A community-based group upper extremity exercise program improves motor function and performance of functional activities in chronic stroke: a randomized controlled trial

Objective—To assess the effects of a community-based exercise program on motor recovery and functional abilities of the paretic upper extremity in persons with chronic stroke. Design—Randomized controlled trial. Setting—Rehabilitation research laboratory and a community hall. Participants—A sample of 63 people (≥ 50 years) with chronic deficits resulting from stroke (onset ≥ 1 year). Interventions—The arm group underwent an exercise program designed to improve upper extremity function (1 hour per session, 3 sessions per week for 19 weeks). The leg group underwent a lower extremity exercise program. Main outcome measures—(1) Wolf Motor Function Test (WMFT), (2) Fugl-Meyer Motor Assessment (FMA), (3) hand-held dynamometry (grip strength), and (4) Motor Activity Log. Results—Multivariate analysis showed a significant group × time interaction (Wilk’s Lambda=0.726, P=0.017), indicating that overall, the arm group had significantly more improvement than the leg group. Post-hoc analysis demonstrated that gains in WMFT (functional ability) (P=0.001) and FMA (P=0.001) were significantly higher in the arm group. The amount of improvement was comparable to other novel treatment approaches such as constraint-induced movement therapy or robot-aided exercise training previously reported in chronic stroke. Participants with moderate arm impairment benefited more from the program. Conclusions—The pilot study showed that a community-based exercise program can improve upper extremity function in persons with chronic stroke. This outcome justifies a larger clinical trial to further assess efficacy and cost-effectiveness.