A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).

Stroke (also called cerebrovascular accident) is a debilitating condition that can cause an array of physical and cognitive disabilities. According to the American Heart Association, stroke is a leading cause of serious long-term disability. Prior research has demonstrated the benefits of exercise and increased physical activity in people after a stroke that could lead to potential improvement in physical function, cognitive function, and general quality of life. Despite these potential benefits, people who are living with the effects of a stroke may find it challenging to engage in physical activity and, as a result, may spend the majority of their time sedentary.

One of the challenges may be finding an enjoyable physical activity that is doable, effective, and can be engaged long-term. However, beyond conventional exercise interventions, there have historically been few alternative options for evidence-based activity programs for people post-stroke. The incorporation of music into an exercise program is one alternative that has shown some promise for facilitating physical activity and improving the quality of life in people after a stroke. One such potential alternative  is the Movement-to-Music (M2M) program -- a rhythmic-based exercise program that uses a combination of movement patterns choreographed with music. In past research trials, people with multiple sclerosis who participated in the M2M program showed improvement in mobility and walking endurance.  In a recent NIDILRR-funded study, researchers tested the program with adults who were post-stroke. They wanted to see whether M2M would have an impact on participants’ health and physical function.

Researchers studying Dose-Response Effects of Transformative Exercise in Improving Health and Function in Adults with Stroke and Multiple Sclerosis enrolled 47 participants between the ages of 18 and 65 who were at more than 6 months post-stroke. The participants had lived with the effects of their stroke for an average of about 9 years. All had been cleared by their doctor to participate in an exercise program and were able to maintain sitting and standing balance and to walk with or without an assistive device. The 47 participants were randomly assigned to 2 groups: The M2M group and a control group. The M2M group received three 60-minute sessions per week of the M2M program for 12 weeks. It included a variety of movement combinations that were choreographed to music. Each session started with seated warm-up routines focused on range of motion of the arms and legs. From there, it progressed to arm strengthening in the sitting position, followed by endurance, strengthening, and balance routines for the legs in sitting and/or standing. The control group participants were instructed to continue with their usual activities for 12 weeks. Those participants also received a biweekly educational newsletter with information on nutrition, physical activity, fatigue, health policy, motivation, and coping.

The researchers collected demographic data on all participants (i.e., age, sex, and race). Before and after the 12-week program, the participants in both groups completed three physical fitness tests. First, the participants completed the “Timed Up and Go” test to test their mobility and balance. The researchers measured how long the participants took to stand up from a chair, walk a distance of 3 meters, turn around, walk back, and sit down.  Second, the participants completed the “6-Minute Walk Test” to test their walking endurance. The researchers measured the distance the participants could walk in a 6-minute time period. Third, the participants completed the “Five Times Sit-to-Stand Test” to test their functional leg strength, where they were timed in how long it took for them to stand up and sit down five times. Finally, the participants answered two questionnaires about how often they experienced fatigue and how much pain interfered with their everyday activities.

At the end of the 12 weeks, the researchers compared the fitness, fatigue, and pain measurements for both groups and found the following:

• M2M participants were able to walk longer distances during the 6-Minute Walk Test compared to the control participants (i.e., increased walking endurance).
• M2M participants demonstrated decrease in the Five Times Sit-to-Stand Test time compared to the control participants (i.e., increased functional leg strength).
• M2M participants reported less fatigue compared to the control participants.
• Neither group increased their Timed Up and Go scores (i.e., mobility and balance).

The authors noted that, despite some improvements in walking endurance and functional leg strength, the Timed Up and Go performance remained generally unchanged for the M2M participants. They suggested this may be due to this test requiring a greater number of more complex movements: standing up, walking forward, walking while turning, and walking back to sit down. They suggested that future research may be beneficial for looking at incorporating more specific elements within the M2M intervention for people post-stroke. This may help provide insight into designing movement or exercise interventions with enough sessions to maximize improvement in mobility and balance in people post-stroke. The authors also noted that, though fatigue appears to have improved in this study, they couldn’t pinpoint the underlying specific source of the improvement--whether it was music only, movement only, or a combination of both that helped reduce fatigue. They suggested that future research may help to understand how each of these facets impact fatigue.

The authors noted that this was a small study, with participants who had diverse ability to move and balance. They also noted that participants with hemiparesis required adaptations which were provided during the group sessions, and it may have led to participants without hemiparesis getting less than adequate amount of exercise and hence less training effect and improvement in the measurements. Future research may want to test M2M with a larger sample, or a sample of people with similar levels of physical function. The results of the study offer a promising glimpse into potential alternative interventions for improving the physical functioning and quality of life for people post-stroke.

To Learn More

Research In Focus covered a previous trial of Movement to Music with people with multiple sclerosis. Read about that study in Moving to Music Shows Promise to Improve Fitness for People with MS.

Movement 2 Music continues to be studied and expanded under new grants: 

• Learn more about the Scale-Up of an Innovative, Evidence-Based Movement-2-Music (M2M) Intervention for Adults with Physical/Mobility Disability.
• Learn about the SCIpe-Exercise Program for People with Spinal Cord Injury.

The National Center on Health, Physical Activity, and Disability (NCHPAD) has a wealth of information and resources on ways to engage in adaptive programs, sports, and inclusive wellness. Learn about exercise/physical fitness following stroke.

To Learn More About this Study

Hui-Ju Young, Tapan S. Mehta, Cassandra Herman, Navneet Kaur Baidwan, Byron Lai, and James H. Rimmer. (2021) Effects of a Novel Movement-to-Music (M2M) Intervention on Physical and Psychosocial Outcomes in People Poststroke: A Randomized Controlled Trial. Archives of Rehabilitation Research and Clinical Translation (2021), This article is available from the NARIC collection under Accession Number J87543 and free in full text from the publisher.