Treadmill Exercise in Patients with Chronic Stroke
Abstract by Pandit Tejal
Macko, R. R., Ivey, F. M., Forrester, L. W., Hanley, D., Sorkin, J. D., Katzel, L. I., et al. (2005). Treadmill exercise rehabilitation improves ambulatory function and cardiovascular fitness in patients with chronic stroke: A randomized, controlled trial. Stroke, 36(10), 2206-11.
The purpose of this study was to determine whether treadmill aerobic training (T-AEX) is more efficient than conventional rehabilitation in improving ambulatory function and cardiovascular fitness in patients with chronic stroke.
A total of 61 participants were recruited for the study. Requirements entailed the participants to be over age 45 and diagnosed with chronic hemiparetic gait after ischemic stroke for more than 6 months.
Participants were randomly selected into two groups: A treadmill group, which received treadmill aerobic training (T-AEX); and a R-CONTROL group, which received conventional therapy consisting of stretching and low-intensity treadmill training. Both groups were scheduled for an extra 72 training sessions, equaling 48 hours of training across 6 months.
Several types of tests and measures were administered during this study, including categories of Exercise Testing (treadmill tolerance test), Ambulatory Performance Measures (30-ft/6-mn walks), and Functional Mobility (Rivermead Mobility Index (RMI) and Walking Impairment Questionnaire (WIQ)). Repeated measures of analysis of variance (ANOVA) were used to predict values of outcomes.
From the T-AEX group, 25 participants completed the training, compared to 20 participants in the R-CONTROL group who completed the training. The T-AEX group was more effective in improving cardiovascular fitness levels (17%, P<0.005). Group-by-time analysis showed that T-AEX group improved performance on the 6-minute walk (30%, P<0.01). The group also improved WIQ-distance scores (P<0.05). Increase in treadmill training duration predicted improvements in 6-minute walks (r=0.41, p<0.05), and increase in treadmill training velocity predicted gains in VO2 (r=0.43, P<0.05). Overall, there was no significant group-by time interaction for economy of gait and RMI scores with T-AEX compared to R-CONTROL.
The T-AEX participants demonstrated greater improvements in cardiovascular fitness and in the functional mobility measurements. However, certain specific features of the exercise prescription unique to each participant's abilities may determine the nature of adaptations in motor function versus cardiovascular fitness. In general, further research is needed to determine whether task-oriented exercise can improve long-term functional independence and cardiovascular health in chronic stroke patients.