High-Intensity Interval Training and Moderate-Intensity Continuous Training in Ambulatory Chronic Stroke: Feasibility Study

Boyne, Pierce; Dunning, Kari; Carl, Daniel; Gerson, Myron C.; Khoury, Jane; Rockwell, Bradley; Keeton, Gabriela; Westover, Jennifer; Williams, Alesha; McCarthy, Michael J.; Kissela, Brett M

doi:10.2522/ptj.20150277

Cited by 102 publications

(199 citation statements)

References 52 publications

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“…Six articles met inclusion criteria (Figure ). Study and participant characteristics for three pre‐post studies and three RCTs are presented in Table . All RCTs were rated as good quality according to PEDro score (PEDro = 6‐8).…”

Section: Resultsmentioning

confidence: 99%

“…The mean stroke onset ranged from 13 days to 7 years across studies, with an overall mean onset of 2 years. Participants were in the acute phase of stroke (<1 months) in one study, in the subacute phase (1‐6 months) in one study, and in the chronic phase (>6 months) in four studies . A total of 93 participants had ischemic stroke and 31 had hemorrhagic stroke; one study did not report type of stroke.…”

Section: Resultsmentioning

confidence: 99%

“…Assessments in each study were conducted at baseline and at the completion of intervention. Five studies delivered HIIT on a treadmill, and one study delivered HIIT on a stationary bicycle.…”

Section: Resultsmentioning

confidence: 99%

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Effectiveness of High‐Intensity Interval Training for Fitness and Mobility Post Stroke: A Systematic Review

Wiener

McIntyre

Janssen

et al. 2019

PM&R

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Objective To evaluate the evidence on the effectiveness of high‐intensity interval training (HIIT) in improving fitness and mobility post stroke. Type Systematic review. Literature Survey Medline, Embase, CINAHL, PsycINFO, and Scopus were searched for articles published in English up to January 2018. Methodology Studies were included if the sample was adult human participants with stroke, the sample size was ≥3, and participants received >1 session of HIIT. Study and participant characteristics, treatment protocols, and results were extracted. Synthesis Six studies with a total of 140 participants met inclusion criteria: three randomized controlled trials and three pre‐post studies. HIIT protocols ranged 20 to 30 minutes per session, 2 to 5 times per week, and 2 to 8 weeks in total. HIIT was delivered on a treadmill in five studies and a stationary bicycle in one study. Regarding fitness measures, HIIT produced significant improvements in peak oxygen consumption compared to baseline, but the effect was not significant compared to moderate intensity continuous exercise (MICE). Regarding mobility measures, HIIT produced significant improvements on the 10‐Meter Walk Test (10MWT), 6‐Minute Walk Test (6MWT), Berg Balance Scale (BBS), Functional Ambulation Categories (FAC), Timed Up and Go Test, and Rivermead Motor Assessment compared to baseline. The effect of HIIT was significant compared to MICE on the 10MWT and FAC but not on the 6MWT or BBS. Conclusions There is preliminary evidence that HIIT may be an effective rehabilitation intervention for improving some aspects of cardiorespiratory fitness and mobility post stroke. Level of Evidence I.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Effectiveness of High‐Intensity Interval Training for Fitness and Mobility Post Stroke: A Systematic Review

Wiener

McIntyre

Janssen

et al. 2019

PM&R

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“…The FITT principle, outlining all of the ingredients: frequency, intensity, type and time sheds light on the shortcomings of research to date -delivered with no standard of intensity or citation of error rate that the subjects experience. Recent studies in stroke rehabilitation bear this out in comparing higherintensity training to longer, more moderated-intensity deliveries as well [57]. Recall that dual task training, delivered at a rigorous level, is supported to induce neuroplasticity by the seminal article on such, Kleim and Jones' 2008 writing -directly in the complexity and intensity realms [58].…”

Section: Rehabilitation Of Dual Task In Gait…or Rehabilitation Of Gaimentioning

confidence: 99%

“…Methods in these studies have included sufficient numbers of repetitions, yet have not applied sufficient intensity. The principle of frequency, intensity, type and time (FITT principle) [56], as well as those principles cited of neuroplasticity and motor learning [57,58], lead us to the understanding that it is not the sheer numbers of repetitions or minutes-spent in dual task training, but the level of rigor, complexity, challenge and ultimately intensity -that has the opportunity to make each repetition meaningful and sufficient to induce measurable change. The FITT principle, outlining all of the ingredients: frequency, intensity, type and time sheds light on the shortcomings of research to date -delivered with no standard of intensity or citation of error rate that the subjects experience.…”

Section: Rehabilitation Of Dual Task In Gait…or Rehabilitation Of Gaimentioning

confidence: 99%

Retraining Automaticity: Recovering the Procedural Memory of Walking after Stroke

