Abstract DP397: Exercise Rehabilitation Across the Sub-Acute Stroke Period Improves Functional Mobility, Vascular Health, and Reduces Assistive Device Dependency in Afro-Caribbean Stroke Survivors: A Randomized Clinical Trial

Introduction: The health burden of stroke is higher in African-Caribbean populations. Yet, there is a knowledge and resource gap in provision of evidence-based exercise rehabilitation to reduce disability, recurrent stroke, and improve vascular health for African-Caribbean stroke survivors, particularly in low- and middle-income countries (LMIC). This randomized clinical trial investigates the hypothesis that a 6-month exercise program across the sub-acute stroke period will improve functional mobility, reduce disability, and improve vascular health compared to best usual care for Jamaicans of Afro-Caribbean descent with hemiparetic stroke. Methods: This randomized controlled study assigned Jamaican hemiparetic sub-acute stroke survivors to 6 months of 3 per week exercise or control groups receiving standardized medical care. Exercise consisted of progressive treadmill training + group mobility class. Rehabilitation outcomes were timed walks, Berg Balance (BB), Dynamic Gait Index (DGI), and assistive device dependency. Vascular health outcomes were blood pressure, pulse pressure, cardiovascular fitness, and the cardiometabolic energy cost of walking. Primary analyses was repeated measures analyses of variance between groups across 3- and 6-month time points and non-parametric statistics for ordinal data. Results: We randomized N=173, mean age 62 + 12 yrs. at mean 8-weeks post- stroke to exercise (N=48 completers) and control groups (N=54 completers). Exercise compared to controls improved gait velocity (m/s) (0.21±0.20 vs.0.06±0.14; p<0.001), 6-minute walk (m) (76±66 vs. 37±61; p<0.003), BB (4±6 vs.1±6; p<0.03), and DGI (4±4 vs. 1±6;p<0.03); all reaching clinically important differences Table 1). Exercise improved fitness (ml/kg/min, 2.3±2.7 vs.1.1±2.7; p<0.03), reduced energy costs of hemiparetic gait (ml/kg/min, -2.0±2.4 vs.-1.0±1.6;p<0.01), lowered systolic (mmHg, -21±23 vs.-6±28;p<0.003) and diastolic blood pressure (-13±13 vs.-3±13;p<0.001), compared to controls (Table 2). With exercise 78% initially requiring walking assistive devices transitioned to no device, compared with 28% in controls (p<0.03) (Table 1). Conclusions: This study shows that 6 months exercise rehabilitation across the sub-acute stroke period improves functional mobility, reduces neurologic disability, and improves cardiovascular health and secondary stroke prevention profiles in Jamaican stroke survivors, serving as a potential model to reduce stroke burden in LMIC settings.