sample postural reflexes of a person with stroke during backward platform translations for the (C) paretic MG and (D) paretic BF. Platform translations triggered at time zero. Arrows (solid for baseline assessment and dashed for post-intervention assessment) indicate the onset latency identified by the combination of a computer algorithm and visual inspection.