Tai Chi and SilverSneakers® Interventions Improve Aerobic Endurance in Older Stroke Survivors

Background: Physical activity reduces recurrent stroke risk, yet suitable community-based programs are lacking. Tai Chi (TC) and SilverSneakers® (SS) can be easily adapted for persons with disabilities. TC integrates physical movements with mindfulness, while SS focuses on strength and range of movement.

Purpose: To examine the effects of TC and SS interventions on physical functioning compared to Usual Care (UC).

Methods: A randomized trial was conducted among stroke survivors (n=145), aged ≥ 50 years, and at ≥ 3 months post-stroke (TC, n=53; SS, n=44; or UC, n=48). TC and SS groups attended a 1-hour class 3X/week for 12 weeks. The UC group received a weekly phone call along with written materials for participating in community-based physical activity. The Short Physical Performance Battery (SPPB) assessed balance, gait speed, and lower body strength; a two-minute step-in-place test (StepTest) assessed aerobic endurance. The Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) assessed amount of self-reported physical activity. Clinically meaningful changes in SPPB (small=0.5 points, substantial=1.0 points), and gait speed (small=0.05 m/sec, substantial=0.10 m/sec) were examined. Data were analyzed using 2 (time) X 3 (group) ANOVAs.

Results: Subjects (47% women) were on average 70±10 years old, and 37±48 months post-stroke. The majority were married (58%), White (79%), college educated (79%), retired (80%), reporting an ischemic stroke (66%) with hemiparesis (73%). All groups reported a similar amount of physical activity (PASIPD=14.8±11.0 MET hrs/day, F2,142=1.04, p=0.36); and had substantial improvements in SPPB score (F1,142=85.29, p<0.01), with small improvements in gait speed (F1,142=25.97, p<0.01). There was a significant group by time interaction for the StepTest (F2,142=4.69, p<0.01); TC (t53=2.45, p=0.02) and SS (t44=4.63, p<0.01) had significantly better aerobic endurance over time, while this was not observed in the UC group (t48=1.58, p=0.12).

Conclusions: A goal of stroke rehabilitation is to prevent disability and declines in physical functioning. TC and SS improved aerobic endurance, and both are suitable community-based programs that may aid in stroke recovery and community reintegration.