Dr Jane Sims, School of Physiotherapy,
The University of Melbourne
Beyond Blue Victorian Centre of Excellence
Project completion year
People commonly experience depression following a stroke, with implications for prognosis and recovery.
This study explored whether a progressive resistance training (PRT) program for post-stroke depression can reduce depressive symptoms and improve mental health, physical and social function and quality of life among chronic (6-12 months) stroke survivors. The aim was to assess whether a 10 week, community-based PRT program would reduce post-stroke depression in chronic stroke patients.
The Regenerate research program had two components:
(1) a randomised controlled trial (RCT)
(2) a longitudinal, observational study.
The RCT addressed the research question: “Does a 10 week, community-based progressive resistance training (PRT) program reduce post-stroke depression in chronic stroke patients?” This tested a PRT program for post-stroke depression to determine whether there would be a reduction in depressive symptoms; improved mental health; improved physical and social function and improved quality of life. The goal was to improve health and functionality to enable stroke survivors to access mainstream exercise programs. The observational study focused on people with stroke, both with and without depressive symptoms. The recovery process was followed for six months in people with and without depressive symptoms.
Stroke survivors were recruited from Austin Health, a hospital in Heidelberg, Victoria. Fifty-two participants were screened for depressive status using the Patient Health Questionnaire (PHQ-9)1. Depression severity and history were confirmed by psychiatric assessment. Eligible people (n = 45) were randomly allocated to PRT or a waiting-list comparison group.
The PRT program consisted of two high-intensity sessions per week for 10 weeks at a community-based venue. Depressive status, physical and mental health, functional status and quality of life were measured at baseline, 10 weeks and six months using established, validated tools. Muscle strength was assessed using 1 repetition maximum (1-RM) for upper and lower limbs.
In all, 135 participants entered the observational part of the research program. All completed a baseline assessment form; 115 completed the 10 week follow-up assessment form and 119 completed the six month assessment form.
Sixteen participants were lost to follow-up in the observational study and two in the RCT.
All participants successfully completed the trial. Significant gains in functional health were made by those who did the strength training program.
The RCT consisted of 45 people (27 males and 18 females), aged from 21 to 93 years (median age 69 years). Approximately half were Australian-born (53.3 per cent) and married (49 per cent) and most lived in a house (78 per cent). About a third of participants had never smoked (32.6 per cent), half were ex-smokers and four people still smoked, although three of these smoked less than 10 cigarettes per day.
The majority (69 per cent) had experienced moderate to severe disability in the sub-acute post stroke period. At the time of participating in the study, about a third reported moderate to severe disability. There were no significant differences for any of the demographic variables (age, gender, marital status, housing), nor stroke severity. Intervention group members reported greater walking and moderate activity than their control group counterparts.
Compared to the control group, the intervention group had lower depression scores at all time points.
About half of both groups showed clinically-significant decreases in depressive symptomatology at 10 week follow-up. Twice as many of the intervention group maintained a reduction in depressive symptoms at six month follow-up.
There were modest improvements in physical health and recovery scores over time, but many health and wellbeing outcome scores were lower than reported in non-depressed groups. The PRT participants demonstrated significant improvements in strength in the post-program 1-RM testing.
Program adherence was good: on average 75 per cent of the 10 week program was completed.
Many participants have chosen to continue with the program.
Implications for policy and practice
The intervention appeared to be feasible within a community-based setting and offers scope for referrals from primary care practitioners, with transport being needed to allow some stroke survivors to access the program.
1. Kroenke, K., R.L. Spitzer, and J.B. Williams, The PHQ-9: validity of a brief depression severity measure, Journal of General Internal Medicine, 2001. 16(9): p. 606 – 13