February 2018

Exercising arms improves post-stroke walking

In the moment: Rehabilitation

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Canadian researchers have demonstrated that that arm exercises—specifically, cycling the arms—improves post-stroke gait. The authors said this is the first study to test the effect of arm training on post-stroke leg function, even years after the event. The results appear in the Journal of Neurophysiology.

Researchers recruited 19 patients, age 57 to 87 years of age, who were 7 months to 17 years post-chronic stroke. Patients underwent 30-minute sessions of arm cycling training at a moderate intensity, 3 times a week over the course of 5 weeks. Their physical abilities were measured at baseline and after arm training using the Six-minute Walk Test (6MWT), Timed 10-meter Walk Test (10MWT), the Timed Up and Go (TUG) test, and the Berg Balance Scale (BBS). In addition to electromyography testing, stretch reflexes were tested in the lower legs and wrists during arm cycling and walking tests.

Significant improvement was seen in the first 2 of these 4 outcome measures. Participants realized an 8.5% increase in the 6MWT, from an average of 245.1 m to 266.1 m, compared with the 7.4-m minimal detec02.18 change for patients after stroke. Participants decreased the time to perform the TUG test by 28.9%, from 37.3 s to 26.5 s, which is greater than the 2.9 s minimal detec02.18 change for patients after stroke.

The 10MWT showed a lesser degree of improvement. Participants reduced their time by 15.1%, from 24.5 s to 20.8 s, which is 3.7 s less than the minimal detec02.18 change for patients after stroke. Although BBS scores increased from 41.5 to 43.9, this change was slightly less than the minimal detec02.18 change of 2.5 for patients after stroke.

Furthermore, subjects’ arms showed increased muscle activity and less muscle tightness after arm cycling training.

Prior tests on similar populations have involved both leg and arm cycling, with positive results. This study now demonstrates interlimb connectivity of the arms and legs, and that arm training contributed to improvements that were experienced in combined arm-and-leg training.

“Arm cycling training activated interlimb networks that contribute to the coordination of rhythmic walking,” the researchers wrote. “Although improvements in walking may not be as robust as those from other training modalities, they do highlight the integral role that training the arms can have on rehabilitation of human locomotion.”

Sources:

Kaupp C, Pearcey G, Klarner T, et al. Rhythmic arm cycling training improves walking and neurophysiological integrity in chronic stroke-the arms can give legs a helping hand in rehabilitation. J Neurophysiol. 2017 Dec 6. [Epub ahead of print]

Perera S, Mody SH, Woodman RC, et al. Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc. 2006;54(5):743-749.

Flansbjer UB, Holmbäck AM, Downham D, et al. Reliability of gait performance tests in men and women with hemiparesis after stroke. J Rehabil Med. 2005;37(2):75-82.

Liston RA, Brouwer BJ. Reliability and validity of measures obtained from stroke patients using the Balance Master. Arch Phys Med Rehabil. 2005;77(5):425-430.

 

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