Mt¹

2017

Phys Med Rehabil Int

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Walking upright, on two feet, without a cane or other assistive device -is perhaps the most ubiquitous and arguably the most human of all procedural memories. Yet, walking did not start out as a procedural memory that we were innately born able to do. How did walking become "automatic", or procedural? Is that capacity lost after stroke? The motor control for walking, while it can be adjusted for environment and task, is a relatively individualized pattern superimposed on many basic similarities from person to person. The pathway by which we develop "our" recognizable pattern of walking includes two essential ingredients. First, we need an environment that allows for locomotion as a primary means of transit (i.e., repetitions). Second, we need sufficient demand (in the form of dual task distractions) to push the organization of the motor control of gait into the more primitive structures of the basal ganglia and cerebellum. Our recognizable "walk", evolves over time and, barring injury or change in somatotype (e.g., significant weight gain or loss), remains relatively constant through our adult years. In this paper, we will discuss both what is known in regard to creating this procedural memory, and what is known about re-creating this level of automaticity, particularly after stroke.

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Optimal Intensity and Duration of Walking Rehabilitation in Patients With Chronic Stroke

et al. 2023

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ImportanceFor walking rehabilitation after stroke, training intensity and duration are critical dosing parameters that lack optimization.ObjectiveTo assess the optimal training intensity (vigorous vs moderate) and minimum training duration (4, 8, or 12 weeks) needed to maximize immediate improvement in walking capacity in patients with chronic stroke.Design, Setting, and ParticipantsThis multicenter randomized clinical trial using an intent-to-treat analysis was conducted from January 2019 to April 2022 at rehabilitation and exercise research laboratories. Survivors of a single stroke who were aged 40 to 80 years and had persistent walking limitations 6 months or more after the stroke were enrolled.InterventionsParticipants were randomized 1:1 to high-intensity interval training (HIIT) or moderate-intensity aerobic training (MAT), each involving 45 minutes of walking practice 3 times per week for 12 weeks. The HIIT protocol used repeated 30-second bursts of walking at maximum safe speed, alternated with 30- to 60-second rest periods, targeting a mean aerobic intensity above 60% of the heart rate reserve (HRR). The MAT protocol used continuous walking with speed adjusted to maintain an initial target of 40% of the HRR, progressing up to 60% of the HRR as tolerated.Main Outcomes and MeasuresThe main outcome was 6-minute walk test distance. Outcomes were assessed by blinded raters after 4, 8, and 12 weeks of training.ResultsOf 55 participants (mean [SD] age, 63 [10] years; 36 male [65.5%]), 27 were randomized to HIIT and 28 to MAT. The mean (SD) time since stroke was 2.5 (1.3) years, and mean (SD) 6-minute walk test distance at baseline was 239 (132) m. Participants attended 1675 of 1980 planned treatment visits (84.6%) and 197 of 220 planned testing visits (89.5%). No serious adverse events related to study procedures occurred. Groups had similar 6-minute walk test distance changes after 4 weeks (HIIT, 27 m [95% CI, 6-48 m]; MAT, 12 m [95% CI, −9 to 33 m]; mean difference, 15 m [95% CI, −13 to 42 m]; P = .28), but HIIT elicited greater gains after 8 weeks (58 m [95% CI, 39-76 m] vs 29 m [95% CI, 9-48 m]; mean difference, 29 m [95% CI, 5-54 m]; P = .02) and 12 weeks (71 m [95% CI, 49-94 m] vs 27 m [95% CI, 3-50 m]; mean difference, 44 m [95% CI, 14-74 m]; P = .005) of training; HIIT also showed greater improvements than MAT on some secondary measures of gait speed and fatigue.Conclusions and RelevanceThese findings show proof of concept that vigorous training intensity is a critical dosing parameter for walking rehabilitation. In patients with chronic stroke, vigorous walking exercise produced significant and meaningful gains in walking capacity with only 4 weeks of training, but at least 12 weeks were needed to maximize immediate gains.Trial RegistrationClinicalTrials.gov Identifier: NCT03760016

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High-Intensity Interval Training and Moderate-Intensity Continuous Training in Ambulatory Chronic Stroke: Feasibility Study

Abstract: Although further protocol optimization is needed to improve overground translation of treadmill gains, a definitive RCT comparing HIT and MCT appears to be feasible and warranted.

Cited by 102 publications

References 52 publications

Effectiveness of High‐Intensity Interval Training for Fitness and Mobility Post Stroke: A Systematic Review

Effectiveness of High‐Intensity Interval Training for Fitness and Mobility Post Stroke: A Systematic Review

Retraining Automaticity: Recovering the Procedural Memory of Walking after Stroke

Optimal Intensity and Duration of Walking Rehabilitation in Patients With Chronic Stroke

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