Maximal strength training with chronic stroke patients
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Regaining muscle strength is an essential part of rehabilitation post-stroke. This study aimed to demonstrate that maximal strength training (MST) improves muscle strength, which transfers into improvements in functional measures and quality of life, but not maximal oxygen consumption (VO2peak), amongst chronic stroke survivors. 12 patients acted as their own controls for 4 weeks, prior to 8 weeks training. Patients trained 4 sets of 4 repetitions at 85-95% one repetition maximum (1RM) in leg press and plantarflexion, 3 days/week. Strength was measured by leg press and plantarflexion 1RM. Secondary outcomes included walking economy (Cw), 6 minute walk test (6MWT), timed up and go (TUG) and four step square test (FSST). Quality of life was assessed by the Medical Outcomes Survey short form 36-item questionnaire (SF-36). There were no significant changes in any parameters during the control period except VO2peak, which was attributed to a learning effect. After training, leg press 1RM improved by 30.2kg (72.4%) and 17.9kg (82.9%), and plantarflexion 1RM by 36.6kg (96.1%) and 27.7kg (239%) for the unaffected and affected limbs respectively (all p<0.01). 6MWT improved by 18.6m (p<0.01) and TUG by 0.7 seconds (p<0.05). There were no significant changes in Cw, VO2peak, FSST or SF-36 after training. The lack of improvement in Cw may be because the imbalance between limbs limits hemiplegic gait more than muscle strength per se. The results show that chronic stroke patients not only tolerate but in fact benefit from MST, as it generates large increases in strength and improvements in functional measures.