RESUMEN
BACKGROUND AND PURPOSE: Individuals with Parkinson disease (PD) have motor and nonmotor impairments that interfere with exercise participation. The purpose of this study was to examine the feasibility and physical performance outcomes of a community-based indoor tandem cycling program that was designed to facilitate a higher cadence, consistency, and intensity of training. METHODS: Forty-one participants with mild to moderate PD were enrolled. A high-cadence cycling protocol using mechanically augmented (or forced) exercise on a tandem bicycle was adapted for our program. Participants cycled 3 times per week for 10 weeks. Feasibility measures included program retention, attendance, and adverse events, as well as the ability to reach training goals for heart rate (HR) and cadence. Physical performance outcomes included the Berg Balance Scale (BBS), Short Physical Performance Battery (SPPB), Five-Times-Sit-to-Stand (FTSTS) Test, Timed Up and Go (TUG), and gait parameters during usual and fast-paced walking. RESULTS: Program feasibility was demonstrated with a high attendance rate (96%) and retention rate (100%). There were no adverse events. The majority of participants reached their exercise training goals for target HR (87%) and cadence (95%). Statistically significant physical performance improvement (P < 0.05) was observed across domains of gait, balance, and mobility, suggesting a slowing or reversal of functional decline as a result of this cycling program. DISCUSSION AND CONCLUSION: Program feasibility and improved physical performance outcomes were demonstrated in individuals with mild to moderate PD participating in a community-based indoor tandem cycling program.Video Abstract available for more insights from the authors (see supplemental digital content 1, http://links.lww.com/JNPT/A146).
Asunto(s)
Ciclismo , Destreza Motora , Enfermedad de Parkinson/terapia , Anciano , Estudios de Factibilidad , Humanos , Persona de Mediana EdadRESUMEN
BACKGROUND: Community walking is limited among survivors of stroke; however, the contributing factors are not clearly understood. OBJECTIVE: This study examined the association of features in the environment with frequency of community walking following stroke. DESIGN: An observational study design was used, with frequency of community walking data collected prospectively. METHOD: Thirty survivors of stroke (mean age=67 years; mean months since stroke=40), and 30 older adults without stroke (mean age=68 years) participated. Frequency of community walking (number of trips, walking-related activities [WRA], and the ratio of WRA to trips) and satisfaction were measured using self-report. The Environmental Analysis of Mobility Questionnaire (EAMQ) was used to determine frequency of encounter with versus avoidance of environmental features during community walking. Negative binomial and linear regression models were used to analyze the association of environmental features with measures of community walking. RESULTS: Survivors of stroke reported reduced community walking and fewer encounters with and greater avoidance of features within 8 dimensions of the environment compared with a control group of adults without stroke. Following stroke, avoidance of features in some environmental dimensions was associated with frequency of community walking as measured by number of trips, number of WRA, and the ratio of WRA to trips. Environmental features explained little of the variability in community walking. LIMITATIONS: Limitations included a small sample size and limited diversity among participants. This study examined only physical features in the environment and did not include other environmental factors, such as social support, which may influence participation. CONCLUSIONS: Avoidance of features within some, but not all, environmental dimensions was associated with self-reported frequency of community walking following stroke, suggesting that some environmental features may limit community walking more than others.
Asunto(s)
Rehabilitación de Accidente Cerebrovascular , Caminata/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Comorbilidad , Femenino , Conductas Relacionadas con la Salud , Humanos , Relaciones Interpersonales , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/epidemiologíaRESUMEN
BACKGROUND: Mobility, specifically community walking, is important, but often limited among survivors of stroke. The factors that influence the recovery of community walking are not clearly understood. OBJECTIVE: The purpose of this research was to examine mobility disability following stroke, specifically: (1) the association between subjective and objective measures of participation in community walking and (2) the association between personal factors and participation in community walking. DESIGN: A cross-sectional study design was used. METHODS: Fifty community-dwelling survivors of stroke, aged 50 to 79 years, were enrolled in the study. Participation in community walking was measured subjectively (perceived difficulty and satisfaction) and objectively using self-report data (number of trips and walking-related activities) and step data (pedometer). The association between subjective and objective measures of participation was analyzed using Pearson correlation. The association of personal factors (age, sex, number of comorbidities, fatigue, depression, balance and fall self-efficacy, and importance of walking) with measures of participation was analyzed using multiple linear regression. RESULTS: Subjective and objective measures of participation were weakly associated. Self-efficacy was the only personal factor that was strongly associated with both subjective and objective measures of participation. Personal factors explained 27% to 55% of the variability in participation in community walking. LIMITATIONS: Limitations included a small sample size and limited diversity among participants. Reliability of the pedometer used in this study has not been established in the stroke population. CONCLUSIONS: Subjective and objective measures of participation in community walking were only weakly correlated, suggesting that they measure different aspects of mobility; thus, to fully capture participation, it is critical to measure both. Personal factors were associated with subjective and objective measures of participation and are important in explaining variability in community walking following stroke.
Asunto(s)
Monitoreo Ambulatorio , Autoinforme , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/psicología , Caminata/fisiología , Caminata/psicología , Accidentes por Caídas , Anciano , Estudios Transversales , Depresión/psicología , Evaluación de la Discapacidad , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Equilibrio Postural , Autoeficacia , Participación Social , TransportesRESUMEN
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 prospectively 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.