Circuit Training Is Effective For People With Stroke

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Introduction

Stroke also referred to as the Cerebral vascular Accident (CVA) is defined to a as sudden non-convulsive focal neurological deficit of vascular origin lasting more than 24 hours (WHO, 2017). According to the World Health Organization (WHO), 15 million people are affected by stroke worldwide each year (Rodrigo et al., 2013). Out of these 15 million people five million die and another five million gets permanently disabled (WHO). Physiotherapist play a big role in the rehabilitation of those with stroke to help them regain their function. Physiotherapist work closely with other disciplines in this process. In this essay, I will be looking at what stroke is and on how effective is circuit training in the rehabilitation of those with stroke by reviewing studies that were made in search of this. Circuit training is a form of a treatment program that involves approximately eight to ten exercise stations. After finishing a station, you don’t rest rather you move quickly to the next station. In this station, different exercises are done to help regain function.

What is Stroke and Its Prevalence

Stroke is defined as a sudden non-convulsive focal neurological deficit of vascular origin lasting more than 24 hours (WHO, 2017). It is a clinical syndrome that arises following a disturbance of blood supply to the brain and is also defined as a sudden onset of neurological signs and symptoms due to a disturbance in the blood supply of the brain which then leads to a temporary or permanent dysfunction. According to the World Health Organization (WHO), 15 million people are attacked by stroke worldwide each year as mentioned in the introduction. Five million die and the other 5 million is left permanently disabled. In the year the 2010 Global disease burden proposed that stroke is the second foremost cause of death globally and the third leading cause of premature death and disability as measured in Disability Adjusted Life Years (DALY) (WHO,2017). Cerebrovascular disease is the largest neurologic contributor and accounts for 4.1% of total global daily. The signs of the onset of stroke are sudden numbness or weakness of the face, arm, or leg, mostly on one side of the body, sudden confusion or difficulty speaking or understanding speech, sudden difficulties with vision or sight. Sudden trouble walking, dizziness, or loss of balance or coordination. Sudden severe headache with no known cause.

Causes of a Stroke

The underlying causes of stroke are Ischaemic consisting of Infarct, Occlusion and thrombosis which are the blockage of blood vessels causing inadequate blood supply to the brain and beyond this is the most common as it accounts up 80% of strokes (Physipedia,2019). So, the thrombotic is where a clot forms in the main brain artery or within the small blood vessels inside the brain the clot forms around the athesclerotic plaques. Embolic is therefore when a blood clot occurs within a blood vessel somewhere else in the body and it goes to the brain. There is also a systemic hypofusion which is a general decrease in the blood supply due to shock. We then have a venous thrombosis which is a lot that then forms within a vein.

Secondly, we have the Haemorrhagic which is defined as bleeding within and around the brain. Haemorrhagic Strokes forms when a blood vessel in the brain ruptures and blood comes out. This includes two types being Intracerebral Haemorrhagic Stroke which occurs when the blood vessels in the brain bleed it is said that high blood pressure is the main source of intracerebral haemorrhagic stroke (Physipedia,2019). In Subarachnoid Haemorrhagic Stroke there’s is blood coming out from a blood vessel between the surface of the brain and the arachnoid tissues due to a rupture (Physipedia,2019).

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Risk Factors

Furthermore, we have modifiable and non-modifiable risk factors. Non-modifiable being age the incidence doubles each decade for those more than 55 years. Gender it is equal for both genders though women die more often than men. Heredity family history is there previous TIA or CVA Modifiable risk factors are hypertension (high BP defined as systolic>160mmHG and diastolic>95mmHg), Diabetes, Smoking, Hypercholesterolaemia, Cardiovascular disease: ischaemic heart disease, coronary artery disease, atrial fibrillation, valvular disorders, cardiac failure. Anticoagulant therapy, stress, Female smokers using contraceptive pill, Reduced physical activity and Alcohol.

Management

Physiotherapists must be involved early and must do their own assessment on the patient so that they can be able to formulate their treatment plan specific to the patient. Starting mobilising in the early stages is said to be the best. If rehabilitation occurs on a different setting like that of acute care, the treatment given must be made the same. Type and intensity of therapy should be determined by the patient's needs not the place they are in. There are different treatment approaches that are used to manage stroke acute or sub-acute and chronic. In this review we will be looking at the circuit training for those with stroke. After getting stroke one will need to learn again the most basic things including rolling and sitting up over the bedside, sit to stand, sitting and standing balance, transfers, gait, and going up the stairs (Rose et al., 2010). Health professionals are to construct treatment sessions to provide the most effective means of attaining these skills for the return home and daily activities (Rose et al., 2010).

