INTERVENTIONS TO IMPROVE PHYSICAL ACTIVITY AFTER STROKE

改善中风后身体活动的干预措施

• 批准号: 8298778
• 负责人: DARCY S. REISMAN
• 金额: $ 22.95万
• 依托单位: UNIVERSITY OF DELAWARE
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-01 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8298778
• 关键词: Adult; Attention; Blinded; Chronic; Comorbidity; Cross-Sectional Studies; Development; Devices; Diabetes Mellitus; Diagnosis; Disease; Effectiveness; Elderly; Experimental Designs; Goals; Health; Individual; Intervention; Intervention Studies; Lead; Left; Life; Measures; Medical; Meta-Analysis; Monitor; Outcome; Participant; Persons; Physical activity; Population; Quality of life; Randomized; Rehabilitation therapy; Research; Risk; Risk Factors; Speed; Stimulus; Stroke; Survivors; Testing; Training; United States; Walking; chronic stroke; cost; disability; improved; mortality; novel; post stroke; prevent; programs; sedentary; success

DESCRIPTION (provided by applicant): Stroke is the leading cause of disability in the US. This disability is a consequence of, and a risk factor for, physical inactivity and stroke survivor, as a group, are extremely inactive. Most studies find that the average chronic stroke survivor is more inactive than even the most sedentary adults. Lack of physical activity has serious consequences in persons with stroke, including an increased risk of a second stroke, developing other diseases (i.e. diabetes) and mortality. The potential consequences of inactivity are even more alarming considering that inactivity gets worse over the first year after stroke. Therefore, left untreated, physical inactivity may be one of the most serious and costly sequela of stroke. Despite the severe consequences of inactivity after stroke, very little attention has been paid to whether activity is influenced by rehabilitation interventions for chronic stroke survivors. Nevertheless, one intervention that appears to hold promise for improving activity in chronic stroke survivors is fast treadmill training. However, even with the improvements observed after this intervention, the physical activity of the participants was still well below recommended levels. It is therefore imperative that interventions are developed to improve real-world physical activity in those with chronic stroke. In other populations, step activity monitorin programs have been shown to be extremely effective for increasing daily walking activity; however, their effectiveness has never been tested in chronic stroke survivors. The primary aim of this proposal is to test whether adding a step activity monitoring program to fast treadmill training can improve walking activity in chronic stroke survivors beyond improvements with fast treadmill training alone. The secondary aims will test whether this intervention also impacts walking speed, endurance and the energy cost of walking, all of which are known to be related to walking activity after stroke and are important measures of function. Using a randomized controlled experimental design, 40 chronic (> 6 months) stroke survivors, will receive either 12 weeks of fast treadmill training alone or 12 weeks of fast treadmill training in combination with a step activity monitoring program. The primary (physical activity) and secondary (walking speed, endurance, energy cost) outcomes will be assessed by blinded evaluators prior to initiating treatment (baseline), immediately after the last treatment (12 weeks post baseline) and 3 months after the last treatment (6 months post baseline). The expected positive effects of this novel intervention combining fast treadmill training and a step activity monitoring program on physical activity will provide strong support for the need to expand rehabilitation interventions t include features that facilitate an increase in the real-world physical activity of chronic stroke survivors. PUBLIC HEALTH RELEVANCE: Stroke is the leading cause of disability in the US and this disability is a consequence of, and a risk factor for, physical inactivity. As a result, stroke survivors, as a group, are extremely inactive and this has serious consequences for them, including an increased risk of a second stroke and developing other diseases. This proposal investigates a novel intervention that combines fast treadmill training with a step activity monitoring program to improve inactivity after stroke.

描述（由申请人提供）：中风是美国残疾的主要原因。这种残疾是身体缺乏活动的结果，也是其危险因素，而中风幸存者作为一个群体，极度缺乏活动。大多数研究发现，慢性中风幸存者的平均活动量甚至比最久坐的成年人还要少。缺乏体力活动会给中风患者带来严重后果，包括增加第二次中风、患其他疾病（如糖尿病）和死亡的风险。考虑到中风后第一年不活动的情况会变得更糟，不活动的潜在后果甚至更加令人担忧。因此，如果不及时治疗，缺乏身体活动可能是中风最严重且代价最高的后遗症之一。尽管中风后缺乏活动会带来严重后果，但很少有人关注慢性中风幸存者的康复干预是否会影响活动。尽管如此，一种有望改善慢性中风幸存者活动能力的干预措施是快速跑步机训练。然而，即使在干预后观察到了改善，参与者的体力活动仍然远低于建议水平。因此，必须制定干预措施来改善慢性中风患者的现实身体活动。在其他人群中，步行活动监测计划已被证明对于增加日常步行活动极为有效。然而，它们的有效性从未在慢性中风幸存者中得到测试。该提案的主要目的是测试在快速跑步机训练中添加步数活动监测计划是否可以改善慢性中风幸存者的步行活动，而不仅仅是快速跑步机训练的改善。第二个目标将测试这种干预是否也会影响步行速度、耐力和步行的能量消耗，所有这些都与中风后的步行活动有关，并且是功能的重要衡量标准。采用随机对照实验设计，40 名慢性（> 6 个月）中风幸存者将接受 12 周的快速跑步机单独训练或 12 周的快速跑步机训练与 步骤活动监控程序。主要（体力活动）和次要（步行速度、耐力、能量消耗）结果将由盲法评估员在开始治疗前（基线）、最后一次治疗后立即（基线后 12 周）以及最后一次治疗后 3 个月进行评估（基线后 6 个月）。这种新颖的干预措施结合了快速跑步机训练和对身体活动的步进活动监测计划，其预期的积极效果将为扩大康复干预措施的需要提供强有力的支持，其中包括促进慢性中风幸存者现实世界身体活动增加的功能。 公共健康相关性：中风是美国残疾的主要原因，这种残疾是缺乏身体活动的结果，也是其风险因素。因此，中风幸存者作为一个群体，极度缺乏运动，这对他们造成了严重后果，包括第二次中风和患其他疾病的风险增加。该提案研究了一种新颖的干预措施，将快速跑步机训练与步数活动监测计划相结合，以改善中风后的不活动情况。