Treadmill Exercise Rehabilitation Improves Ambulatory Function and Cardiovascular Fitness in Patients With Chronic Stroke

Abstract

Background and Purpose-Physical inactivity propagates disability after stroke through physical deconditioning and learned nonuse. We investigated whether treadmill aerobic training (T-AEX) is more effective than conventional rehabilitation to improve ambulatory function and cardiovascular fitness in patients with chronic stroke. Methods-Sixty-one adults with chronic hemiparetic gait after ischemic stroke (Ͼ6 months) were randomized to 6 months (3ϫ/week) progressive T-AEX or a reference rehabilitation program of stretching plus low-intensity walking (R-CONTROL). Peak exercise capacity (VO 2 peak), O 2 consumption during submaximal effort walking (economy of gait), timed walks, Walking Impairment Questionnaire (WIQ), and Rivermead Mobility Index (RMI) were measured before and after 3 and 6 months of training. Results-Twenty-five patients completed T-AEX and 20 completed R-CONTROL. Only T-AEX increased cardiovascular fitness (17% versus 3%, ␦% T-AEX versus R-CONTROL, PϽ0.005). Group-by-time analyses revealed T-AEXimproved ambulatory performance on 6-minute walks (30% versus 11%, PϽ0.02) and mobility function indexed by WIQ distance scores (56% versus 12%, PϽ0.05). In the T-AEX group, increasing training velocity predicted improved VO 2 peak (rϭ0.43, PϽ0.05), but not walking function. In contrast, increasing training session duration predicted improved 6-minute walk (rϭ0.41, PϽ0.05), but not fitness gains. Conclusions-T-AEX

Task-oriented treadmill exercise training in chronic hemiparetic stroke

“…[42]. This result supports the rationale for long-term exercise after stroke, which is consistent with public health recommendations for sustained regular exercise to improve fitness and cardiovascular health for all Americans.…”

“…Results show that the time profile of cardiovascular fitness gains with regular TM exercise training are progressive and nearly equal across the initial 3 months and months 3 to 6 poststroke (Figure 2) [42]. No evidence of a plateau exists, which suggests that training even beyond 6 months may produce further benefits in peak fitness levels.…”

“…The latter principle of progression raises fundamental questions regarding which exercise formulas can optimally improve functional and metabolic health outcomes. As a starting point, we developed a conservative, low-intensity, progressive aerobic exercise program based on cardiac rehabilitation that is adjusted to baseline cardiopulmonary tolerance and gait deficit severity for patients with stroke [41][42][43][44][45]. The following sections provide an overview of our exercise protocols and safety data that have been used in randomized controlled studies on improving fitness and ambulatory function in older individuals with chronic hemiparetic gait following stroke.…”

“…Using this protocol, we have 88 percent compliance for three time a week exercise attendance with no adverse events, somatic complaints, or overuse syndromes compared with matched control subjects who perform supervised stretching exercises [42]. Training duration can be expected to increase by 240 percent and training velocity by 35 percent across 6 months [42].…”

“…Training duration can be expected to increase by 240 percent and training velocity by 35 percent across 6 months [42]. However, these limited data do not fully define stroke patients' ability to progress in training capacity nor do they define the training parameters needed to optimize functional and cardiovascular health gains.…”