High frequency and intensity rehabilitation in 641 sub-acute ischemic stroke patients.

Abstract Objective To determine the effects of Exergaming on quality of life (QoL), motor, and clinical symptoms in sub-acute stroke patients. Design A pseudo randomized clinical trial, using a before-after test design. Settings University hospital setting. Participants Of 3,857 sub-acute, ischemic stroke outpatients, 680 were randomized and 641 completed the study. Interventions We determined the effects of 5x/week twice (EX2, 50 sessions, n=286) and once daily (EX1, 25 sessions, n=272) Exergaming and low-intensity standard care (CON, 25 sessions, n=83) on clinical, mobility, blood pressure (BP), and QoL outcomes. Main Outcome Measures The primary outcome: Modified Rankin Scale (mRS). Secondary outcomes: Activities of daily living (ADL), five aspects of health-related QoL(EQ-5D), Beck Depression Inventory (BDI), six-minute walk test (6MWT), Berg Balance Scale (BBS) and static balance (center of pressure, COP). Results During exercise, peak heart rate was 134, 134, and 126 b·min-1 in EX2, EX1, and CON. mRS improved similarly in EX2 (-1.8, effect size, d=-4.0) and EX1 (-1.4, d=-2.6) but more than in CON (-0.7, d=-0.6). QoL, Barthel index, Berg balance scale, six-minute walk test, and standing posturography improved in a pattern of EX2>EX1=CON. Systolic and diastolic rBP decreased more in EX2 and EX1 than CON. The intervention effects did no differ between males (n=349) and females (n=292). Conclusion Twice daily compared with once daily high-intensity Exergaming or once-daily lower intensity standard care produced superior effects on clinical and motor symptoms, BP, and QoL in male and female sub-acute ischemic stroke participants.