High-intensity treadmill training improves gait ability, VO2peak and cost of walking in stroke survivors: preliminary results of a pilot randomized controlled trial

Munari, Daniele; Pedrinolla, Anna; Smania, Nicola; Picelli, Alessandro; Gandolfi, Marialuisa; Saltuari, Leopold; Schena, Federico

doi:10.23736/s1973-9087.16.04224-6

Cited by 60 publications

(73 citation statements)

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“…The current findings add to a growing body of evidence showing promising potential for locomotor HIIT to improve stroke rehabilitation outcomes (13)(14)(15)(16)(17)(18)(19)(20). Powered randomized trials with clinically representative samples are now needed to definitively test the efficacy and effectiveness of locomotor HIIT in comparison with alternative strategies for optimizing recovery.…”

Section: Summary Of Implications For Future Studiesmentioning

confidence: 81%

“…This method involves bursts of fast walking alternated with recovery periods to enable vigorous aerobic intensities, using burst and recovery intervals ranging from short (e.g., 30 s) to long (e.g., 3-4 min) (12). Initial longitudinal stroke studies suggest that both short-interval and long-interval locomotor HIIT are feasible, can improve gait function and exercise capacity (13)(14)(15)(16)(17)(18)(19)(20), and could be more efficacious than conventional moderateintensity exercise (15,16).…”

Section: Introductionmentioning

confidence: 99%

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Preliminary Outcomes of Combined Treadmill and Overground High-Intensity Interval Training in Ambulatory Chronic Stroke

et al. 2022

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PurposeLocomotor high-intensity interval training (HIIT) is a promising intervention for stroke rehabilitation. However, overground translation of treadmill speed gains has been somewhat limited, some important outcomes have not been tested and baseline response predictors are poorly understood. This pilot study aimed to guide future research by assessing preliminary outcomes of combined overground and treadmill HIIT.Materials and MethodsTen participants >6 months post-stroke were assessed before and after a 4-week no-intervention control phase and a 4-week treatment phase involving 12 sessions of overground and treadmill HIIT.ResultsOverground and treadmill gait function both improved during the treatment phase relative to the control phase, with overground speed changes averaging 61% of treadmill speed changes (95% CI: 33–89%). Moderate or larger effect sizes were observed for measures of gait performance, balance, fitness, cognition, fatigue, perceived change and brain volume. Participants with baseline comfortable gait speed <0.4 m/s had less absolute improvement in walking capacity but similar proportional and perceived changes.ConclusionsThese findings reinforce the potential of locomotor HIIT research for stroke rehabilitation and provide guidance for more definitive studies. Based on the current results, future locomotor HIIT studies should consider including: (1) both overground and treadmill training; (2) measures of cognition, fatigue and brain volume, to complement typical motor and fitness assessment; and (3) baseline gait speed as a covariate.

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Section: Summary Of Implications For Future Studiesmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Preliminary Outcomes of Combined Treadmill and Overground High-Intensity Interval Training in Ambulatory Chronic Stroke

et al. 2022

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“…There was no clear consensus about an appropriate method for capturing baseline fitness of an individual. This was demonstrated by Munair et al (45) who discussed intensity and its role in exercise prescription and how this needs to be specifically aimed at the appropriate body structure, functional task, or energy system the exercise intervention is being aimed at. They also discussed how other systems such as muscular strength or power may limit an individual reaching the desired level of intensity from a CV perspective.…”

Section: Methods Used In the Testing And Assessing Fitness In Pwsmentioning

confidence: 99%

“…Multiple desired training effects were sought in primary studies and reviewed in both of the systematic review studies. The most common intended training effect was improved walking speed using bodyweight supported treadmill training, used in 14 of the 17 (82%) studies (39,40,(44)(45)(46)(47)(48)(49). Improved CV fitness was used in 13 of the studies (76%) (39,40,44,(50)(51)(52)(53).…”

Section: Desired Training Effectsmentioning

confidence: 99%

What Is Intensity and How Can It Benefit Exercise Intervention in People With Stroke? A Rapid Review

Church¹,

Smith²,

Ali³

et al. 2021

Front. Rehabilit. Sci.

