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Therapeutic Exercise and Depressive Symptoms After Stroke

Authors

  • Sue-Min Lai PhD, MS, MBA,

    1. From the *Department of Preventive Medicine and Public Health, Health Policy and Management, and Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas§Department of Medicine (Geriatrics), University of Pittsburgh, Pittsburgh, PennsylvaniaGeriatric Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PennsylvaniaRehabilitation Research and Development, Veterans Affairs Medical Center at Gainesville and Occupational Therapy Department, Gainesville, Florida#Research Service, Department of Veterans Affairs Medical Center, Kansas City, Missouri**Center of Excellence on Rehabilitation Outcomes, Department of Veteran Affairs, Department of Aging and Geriatric Rehabilitation, College of Medicine, University of Florida, Guinesville, Florida.
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  • Stephanie Studenski MD, MPH,

    1. From the *Department of Preventive Medicine and Public Health, Health Policy and Management, and Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas§Department of Medicine (Geriatrics), University of Pittsburgh, Pittsburgh, PennsylvaniaGeriatric Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PennsylvaniaRehabilitation Research and Development, Veterans Affairs Medical Center at Gainesville and Occupational Therapy Department, Gainesville, Florida#Research Service, Department of Veterans Affairs Medical Center, Kansas City, Missouri**Center of Excellence on Rehabilitation Outcomes, Department of Veteran Affairs, Department of Aging and Geriatric Rehabilitation, College of Medicine, University of Florida, Guinesville, Florida.
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  • Lorie Richards PhD,

    1. From the *Department of Preventive Medicine and Public Health, Health Policy and Management, and Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas§Department of Medicine (Geriatrics), University of Pittsburgh, Pittsburgh, PennsylvaniaGeriatric Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PennsylvaniaRehabilitation Research and Development, Veterans Affairs Medical Center at Gainesville and Occupational Therapy Department, Gainesville, Florida#Research Service, Department of Veterans Affairs Medical Center, Kansas City, Missouri**Center of Excellence on Rehabilitation Outcomes, Department of Veteran Affairs, Department of Aging and Geriatric Rehabilitation, College of Medicine, University of Florida, Guinesville, Florida.
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  • Subashan Perera PhD,

    1. From the *Department of Preventive Medicine and Public Health, Health Policy and Management, and Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas§Department of Medicine (Geriatrics), University of Pittsburgh, Pittsburgh, PennsylvaniaGeriatric Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PennsylvaniaRehabilitation Research and Development, Veterans Affairs Medical Center at Gainesville and Occupational Therapy Department, Gainesville, Florida#Research Service, Department of Veterans Affairs Medical Center, Kansas City, Missouri**Center of Excellence on Rehabilitation Outcomes, Department of Veteran Affairs, Department of Aging and Geriatric Rehabilitation, College of Medicine, University of Florida, Guinesville, Florida.
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  • Dean Reker PhD,

    1. From the *Department of Preventive Medicine and Public Health, Health Policy and Management, and Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas§Department of Medicine (Geriatrics), University of Pittsburgh, Pittsburgh, PennsylvaniaGeriatric Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PennsylvaniaRehabilitation Research and Development, Veterans Affairs Medical Center at Gainesville and Occupational Therapy Department, Gainesville, Florida#Research Service, Department of Veterans Affairs Medical Center, Kansas City, Missouri**Center of Excellence on Rehabilitation Outcomes, Department of Veteran Affairs, Department of Aging and Geriatric Rehabilitation, College of Medicine, University of Florida, Guinesville, Florida.
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  • Sally Rigler MD, MPH,

    1. From the *Department of Preventive Medicine and Public Health, Health Policy and Management, and Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas§Department of Medicine (Geriatrics), University of Pittsburgh, Pittsburgh, PennsylvaniaGeriatric Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PennsylvaniaRehabilitation Research and Development, Veterans Affairs Medical Center at Gainesville and Occupational Therapy Department, Gainesville, Florida#Research Service, Department of Veterans Affairs Medical Center, Kansas City, Missouri**Center of Excellence on Rehabilitation Outcomes, Department of Veteran Affairs, Department of Aging and Geriatric Rehabilitation, College of Medicine, University of Florida, Guinesville, Florida.
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  • Pamela W. Duncan PhD, PT, FAPTA

    1. From the *Department of Preventive Medicine and Public Health, Health Policy and Management, and Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas§Department of Medicine (Geriatrics), University of Pittsburgh, Pittsburgh, PennsylvaniaGeriatric Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PennsylvaniaRehabilitation Research and Development, Veterans Affairs Medical Center at Gainesville and Occupational Therapy Department, Gainesville, Florida#Research Service, Department of Veterans Affairs Medical Center, Kansas City, Missouri**Center of Excellence on Rehabilitation Outcomes, Department of Veteran Affairs, Department of Aging and Geriatric Rehabilitation, College of Medicine, University of Florida, Guinesville, Florida.
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Address correspondence to Sue-Min Lai, PhD, MS, MBA, Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Mail Stop 1008, 3901 Rainbow Boulevard, Kansas City, KS 66160. E-mail: slai@kumc.edu

Abstract

OBJECTIVES: To examine the effect of exercise on depressive symptoms and the effect of baseline depressive symptoms on the benefits from exercise in stroke survivors who have completed acute rehabilitation.

DESIGN: Planned secondary analysis of the data from a 9-month randomized, controlled trial.

SETTING: Participant homes.

PARTICIPANTS: One hundred stroke survivors who had completed acute rehabilitation.

INTERVENTION: A progressive, structured, 3-month physical exercise program.

MEASUREMENTS: Demographics, stroke characteristics, impairments, functional limitations, the Geriatric Depression Scale, the Stroke Impact Scale, and the Medical Outcomes Study 36-Item Short Form.

RESULTS: Baseline rates of depressive symptoms and other stroke sequelae were similar between the two arms. Ninety-three participants were assessed immediately after the intervention (3 months after enrollment), and 80 were assessed 9 months after enrollment. Six (14%) of the exercise group and 16 (35.6%) of the usual-care group had depressive symptoms at 3 months (P=.03). At 9 months, three (7.5%) of the exercisers had significant depressive symptoms compared with 10 (25%) who received usual care (P=.07). Participants with and without baseline depressive symptoms had equivalent treatment-related gains in impairments and functional limitations, but only participants with depressive symptoms had improved quality of life.

CONCLUSION: Exercise may help reduce poststroke depressive symptoms. Depressive symptoms do not limit gains in physical function due to exercise. Exercise may contribute to improved quality of life in those with poststroke depressive symptoms.

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