[Training programs in stroke patients: literature review]. / Réentraînement à l'effort chez l'hémiplégique vasculaire: revue de la littérature.

INTRODUCTION: An increased number of physical retraining programs are available for the rehabilitation of stroke patient; generally positive results are observed, but no consensus in methodology exists (program characteristics, intensity, duration, frequency, etc.). OBJECTIVE: To review the literature about training program characteristics for stroke patients and describe their efficacy, limits, and results. METHODS: A search of the Medline database revealed 97 references, including 53 clinical studies examining protocols of physical training and 15 meta-analyses and literature reviews of physical training. RESULTS: Three physical training protocols were found (walking, neuromuscular and 'force' training). Each training had specific effects: cardiovascular, functional, and muscular. DISCUSSION-CONCLUSION: To obtain positive cardiovascular effects and/or walking improvement, classical rehabilitation and physical training programs need to be associated for rehabilitation of the stroke patient.

Effect of training programs and exercise in adult stroke patients: literature review.

INTRODUCTION: An increasing number of training programs are proposed for the rehabilitation of patients after stroke, with positive results published but without formal validation, and without recommendations regarding indications for specific techniques and procedures. OBJECTIVE: To review data from the literature about training and exercise programs for stroke patients and to describe the efficacy, limitations, and effect of such programs on organ systems. METHODS: A search of MedLINE and relevant medical journals for articles of clinical trials, meta-analyses, and literature reviews pertaining to physical training and exercise programs after stroke. RESULTS: We found 58 articles reporting on various training and exercise techniques (walking, cardiovascular training, muscle strengthening, and others) and their results (on the cardiovascular, musculoskeletal, and neurologic systems, as well as functional status) in hemiplegic stroke patients. DISCUSSION-CONCLUSION: Training and exercise programs have value in stroke rehabilitation, and published results are, in general, promising. However, differences in the populations tested, methods, and criteria for analysis do not allow for recommending specific procedures.

[Relationship between walking capacity and maximal exercise capacity, strength and motor deficiency in adult hemiplegic stroke patients]. / Relation entre les capacités de marche et les capacités maximales à l'effort, les capacités musculaires et la déficience motrice après hémiplégie vasculaire chez l'adulte.

OBJECTIVE: To evaluate the relation between walking capacity and maximal exercise capacity, strength and motor deficiency in hemiplegic stroke patients. DESIGN: Uncontrolled observational study. SETTING: Physical medicine and rehabilitation unit in a teaching hospital. PARTICIPANTS: Twenty hemiplegic stroke patients (17 men and 3 women) aged 18-70 years, whose stroke occurred more than 3 months before the study and who could walk independently with or without walking aids. MAIN OUTCOME MEASURES: Peak oxygen uptake (VO(2peak)), maximal power output walking capacity (6-min walk test) and motor deficiency (Fugl-Meyer scale). RESULTS: Walking capacity was correlated with both VO(2peak) and maximal power output (Pmax) [r=0.609, P<0.003 and r=0.868, P<0.0001, respectively] but also with strength (from r=0.640 to r=0.734; P=0.0018 to P=0.0001) and motor deficiency (r=0.6; P=0.004). CONCLUSIONS: Aerobic capacity and walking capacity are correlated and decreased in hemiplegic stroke patients. These results underscore the need for future studies to confirm the role of fitness in relation to walking capacity and to evaluate the benefit of integrating aerobic training into more traditional rehabilitation programs after stroke.

[Hemiplegia and a hiking tour of Mont Blanc: from hope to reality]. / Hémiplégie et tour du Mont Blanc: de l'espoir à la réalité.

INTRODUCTION: At the end of an endurance training program for stroke patients with hemiplegia, we offered a hiking tour around the Mont Blanc Pedestrian Tour. We found no publication describing a similar experience and no scientific data in the literature to determine the physiological characteristics required for this performance, particularly regarding cardiac and vascular capacities, level of impairment, and functional abilities. OBJECTIVE: To complete a part of the Mont Blanc Pedestrian Tour over six days, with a group of adults with hemiparesis and aphasia due to stroke. POPULATION: Seven of 20 subjects with right hemiparesis and aphasia were selected on the basis of results of physiological tests, after an endurance training program and two tests hikes at medium altitude. Mean age was 51.71 +/- 7.13 years, mean VO(2max) 19.76 +/- 3.46 ml.g(-1).mm(-1), mean P(max) 90 +/- 22.68 and mean walking speed 3.60 +/- 1.30 km/hour. ORGANIZATION: Organization involved setting up the itinerary, recruiting accompanying personnel (9 people), and arranging security. No specific adaptations for accessibility were available, and no specific equipment was used, except for standard walking sticks. RESULTS: During this pedestrian tour, the subjects demonstrated strong motivation, as well as exceptional physical and functional performance, despite significant changes in elevation (up to 1500 m per day) and long walking times (from 5 to 9 hours per day). DISCUSSION: This experience has enriched our reflection about the medical, functional, and psychological conditions required for this type of physical effort, both from patients and accompanying personnel. In the absence of reports on similar experiences with this patient population, we thought it interesting, six months after this challenge, to present our observations as well as the patients' point of view. This may encourage other rehabilitation teams to offer intensive walking activities for stroke patients.

The feasibility and the effects of cycloergometer interval-training on aerobic capacity and walking performance after stroke. Preliminary study.

BACKGROUND: After stroke, the early and persistent decline in aerobic capacity leads to diminish walking capacities. The aim of the study is to investigate the effects of aerobic cycloergometer interval-training on the walking performances in subacute and chronic stroke survivors. METHOD: A prospective design was used. Fourteen patients whose stroke had occurred more than 3 months and less than 2 years performed an aerobic training session with a cycloergometer for 8 weeks. A maximal exercise test, a 6-min walking test, a 20-m test and an isokinetic muscle strength test were realized before and after training session. RESULTS: There was a significant increase after aerobic training in maximal power (Pmax) (mean 23.2%, P<0.0001), in VO(2peak) (mean 14.8%, P=0.04), and in the knee extension and flexion muscle peak torque on the nonparetic side and extension on the paretic side in isokinetic mode (mean from 13 to 29%, P=from 0.019 to P=0.0007) and in the walking performances on the 6-min walk test (mean 15.8%, P=0.0002). CONCLUSION: Patients with subacute and chronic stroke can improve aerobic capacity, muscle strength and walking performances after cycloergometer interval-training. Although these results must be interpreted with caution considering the small size of our sample, they suggest that aerobic training is a safe and potentially effective training after stroke and an alternative to walking treadmill training.