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Background: Stroke is one of the major causes of chronic physical disability in the United Kingdom, typically characterized by unilateral weakness and a loss of muscle power and movement coordination. When combined with pre-existing comorbidities such as cardiac disease and diabetes, it results in reductions in cardiovascular (CV) fitness, physical activity levels, functional capacity, and levels of independent living. High-intensity training protocols have shown promising improvements in fitness and function for people with stroke (PwS). However, it remains unclear how intensity is defined, measured, and prescribed in this population. Further, we do not know what the optimal outcome measures are to capture the benefits of intensive exercise.Aim: To understand how intensity is defined and calibrated in the stroke exercise literature to date and how the benefits of high-intensity training in PwS are measured.Methods: A rapid review of the literature was undertaken to provide an evidence synthesis that would provide more timely information for decision-making (compared with a standard systematic review). Electronic databases were searched (including Medline, PubMed, CINAHL, and Embase for studies from 2015 to 2020). These were screened by title and abstract for inclusion if they: (a) were specific to adult PwS; and (b) were high-intensity exercise interventions. Eligible studies were critically appraised using the Mixed Method Appraisal Tool (MMAT). The data extraction tool recorded the definition of intensity, methods used to measure and progress intensity within sessions, and the outcomes measure used to capture the effects of the exercise intervention.Results: Seventeen studies were selected for review, 15 primary research studies and two literature reviews. Sixteen of the 17 studies were of high quality. Nine of the primary research studies used bodyweight-supported treadmills to achieve the high-intensity training threshold, four used static exercise bikes, and two used isometric arm strengthening. Five of the primary research studies had the aim of increasing walking speed, five aimed to increase CV fitness, three aimed to improve electroencephalogram (EEG) measured cortical evoked potentials and corticospinal excitability, and two investigated any changes in muscle strength. Although only one study gave a clear definition of intensity, all studies clearly defined the high-intensity protocol used, with most (15 out of 17 studies) clearly describing threshold periods of high-intensity activity, followed by rest or active recovery periods (of varying times). All of the studies reviewed used outcomes specific to body structure and function (International Classification of Functioning, Disability, and Health (ICF) constructs), with fewer including outcomes relating to activity and only three outcomes relating to participation. The reported effect of high-intensity training on PwS was promising, however, the underlying impact on neurological, musculoskeletal, and CV systems was not clearly specified.Conclusions: There is a clear lack of definition and understanding about intensity and how thresholds of intensity in this population are used as an intervention. There is also an inconsistency about the most appropriate methods to assess and provide a training protocol based on that assessment. It remains unclear if high-intensity training impacts the desired body system, given the diverse presentation of PwS, from a neuromuscular, CV, functional, and psychosocial perspective. Future work needs to establish a clearer understanding of intensity and the impact of exercise training on multiple body systems in PwS. Further understanding into the appropriate assessment tools to enable appropriate prescription of intensity in exercise intervention is required. Outcomes need to capture measures specific not only to the body system, but also level of function and desired goals of individuals.

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“…3 Initial longitudinal stroke studies suggest that both short-interval and long-interval locomotor HIIT are feasible, can improve gait function & exercise capacity, [4][5][6][7][8][9][10][11] and could be more efficacious than conventional moderate-intensity exercise. 6,7 However, locomotor HIIT has only been tested on a treadmill, and treadmill-only exercise often has limited translation to overground gait improvements after stroke. 6,12,13 Based on the neuroplasticity principle of task-specificity, 14 we proposed combining overground and treadmill HIIT to improve overground translation.…”

Section: Introductionmentioning

confidence: 99%

Preliminary outcomes of combined treadmill and overground high-intensity interval training in ambulatory chronic stroke

Boyne

Doren

Scholl

et al. 2021

Preprint

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Introduction: Locomotor high-intensity interval training (HIIT) is a promising intervention for stroke rehabilitation that typically involves bursts of fast treadmill walking alternated with recovery periods. However, overground translation of treadmill speed gains has been somewhat limited, some important outcomes have not been tested and baseline response predictors are poorly understood. This pilot study aimed to guide future research by assessing preliminary outcomes of combined overground and treadmill HIIT. Methods: Ten participants >6 months post stroke completed a multi-domain assessment battery before and after a 4-week no-intervention control phase, then again after a 4-week treatment phase involving 12 sessions of overground and treadmill HIIT. The primary analyses assessed relative changes in overground and treadmill walking speeds after HIIT, evaluated responsiveness of different outcome measures and estimated effects of baseline gait speed on treatment response. Results: Overground and treadmill gait function both improved during the treatment phase relative to the control phase, with overground speed changes averaging 61% of treadmill speed changes (95% CI: 33-89%). Moderate or larger effect sizes were observed for measures of gait performance, balance, fitness, cognition, fatigue, perceived change and brain volume. Participants with baseline comfortable gait speed <0.4 m/s had less absolute improvement in walking capacity but similar proportional and perceived changes. Discussion: Future locomotor HIIT studies should consider including: 1) both overground and treadmill training; 2) measures of cognition, fatigue and brain volume, to complement typical motor & fitness assessment; and 3) baseline gait speed as a covariate.

show abstract

High-intensity treadmill training improves gait ability, VO2peak and cost of walking in stroke survivors: preliminary results of a pilot randomized controlled trial

Cited by 60 publications

References 0 publications

Preliminary Outcomes of Combined Treadmill and Overground High-Intensity Interval Training in Ambulatory Chronic Stroke

Preliminary Outcomes of Combined Treadmill and Overground High-Intensity Interval Training in Ambulatory Chronic Stroke

What Is Intensity and How Can It Benefit Exercise Intervention in People With Stroke? A Rapid Review

Preliminary outcomes of combined treadmill and overground high-intensity interval training in ambulatory chronic stroke

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