Is water-based exercise as effective as land-based exercise in improving walking speed and leg muscle strength in stroke survivors?

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Stroke survivors often have difficulty walking quickly and this can limit their ability to walk at home and in the community. Exercises to train power in the leg muscles, plyometric exercises, have been shown to improve the speed of walking in younger and healthy older people. These exercises can be undertaken on land or in the pool, but stroke survivors may find the exercises easier in the pool. This pilot trial will therefore investigate whether aquatic plyometric exercises are as effective as land-based plyometric exercises to improving walking speed, endurance and leg power in stroke survivors. Hypotheses: • It is hypothesised that aquatic plyometric exercise will be equally effective as land-based plyometric exercise in improving gait speed, endurance and plantar flexor power in people with chronic stroke. • It is hypothesised that land-based plyometric exercise will result in greater heart rate and blood pressure changes than aquatic plyometric exercise The trial will aim to recruit twenty stroke survivors who have suffered a stroke more than three months ago, are living at home and can walk at least 10m independently or only need a walking stick. The trial will be a cross-over design, with participants randomly assigned into one of two groups. One group will start with twice a week aquatic exercise for two weeks, while the other group will start with twice a week land-based exercises. After two weeks, the groups will swap over with the aquatic group completing the land exercises and the second group completing the exercises in the pool. A range of functional assessments will be completed. Walking speed will be measured on a ten metre walking track. Endurance will be measured by the distance participants can walk in six minutes. Lower leg power and strength will be recorded using a small, hand-held device which measures how much force is used to push into the device's force plate. Leg power will also be measured by seeing how high participants can reach when jumping from a standing position. In addition, measures of heart rate, blood pressure and muscle soreness will be recorded before and after each of the exercise sessions. Functional assessments will be completed before starting the exercise programs, after two weeks before swapping to the other exercise modality, after finishing the final exercise program and four weeks after completing the exercise protocols. Statistical analysis will be used to compare differences between the two exercise programs and groups of participants to see whether the exercise programs increased walking speed, endurance and leg power in stroke survivors.

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