Treadmill training improves fitness reserve in chronic stroke patients

Macko, Richard F.; Smith, Gerald V.; Dobrovolny, C.Lynne; Sorkin, John D.; Goldberg, Andrew P.; Silver, Kenneth H.

doi:10.1053/apmr.2001.23853

Cited by 307 publications

(240 citation statements)

References 31 publications

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“…Our initial TM stress testing cohort revealed previously undiagnosed asymptotic myocardial ischemia in 29 percent of stroke patients, which is consistent with other reports [45] and highlights the importance of careful cardiac screening in this high CVD risk population. Patients eligible for exercise training included those who could successfully complete 3 consecutive minutes of TM walking at ≥0.13 m/s (≥0.3 mph) and 0° incline without significant signs of myocardial ischemia or other contraindications to participation in regular aerobic exercise training.…”

Section: Treadmill Testing and Training Protocolssupporting

confidence: 90%

“…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.…”

Section: Task-oriented Training: Combining Locomotor Learning With Aementioning

confidence: 99%

“…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. TM training improves physiological fitness reserve in chronic stroke patients by increasing VO 2 while lowering the energy cost of hemiparetic gait [45]. These improvements may enhance functional mobility in chronic stroke by increasing peak ambulatory workload capacity and enabling basic mobility ADL to be performed at a lower percentage of peak exercise capacity [43].…”

Section: Effects Of Treadmill Training On Fitness and Economy Of Gaitmentioning

confidence: 99%

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Task-oriented treadmill exercise training in chronic hemiparetic stroke

Ivey

Hafer‐Macko²,

Macko³

2008

JRRD

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Abstract-Patients with stroke have elevated hemiparetic gait costs secondary to low activity levels and are often severely deconditioned. Decrements in peak aerobic capacity affect functional ability and cardiovascular-metabolic health and may be partially mediated by molecular changes in hemiparetic skeletal muscle. Conventional rehabilitation is time delimited in the subacute stroke phase and does not provide adequate aerobic intensity to reverse the profound detriments to fitness and function that result from stroke. Hence, we have studied progressive full body weight-support treadmill (TM) training as an adjunct therapy in the chronic stroke phase. Task-oriented TM training has produced measurable changes in fitness, function, and indices of cardiovascular-metabolic health after stroke, but the precise mechanisms for these changes remain under investigation. Further, the optimal dose of this therapy has yet to be identified for individuals with stroke and may vary as a function of deficit severity and outcome goals. This article summarizes the functional and metabolic decline caused by inactivity after stroke and provides current evidence that supports the use of TM training during the chronic stroke phase, with protocols and inclusion/exclusion criteria described. Our research findings are discussed in relation to associated research.Key words: aerobic activity, ambulatory function, cardiovascular disease risk, exercise training, hemiplegia, metabolic health, physical deconditioning, rehabilitation, stroke, treadmill. PROBLEM OF POSTSTROKE DECONDITIONINGStroke is a leading cause of disability [1][2][3][4], with residual neurological deficits that persistently impair function and lead to profound physical deconditioning [5][6]. By limiting mobility and increasing fall risk, the hemiparetic gait that accompanies chronic stroke promotes a sedentary lifestyle, which leads to disability through deconditioning and "learned non-use" [7][8]. Peak cardiovascular fitness levels following hemiparetic stroke are roughly half those of age-matched sedentary individuals [5,[9][10]. Further, the energy requirements of hemiparetic gait are elevated by 55 to 100 percent compared with age-matched control subjects [11][12]. This detrimental combination of poor peak exercise capacity and elevated energy demands for hemiparetic gait is termed diminished physiological fitness reserve [13]. The cardiovascular deconditioning coupled with the secondary body composition abnormalities that follow stroke Abbreviations: ACSM = American College of Sports Medicine, ADL = activities of daily living, BMI = body mass index, CVD = cardiovascular disease, ECG = electrocardiogram, HR = heart rate, HRR = HR reserve, IGT = impaired glucose tolerance, MHC = myosin heavy chain, T2DM = type 2 diabetes mellitus, TM = treadmill, TNF-α = tumor necrosis factor-α, WIQ = Walking Impairment Questionnaire, VA = Department of Veterans Affairs, VO 2 = peak oxygen consumption.

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Section: Treadmill Testing and Training Protocolssupporting

confidence: 90%

Section: Task-oriented Training: Combining Locomotor Learning With Aementioning

confidence: 99%

Section: Effects Of Treadmill Training On Fitness and Economy Of Gaitmentioning

confidence: 99%

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Task-oriented treadmill exercise training in chronic hemiparetic stroke

Ivey

Hafer‐Macko²,

Macko³

2008

JRRD

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“…A similar protocol was used by Chin et al [21] to evaluate the fitness of young adult traumatic amputees (mean age: 26.0 AE 5.7 years) pedalling one lower limb at a time with their healthy lower limb. The mean maximal workload that patients could reach was 67.6 AE 20.2 W, whereas healthy subjects could reach 102.4 AE 33.6 W. This low working capacity could also be explained by cardiovascular deconditioning and comorbidities [22], neurological impairments [24], muscular atrophy, decreased lean tissue mass and increased intramuscular-fat in paretic lower limb [23].…”

Section: Working Capacitymentioning

confidence: 99%

Efficiency of work production by spastic muscles

et al. 2005

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“…Possible strategies could include pharmaceuticals [50][51], functional electrical stimulation [30,53], and aerobic or resistive exercise training. The beneficial effects of aerobic exercise training have been demonstrated in stroke [17,[54][55][56] and SCI rehabilitation programs [57][58][59][60]. Proposed influences of stroke on skeletal muscle and possible gene clusters induced by these muscle changes.…”

Section: Discussionmentioning

confidence: 99%

Human genome comparison of paretic and nonparetic vastus lateralis muscle in patients with hemiparetic stroke

McKenzie

Yu²,

Macko³

et al. 2008

JRRD

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Hemiparetic stroke leads to major skeletal muscle abnormalities, as illustrated by paretic leg atrophy, weakness, and spasticity. Furthermore, the hemiparetic limb muscle shifts to a fast-twitch muscle fiber phenotype with anaerobic metabolism. This study investigated whether skeletal muscle genes were altered in chronic hemiparetic stroke. The nonparetic leg muscle served as an internal control. We used Affymetrix microarray analysis to survey gene expression differences between paretic and nonparetic vastus lateralis muscle punch biopsies from 10 subjects with chronic hemiparetic stroke. Stroke latency was greater than 6 months. We found that 116 genes were significantly altered between the paretic and nonparetic vastus lateralis muscles. These gene differences were consistent with reported differences after stroke in areas such as injury and inflammation markers, the myosin heavy chain profile, and high prevalence of impaired glucose tolerance and type 2 diabetes. Furthermore, while many other families of genes were altered, the gene families with the most genes altered included inflammation, cell cycle regulation, signal transduction, metabolism, and muscle contractile protein genes. This study is an early step toward identification of specific gene regulatory pathways that might lead to these differences, propagate disability, and increase vascular disease risk.

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Treadmill training improves fitness reserve in chronic stroke patients

Cited by 307 publications

References 31 publications

Task-oriented treadmill exercise training in chronic hemiparetic stroke

Task-oriented treadmill exercise training in chronic hemiparetic stroke

Efficiency of work production by spastic muscles

Human genome comparison of paretic and nonparetic vastus lateralis muscle in patients with hemiparetic stroke

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