Effects of inclined treadmill training on functional and cardiovascular parameters of stroke patients: study protocol for a randomized controlled trial

Abstract

Background Treadmill training has been widely used for gait recovery after stroke. Gait re-establishment is one of the main objectives of rehabilitation programs after stroke, aiming to acquire more functional patterns and increase walking speed, along with improvement in cardiovascular function. The aim of this study is to evaluate the effects of a treadmill gait training protocol on functional and cardiovascular variables in patients with chronic stroke. Methods A single-blind randomized clinical trial will be conducted. The sample will consist of 36 patients, who will be allocated in three groups: control group (n = 12), experimental group 1 (n = 12), and experimental group 2 (n = 12). The intervention will occur for 6 consecutive weeks, three times a week, 30 min each session, in all groups. The control group will perform a treadmill gait training without inclination, experimental group 1 will perform a treadmill gait training with anterior inclination of 5%, and experimental group 2 will perform a treadmill gait training with anterior inclination of 10%. All participants will be assessed for sample characterization measures, gait speed, functional capacity, systemic arterial blood pressure, heart rate, peripheral oxygen saturation, exercise capacity, neuromuscular torque, and quality of life. Evaluations of outcome measures will occur at the end of the interventions (post-training) and after 1 month and 1 year after the end of the interventions (short- and long-term follow-up). Statistical analysis will be performed descriptively and inferentially. Alpha equals 5% will be considered for inferential analysis. Mixed analysis of variance with repeated measures will be used to compare outcome measures between groups and between baseline, post-training, and follow-up. Normality test (Shapiro–Wilk) and subsequently t test (or Mann–Whitney) will be used to compare groups during the same training session. Discussion It is believed that treadmill training, especially treadmill training with anterior inclination, may result in improved exercise capacity in patients with stroke, reduced blood pressure and heart rate values, and an improvement in functional parameters with increased gait speed, functional capacity, quadriceps muscle torque, and quality of life. Trial registration Registration in Brazilian Registry of Clinical Trials (ReBEC) identifier RBR-5ffbxz , date of registration October 25 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3298-3) contains supplementary material, which is available to authorized users.

Effect of Exercise Using an Exoskeletal Hip-Assist Robot on Physical Function and Walking Efficiency in Older Adults

“…Using a treadmill to exercise instead of walking outside can reduce the risk of injury to the hip, knee, and ankle joints because an inclined treadmill increases intensity levels without stressing the body's joints. Previous studies have indicated that gait training on an inclined treadmill can be helpful for maintaining muscle strength and heart health [54][55][56]. The results of this study suggest that intensive inclined treadmill exercise with an EX1 may lead to improved mobility and balance in older adults.…”

Effect of Different Treadmill Inclination Training on Postural Balance in Elderly

“…Kim et al, [17] found that the activities of trunk muscles and quadriceps femoris muscle increased as the inclination of treadmill increased during walking. Also, Raiff et al, [12] discovered that walking on inclined treadmill helps in improvement of postural balance during gait as result of increased dorsiflexion to accommodate the vertical orientation of the torso and the pelvis during the ascent phase. This leads to improve dorsiflexion activation and mechanical properties of muscles involved in planter flexion.…”

“…Upslope walking increases the ankle dorsiflexion which occurs to accommodate the vertical orientation of the torso and pelvis during the ascent phase. This also contribute to improve dorsiflexion activation or mechanical properties of muscles involved in planter-flexion [12].…”

Single-session training on an ascending treadmill slope: effects on gait parameters in persons with stroke. A pilot study

“…5.71°) appeared to be the most relevant, realistically feasible for 20 min of single-session training in persons with stroke and induced greater changes on previous studies [18,19]. The same choice was made in a recently published protocol [22]. The incline was in place throughout the whole session and the treadmill speed was increased progressively over a few minutes until aim the participant's comfortable gait speed measured overground.…”

“…The posteffects of a training session on an ascending treadmill slope on all the biomechanical gait parameters in persons with stroke have not yet been evaluated. This relevant field of research is currently studied with a published protocol assessing the effects of inclined treadmill training on walking speed and cardiovascular function in persons with stroke [22].…”