Adaptive Physical Activity for Chronic Stroke

The purpose of this study is to translate the Italian APA exercise model into a sustainable,
evidence-based VA community program of exercise for older adults with chronic stroke. Our
short-term objectives are to test study hypotheses using a Randomized Clinical Trial (RCT)
with an Attention Control (also referred to as the "Sittercize" exercise program). We will
also explore factors related to exercise adherence in a community program for chronic stroke
survivors. Our longer term objective is to disseminate this model to facilitate the
development of a network of community-based exercise programs for older adults with chronic
stroke. In the RCT we propose to offer courses in Office of Aging (OoA) Senior Centers and
a Veterans of Foreign Wars (VFW) hall. At the conclusion of the research study, the OoA
plans to continue offering APA-stroke courses. Through partnership, the Veterans Health
Administration (VHA) and the Administration of Aging (AoA) can potentially replicate this
model at the community throughout the U.S. using local OoA Senior Centers, VFWs, and other
facilities that would increase community access for veterans.

Inclusion Criteria:

- evidence of stroke (ischemic or hemorrhagic) minimum 6 months prior in men or women
ages 40 or older;

- residual hemiparetic gait deficits;

- already completed all conventional inpatient and outpatient physical therapy;

- ability to rise from a chair unaided and without an assistive device

Exclusion Criteria:

- cardiac history of active unstable angina, recent (less than 3 months) myocardial
infarction, or congestive heart failure (NYHA category II or higher);

- orthopedic, circulatory, or chronic pain conditions restricting exercise;

- active cancer; poorly controlled hypertension ( greater than 180/100 on 2 readings
separated by 5 minutes rest);

- dementia;

- severe receptive or global aphasia with inability to follow 2-step commands;

- co-morbid non-stroke neurological disorder that impairs mobility (e.g. MS or
Parkinson's);

- untreated clinical depression;

- inability to complete the "6-Minute Walk" test during baseline testing