What is Circuit Training

Circuit training workout comprises of approximately ten exercise stations after one is done with a station, they don’t rest rather they quickly go to the next station (Exercise, 2019). For an example a muscle power and endurance circuit work on different muscle groups muscle such as upper limbs, lower limbs and core muscles, so one can take a small break or not break at all in between stations. So, the article concentrates on a different form of circuit training which is cardiovascular fitness and strength. The circuit comprises of one to two sets of resistance exercise which are bodyweight, weights, dumbbells, TheraBand’s, and so on with a session of cardiovascular exercise such as jogging in one place, fixed cycling, rowing, etc which lasts anywhere from thirty seconds to three minutes (Exercise, 2019). Dependent on your aims and the number of circuit stations, one can finish one or more circuits in a thirty-sixty-minute session.

How Effective is Circuit Training in Stroke Patients

On a study done by Ingrid G L van de Port et al,2012 they studied how safe and how effective is t circuit training as a substitute to normal physiotherapy provided at a rehabilitation centre to improve walking). Their hypothesis was that circuit training would be a safe treatment strategy that is greater to traditional physiotherapy in terms of self-reported skill in walking for patients cleared from a rehabilitation centre to their homes in the duration of 24 weeks. They reached a conclusion that circuit training can safely substitute traditional physio treatment for those with stroke who are cleared from the rehab centre to their homes and it is also required for more when training using gait-related activities as an outpatient (van de Port et al., 2012). For these research patients with stroke with the ability to walk at least 10m with no help and were in an outpatient rehab centre. Patients were either placed to circuit training or normal physio treatment, after stratification by rehabilitation centre, with an online randomisation procedure (van de Port et al., 2012). Those in the intervention group got circuit training in ninety-minute sessions two times a week for 12 weeks. This included eight different workstations in a gym, it was planned to advance how they do tasks in relation to their walking ability. Evidence that supports that circuit training has an effect in improving the walking competency of patients with chronic stroke is increasing. Circuit Training benefits are a significant feature of the task-oriented circuit training the benefit being the fact that it is given in groups of two to eight patients, dropping the ratio of physios to patients making it more cost-effective (English, Hillier and Lynch, 2017).

A pilot study by Dean, Richards and Malouin (2000) proves that a task related circuit training is an effect in educating locomotor function in patients with stroke. The intervention group showed a great instantly and retained improvement compared with the control group when it came to walking speed and endurance, force in generated in the affected leg when doing sit-to-stand, and how many repetitions are done in the step test (Dean, Richards and Malouin, 2000). In the study function of the low limbs was assessed through making a measurement of their walking speed and endurance, peak vertical ground reaction force through the affected foot during sit-to-stand, and the step test (Dean, Richards and Malouin, 2000).

In a study by Rose et al, 2010 it was found that treatment based on task-related functional activities can be effectively applied in an inpatient rehabilitation stroke centre not only outpatient. Circuit-training session lead to in more improvements in gait velocity throughout the session of inpatient rehabilitation compared to the typical model of care (Rose et al., 2010). Home-based facilities after a hospital discharge are keep these gains and must be encompassed in the variety rehabilitation care. Persons took part in either a circuit training or an ordinary model of physiotherapy for five days in a week. Each sixty-minute circuit training session, wad done based on how severe the level is, it was comprised of four functional activities. The circuit training model was effectively executed in an acute rehabilitation setting the group presented a significantly superior improved change in gait speed from hospital admission to discharge as compared to the normal physiotherapy group (Rose et al., 2010). Circuit training is found to be helpful for in improving muscle strength and gait-related activities in acute and chronic stroke patients (Jeon, Kim and Park, 2015). This study analysed other studies search for evidence supporting their claims. The eminence of each study was evaluated using the Physiotherapy Evidence Database (PEDro) scale. Eleven studies were analysed concerning the size of effect sizes (ESs) and categorized according to extremities focused upon for training, outcome measures, and study variables (Jeon, Kim and Park, 2015). This comprised of the period and regularity of training and stroke stage the PEDro scores ranged from four to eight. The complete effective size of the eleven studies was great. The effectiveness for lower extremities and both acute and chronic stroke were big and noteworthy. This effect was too found for gait velocity, gait endurance, balance, timed up and go test, and strength of the lower extremities (Jeon, Kim and Park, 2015). Training for a period of two weeks and regularity of seven days a week had the highest effects. This study, therefore, supports task-oriented circuit class training to improve gait and gait-related activities in patients with chronic stroke (Jeon, Kim and Park, 2015).

Conclusion

Circuit training is found to be more effective than regular physiotherapy treatment for people with stroke. It has shown a greater effect in helping those with stroke to be able to walk again. It has also been proven to increase gait velocity in those with stroke as compared to standard physio treatment. Circuit training advances locomotor function in chronic stroke. It has been found to be helpful for increasing muscle power and activities that require walking in stroke patients. Circuit training is a better treatment strategy as compared to the traditional physio treatment. Circuit Training’s advantage is that it is offered in groups ranging from two to eight patients, it, therefore, decreases the ratios of physiotherapist which makes it a cost-effective treatment strategy.

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