Which method is useful in youth rehabilitation

Stroke rehabilitation: which training is useful?

Thanks to medical advances, more and more people are surviving a stroke. However, this also increases the number of patients who have to live with permanent disabilities. Rehabilitation after a stroke is therefore becoming increasingly important. But it is still unclear which training method promises the greatest success. In a recent study, the endurance training recommended by American specialist societies proved to be not superior to relaxation therapy. In the early phase after a stroke, “less is perhaps more”.

Often recommended treadmill exercise

At least a third of stroke patients do not regain all of their previous functions. However, the recovery process can be well supported by rehabilitation measures. Physiotherapy and occupational therapy are primarily available, and in the case of speech disorders, speech therapy is also available.

Often times, treadmill training is also recommended. It is said to improve speed and stamina when walking and climbing stairs, as well as promoting the neuroplasticity of the brain. The American Heart Association & American Stroke Association therefore recommends that stroke patients do endurance training for 20 to 60 minutes from the subacute phase three to five times a week. 55 to 80 percent of the maximum heart rate should be achieved.

Data situation so far contradicting

But how useful is such endurance training really? According to the German Society for Neurology, the data situation is contradictory. "In general, the studies are difficult to compare because of the differences in terms of type, intensity and time at which training begins," explains Prof. Dr. Agnes Flöel, Director of the Clinic for Neurology at the University Medical Center Greifswald. "Especially for patients in the early phase after a stroke, there are uncertainties as to which training is optimal."

In the multi-center study "PHYS-STROKE", researchers under the direction of Prof. Flöel therefore examined the effects of aerobic treadmill training from the early phase after a stroke. In addition to the standard rehabilitation measures, half of the study participants completed aerobic treadmill training, the other half took part in relaxation training instead.

Endurance training did not lead to significant improvements

The respective training was carried out five times a week for a total of four weeks, each for 25 minutes. After this time, the patients continued to take standard therapy. The patients' maximum walking speed and everyday activity three months after the stroke were rated as the primary outcome.

As it turned out, endurance training did not lead to a significant increase in maximum walking pace or to an improvement in everyday activity. Compared to the relaxation group, however, there were 1.8 times more serious adverse events such as further strokes or falls.

Aerobic exercise is not for everyone

"In summary, the early four-week treadmill training after three months was not superior to relaxation training in terms of maximum walking pace and everyday fitness," said Prof. Martin Ebinger, Medical Park Berlin Humboldtmühle, who was involved in planning and carrying out the study. “The available data therefore suggest that aerobic training should not be forced in moderately to severely affected patients in the subacute phase after a stroke. However, patients who are more easily affected could possibly benefit earlier. This question must be investigated in future studies so that specific recommendations can be made for this group. "

Photo: © drubig-photo - Fotolia.com

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