Eficácia do treino específico da tarefa no nível de atividade física e na mobilidade de indivíduos acometidos pelo acidente vascular encefálico

Abstract

Individuals affected by stroke have a higher risk of secondary cardiac complications and recurrence of the neurological episode. In addition, maintaining modifiable risk factors, such as physical inactivity, can lead to increased disability in these individuals, generating a vicious cycle that compromises their health and functionality. In view of this, the current scientific literature has recommended an increase in physical activity levels after stroke through lifestyle changes and rehabilitation programs. Different factors are related to the physical activity level in individuals affected by stroke, among them, it is important to highlight the mobility impairments that lead to functional dependence, increased risk of falls and low perception of quality of life. It is possible that therapeutic strategies used to improve mobility in these individuals also have an impact on their physical activity level. Taskspecific training is a therapeutic strategy that has the potential to achieve this goal since it has already shown benefits in improving mobility of individuals affected by stroke. However, its effectiveness in improving the physical activity level in this population is not clear. In addition, studies involving task-specific training include activities of only one body segment. The inclusion of activities for upper and lower limbs can have a significant impact on the improvement of the general functional mobility of these individuals and consequently on the improvement of their physical activity level. Thus, the objectives of the present study were: 1) To investigate the efficacy of task-specific training focused on both upper and lower limbs in improving physical activity levels and mobility of individuals with stroke; 2) To investigate the efficacy of task-specific training in improving muscle strength, exercise capacity, and quality of life. To achieve these objectives, a randomized controlled trial with a blinded examiner was conducted with community-dwelling individuals at the chronic phases of stroke. Participants were randomly assigned to the experimental group, who received task-specific training intervention focused on both the upper and lower limbs; or to the control group, who received global stretching, memory exercises, and health education intervention. Both groups received 36 one-hour intervention sessions (approximately 12 weeks), three times a week. The group sessions were provided by the same physiotherapist. Prior to interventions (week 0), immediately after interventions (week 12), and at follow-up (16 weeks), outcome measures were collected by the same assessor, who was blinded to group allocation. Primary outcomes included physical activity level, which was assessed by direct (SenseWear® multisensory) and indirect (Human Activity Profile questionnaire) methods, and upper (Test d’Évaluation des Membres Supérieurs de Personnes Agées) and lower-limb (10-meter walk test) mobility tests. Secondary outcomes included isometric strength of grip and knee extensor muscles (hand-held dynamometry), exercise capacity (6-minute walk test), and quality of life (Stroke Specific Quality of Life scale). Statistical analyzes were performed by an independent researcher, who was blinded to the group allocation. Intention to treat analysis was used. Analysis of variance (ANOVA 2X3) with two factors (groupXtime), with repeated measures on the time factor (week 0, week 12, week 16) was used to evaluate differences between the groups regarding all outcomes. Thirty-six individuals (18 in the experimental and 18 in the control group), who had a mean age of 55±15 years and a mean time since the onset of the stroke of 47±41 months, participated. There were no differences between-groups and any interaction effects between-time and group factors (0.11≤p≤0.99), except for quality of life which improved in the experimental group at 12-week (95% CI 2-22) and 16-week followups (95% CI 2-30). The results of the present study demonstrated that task-specific training focused on both the upper and lower limbs was not effective in improving the physical activity level and mobility of individuals at the chronic phases of stroke. However, it was effective in improving the quality of life. Since this is the first study to investigate the effects of task-specific training focused on both upper and lower limbs, future studies are necessary to better understand the effect of this type of intervention on mobility and physical activity levels of individuals at the chronic phases of stroke.