Enhancing Mobility and Psychosocial Function in Stroke Survivors Who Are Overweight via Weight Loss and Exercise (EMPOWER): A Feasibility Trial

Research Objectives: To investigate the feasibility and effectiveness of an intentional weight-management program, in chronic stroke survivors, with and without exercise. Despite an abundance of information regarding weight loss approaches in neurologically healthy individuals, there is a lack of information regarding the impact of intentional weight loss strategies in this population. With a surviving cohort of nearly 7 million individuals, stroke is a leading cause of long-term disability in the United States. Concurrently, obesity is highly prevalent in stroke survivors (~30-45% of stroke survivors have a BMI>30) and is associated with increased levels of disability and risk for numerous adverse health-related outcomes, including re-occurrence of stroke and all-cause mortality. Thus, exploration is both warranted and needed.

Design: Randomized parallel arm

Setting: Community setting.

Participants: Community-dwelling chronic (>6 months) stroke survivors.

Interventions: Participants were randomized into 1) weight management intervention alone (WL), or 2) weight management intervention plus structured exercise (WL+EX). WL participants received a 15-week lifestyle weight management program. The WL program involved weekly meetings with personnel on a multidisciplinary team, and meal plans for a hypocaloric diet, based around a progressive three-phase weight management system. WL+EX participants received the same weight management intervention plus multicomponent supervised exercise thrice weekly.

Main Outcome Measures: Feasibility was assessed through adherence, acceptability, retention and adverse events. Anthropometric (weight), physical function (balance, gait, and walking parameters), and health-related quality of life (Stroke Impact Scale-SIS version 3.0) were assessed as primary outcome measure following feasibility.

Results: Participants (n=8; 56.89.9 yrs), with class II obesity (BMI 35.66.6 kg/m2). Notably, WL+EX participants (n=4) had significantly greater adherence to the WL intervention (98% session attendance rate) than the WL only group (n=4; 72% session attendance rate; p=0.049). Furthermore, WL+EX participants completed the intervention sessions over the intended duration (mean 111% of intended duration), while WL alone participants took longer (119% of intended duration). Both groups experienced significant reductions in weight (WL: mean -5.1 kg, p=0.010; WL+EX: mean -13.6 kg, p=0.015) and BMI (WL: mean -1.6 kg/m2, p=0.010; WL+EX: mean -4.7 kg/m2, p=0.015). WL+EX participants experienced significant improvements in 6-minute walk test (18.71%, dz=-1.58), and SIS score (7.65%, dz=-1.32), whilst none were observed in the WL group.

Conclusions: Multicomponent lifestyle interventions appear to be a feasible modality to achieve clinically meaningful (>5%) weight loss in chronic stroke survivors. However, inclusion of group exercise may be a critical component for achieving greater weight loss, as well as intervention adherence and improvements in physical function among participants.

Author(s) Disclosures: None to disclose.