VA Maryland Health Care System
Novel Collaboration between VA Research and Communities Benefits Maryland’s Chronic Stroke Survivors
In a novel collaboration between researchers at the Veterans Affairs (VA) Maryland Health Care System and the Howard County Department of Aging, Veterans and members of the community are benefiting from a VA-funded research project focused on chronic stroke survivors.
The “Adaptive Physical Activity for Chronic Stroke Study” that is now being conducted in partnership between the VA Maryland Health Care System and the Howard County Department of Aging has three main goals. It aims to work with chronic stroke survivors at community gyms on exercise training in an effort to improve gait and balance, cardiovascular health, and decrease the risk for falls. It also addresses depression and social isolation suffered by chronic stroke survivors, and seeks to improve the survivor’s overall physical health. Richard Macko, MD, director of the Maryland Exercise & Robotics Center of Excellence (MERCE) at the VA Maryland Health Care System and professor of neurology, medicine, physical therapy and rehabilitation science at the University of Maryland School of Medicine, and Mary Stuart, ScD, a VA investigator and the director of Health Administration Public Policy at University of Maryland Baltimore County, are co-principle investigators of the randomized controlled study that has recently been increased to $1 million.
“Stroke is one of the leading causes of long-term disabilities in the US. Two-thirds of stroke survivors are left with persistent neurological deficits, chiefly the hemiparetic gait that limits mobility and increases the risk of falls. These deficits often lead to a sedentary lifestyle that propagates physical disability through physical de-conditioning,” said Macko. “Increasing evidence links exercise for people with chronic stroke to the preventive benefits of improved cardiovascular health, physical fitness, and ambulatory function. Despite the potential health benefits to chronic stroke survivors offered by increased exercise, there is limited experience translating this research into community-based exercise alternatives adapted specifically for the needs of stroke survivors.”
Macko, who worked in collaboration with the Italian Health Authority to develop the study’s first round that took place in Florence, Italy, further developed the model to include treadmill work to test short-term objectives. This reiteration of the study, which took place at the Baltimore VA Medical Center, a division of the VA Maryland Health Care System, was conducted to test if the exercise model would demonstrate greater improvements in walking speed, free ambulatory profiles and quality of life. The collaboration with the Howard County Department of Aging seeks to test the study’s long-term objective of disseminating a U.S. model by developing a network of accessible community exercise programs for Veterans with chronic stroke that can help them better reintegrate into the social mainstream.
“Many people spend an hour in the gym three times a week. There are no reasons that chronic stroke survivors can’t exercise for fun and all around physical health,” Stuart said. “The study addresses social isolation and depression that plagues chronic stroke survivors because participants attend three, hour-long sessions per week, which help to foster social interaction that can lift depression.”
Participants engage in exercises that are specifically designed to improve cardiovascular health. The exercises also address the persistent neurological deficits that propagate disability through physical de-conditioning and “learned non-use” due to a sedentary lifestyle associated with stroke-induced limitations. These limitations often give rise to diabetes, glucose intolerance, heart disease, depression, subsequent strokes and death. VA researchers want to explore if fitness exercise activities specifically adapted to the needs of stroke survivors and that takes place in a community setting (rather than in a hospital or rehabilitation center) provide the optimal management strategy to prevent the progression and disability that chronic stroke survivors currently undergo.
“Education is also key,” Macko said. “Veterans and community members who are better educated about taking care of themselves can experience a higher quality of life.”
As a result of the positive impact on the community and the participants, the Howard County Department of Aging has decided to expand its study “to enable participants to exercise one full year, one of the few if not the only studies that runs that long” Macko said, noting that “most published research [on chronic stroke] has been conducted in the hospital or rehabilitation setting and the optimal management strategy to prevent the progression of disability in chronic stroke survivors remains unknown.”
“The Howard County Department of Aging is dedicated to keeping the exercise program open as a service to its seniors disabled by stroke, even after the research study has ended,” Macko said.
Plans are being made to expand the programs to Baltimore County to increase access by Americans with disabilities to health-promoting exercise.