Cardiopulmonary Response During Exercise of a β1-Selective β-Blocker (Atenolol) and a Calcium-Channel Blocker (Diltiazem) in Untrained Subjects with Hypertension

Neurorehabil Neural Repair

Straube

Kinnaird

et al. 2014

136

Background Previous data suggest the amount and aerobic intensity of stepping training may improve walking post-stroke. Recent animal and human studies suggest training in challenging and variable contexts can also improve locomotor function. Such practice may elicit substantial stepping errors, although alterations in locomotor strategies to correct these errors could lead to improved walking ability. Objective This un-blinded, pretest-posttest pilot study was designed to evaluate the feasibility and preliminary efficacy of providing stepping practice in variable, challenging contexts (tasks and environments) at high aerobic intensities in participants with chronic (< 6 months) and subacute (1–6 months) stroke. Methods Twenty-five participants with stroke (gait speeds < 0.9 m/s with no more than moderate assistance) participated in ≤ 40 1-hr training sessions within 10 weeks. Stepping training in variable, challenging contexts was performed at 70–80% heart rate reserve, with feasibility measures of total steps/session, ability to achieve targeted intensities, patient tolerance, dropouts, and adverse events. Measures of daily stepping, gait speed, symmetry, and 6-min walk were performed every 4–5 weeks or 20 sessions with a 3 month follow-up. Results Twenty-two participants completed ≥ 4 weeks of training, averaging 2887±780 steps/session over 36±5.8 sessions. Self-selected and fastest speed, paretic single limb stance, and 6-min walk improved significantly at post-training and follow-up. Conclusions This preliminary study suggests stepping training at high aerobic intensity in variable contexts was tolerated by participants post-stroke, with significant locomotor improvements. Future trials should delineate the relative contributions of amount, intensity and variability of stepping training to maximize outcomes.

Section: Methodsmentioning

confidence: 99%

Feasibility and Potential Efficacy of High-Intensity Stepping Training in Variable Contexts in Subacute and Chronic Stroke

Neurorehabil Neural Repair

Straube

Kinnaird

et al. 2014

136

“…For individuals on β-blockers, the target HR training zone was lowered 10 bpm. 35 Participants were provided up to 40 1-hr training sessions over 10 weeks. During each session, subjects performed up to 40 minutes of stepping with rest breaks as needed.…”

Section: Methodsmentioning

confidence: 99%

Alterations in Aerobic Exercise Performance and Gait Economy Following High-Intensity Dynamic Stepping Training in Persons With Subacute Stroke

Leddy

Connolly

Journal of Neurologic Physical Therapy

et al. 2016

Background and Purpose Impairments in metabolic capacity and economy (O2cost) are hallmark characteristics of locomotor dysfunction following stroke. High-intensity (aerobic) training has been shown to improve peak oxygen consumption in this population, with fewer reports of changes in O2cost. However, inconsistent gains in walking function are observed, particularly in persons with subacute stroke, with minimal associations with gains in metabolic parameters. The purpose of this study was to evaluate changes in aerobic exercise performance in participants with subacute stroke following high-intensity, variable stepping training as compared to conventional therapy. Methods A secondary analysis was performed from a randomized controlled trial (RCT ) comparing high-intensity training to conventional interventions, and a pilot study that formed the basis for the RCT. Participants 1–6 months post-stroke received ≤40 sessions of high intensity variable stepping training (n=21) or conventional interventions (n=12). Assessments were performed at baseline (BSL), post-training and 2–3 month follow-up, and included changes in submaximal VO2 (VO2submax) and O2cost at fastest possible treadmill speeds and peak speeds at BSL testing. Results Significant improvements were observed in VO2submax with less consistent decreases in O2cost, although individual responses varied substantially. Combined changes in both VO2submax and VO2 at matched peak BSL speeds revealed stronger correlations to improvements in walking function as compared to either measure alone. Conclusions High-intensity stepping training may elicit significant improvements in VO2submax, while changes in both peak capacity and economy better reflect gains in walking function. Providing such training to improve locomotor and aerobic exercise performance may increase the efficiency of rehabilitation sessions. See Video Abstract available for more insights from the authors (see supplemental digital content).

“…25 The Borg Rating of Perceived Exertion 26 (RPE; ordinal 6-20 scale) was also assessed, with scores ≥14 (ie, >13 or "somewhat hard") targeted and documented similarly. Patients with significant cardiorespiratory disease were not excluded, although targeted HR ranges were reduced as prescribed by the treating physician.…”

Section: Interventionsmentioning

confidence: 99%

Feasibility of Focused Stepping Practice During Inpatient Rehabilitation Poststroke and Potential Contributions to Mobility Outcomes

Hornby

Neurorehabil Neural Repair

Leddy

et al. 2015