Dr Carron Gordon, lead researcher in the breakthrough study on using walking in stroke recovery. Rudolph Brown/Photographer
Anastasia Cunningham, CoordinatorTaking a stroll around your community could greatly increase your chances of recovering from a stroke, according to a breakthrough study from researchers at the University of the West Indies (UWI).
The five-year study, led by Dr Carron Gordon, along with Professors Rainford Wilks and Affette McCaw-Binns, published last month under the title Community Based Walking After Stroke, has caused specialists to now rethink their approach in the treatment of stroke survivors.
" intervention had been used before, using a number of means, but no one had looked at walking as a single intervention, simple outdoor walking, which is a common, accessible modality. In our context, a lot of persons would not have access to the equipment used as part of the other studies, but walking is so accessible and can be done at the community level. It's familiar, inexpensive and something people could very easily get into," noted Gordon, a physiotherapist for more than 30 years with a PhD in public health.
The study was designed to determine the effect of 30 minutes of aerobic walking, three times per week for three months in patients who has suffered a stroke, examining the outcomes -related quality of life, functional status, endurance, strength and fitness.
A stroke is caused when there is an interruption in supply of blood to the brain, which may be a result of a clot or rupture of a blood vessel. This leads to death of parts of the brain supplied by that blood vessel. The patient then begins to experience a range of difficulties, usually including decreased mobility to one side of the body, cognitive and sensory problems, difficulty speaking, swallowing, among other complications. Some chronic cases result in coma.
A 2008 study showed that there were 25,000 stroke victims between 15 and 74 years old, a prevalence rate of 1.5 per cent of the Jamaican population.
THE STUDY
In 2004, Gordon and her team recruited 128 persons, aged 42 to 90, from communities across Kingston and St Andrew who had had a stroke six months earlier and beyond.
They were divided into two groups - a controlled group, which received light massages to the affected side for 25 minutes, three times per week for three months.
The other group went through a supervised walking programme, walking in their community or anywhere they felt comfortable, with their vital signs being closely monitored. The walkers started out by following a designated route for 15 minutes, lengthening the duration of their walk by five minutes a week until they walked for 30 straight minutes.
As persons became fitter, they gradually increased their pace, reaching 60 to 85 per cent of their target heart rate.
"One of the reasons we did this was that persons would have had rehabilitation for three months or more and then after that go back home. Despite the fact that they had gone through rehab, they may have been experiencing residual weakness, which would normally cause them to be very restrictive in their mobility, and they didn't have anything after rehab to keep them going and to maintain whatever gains they had achieved," Gordon told Health from her office at the Faculty of Medical Sciences Teaching and Research Complex at UWI.
"The burden was to prevent them from losing function and becoming de-conditioned and dependent after getting a stroke."
200% IMPROVEMENT
At the end of the study, the researchers found that the walking group showed significantly greater endurance compared to the controlled group. Those in the walking group walked 17.6 per cent farther in a six-minute endurance test than did persons in the massage group and had a resting heart rate that was 1.5 per cent lower. Additionally, the walkers had nearly a 17 per cent trend towards a better health related quality of life.
"Taken all-stogether, it showed that if an individual is able to walk longer and faster and be fitter, then they could do everyday activities much better and with much less strain," Gordon said.
Heartened by the results, the director of the Physical Therapy Programme at UWI revealed, "The first time we assessed one gentleman, he was really very limited, he couldn't finish the test. However, at the end of the study, he had about 200 per cent improvement. He was ecstatic and really very appreciative of what we had helped him to accomplish.
"We had another lady who said she was able to go to the clinic and market by herself at the end of the three months. Before, she had to wait on someone to take her.
"Generally, I would say that it was very well received and people were very pleased about how they had been helped."
Widespread interest
After the study was published in April in Stroke, a journal of the American Heart Association, it generated widespread interest across the United States.
"It was important to them that it was a randomised, controlled trial, and this type of design provides the strongest evidence for anything, which to them would have been good evidence for the use of walking in persons with chronic stroke and something they would certainly recommend," she said.
The UWI lecturer added, "I must say the results are applicable only to persons who are able to walk, even with aid. There are some persons who have had a stroke and can't walk at all. This would not be applicable to them. Additionally, the walking programme would be part of a comprehensive approach to stroke recovery."
The physiotherapist is now looking at the effects of walking on mental recovery, as well as preventing a second stroke.
"There is always a possibility of another stroke. It is important to focus attention on the risk factors for a stroke in the first place, but preventing a second stroke is critical. So I would like to explore a little bit more how walking can modify some of the risk factors to prevent another stroke," Gordon said.
"In addition, I would also like to see how it affects the mental aspect of the quality of life, because the first study was more on the impact of the physical aspect."
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