Eccentric training effects for patients with post-stroke hemiparesis on strength and speed gait: A randomized controlled trial

Abstract

BACKGROUND: In hemiparetic patients, the skeletal muscle is mainly affected with a combination of abnormalities (denervation, remodeling, spasticity, and eventually muscular atrophy). OBJECTIVE: This study examined the role of eccentric exercise in strengthening muscles of the lower extremity and ultimately improving autonomy in patients with post-stroke hemiparesis during gait. METHODS: Thirty-seven patients hemiparetic adults were recruited, randomized into a control group (n = 19) and an intervention group receiving eccentric muscle strengthening (n = 18). The protocol consisted of three sets of five repetitions of eccentric contraction of the paretic limb after determining the maximum repetition (1 MRI). Evaluation of the 1RM, 10 meters and 6WMT was performed before and after the exercise for each group. Manova test was used to compare the differences between the control and intervention groups. RESULTS: The paretic limb showed significant increase in one-repetition maximum (1RM) between before and after rehabilitation (p≤0.00003). The two groups of Patients increased their walking speed (p≤0.0005), but we observed a significant difference between groups only for the 6MWT and not on the 10 meters Test. CONCLUSIONS: Eccentric training can be useful in strengthening the muscles of the lower limbs, and promoting gait performance. Eccentric training could complement other methods of managing patients with post-stroke hemiparesis.

Concepts and Application of Tai Ji in Stroke Rehabilitation: A Narrative Review

“…The justification where this movement improves the lower limb muscle strength leading to better static postural stability can be seen through its form, where it puts the quadriceps in eccentric contraction. According to a randomized controlled trial on hemiparesis patients, eccentric contraction of the quadriceps promotes lower limb strength based on one repetition maximum and gait performance based on six-minute-walk-test ( 67 ), although six-minute-walk-test incorporated with cognitive behavioral-based therapy has promising outcomes in pain ( 68 ). Besides, it was reported that eccentric muscle contractions were more effective for improving neuromuscular activation, strength, and walking speed than concentric contractions ( 69 ).…”

Necessity and Content of Swing Phase Gait Coordination Training Post Stroke; A Case Report

“…A number of researchers have published work that describes the necessity of strength for mobility. For example, others have, reported relationships between strength improvement and gait speed [17][18][19][20], walking endurance [15,16,20], and balance and functional capability [21], but there is mixed evidence regarding recovery of function as a result of strength training. For example, Dorsch et al [50] conducted a systematic review of results from progressive resistance training; they reported a large effect size regarding strength improvement, but notably, there was no definitive effect at the level of activity.…”

“…For example, Dorsch et al [50] conducted a systematic review of results from progressive resistance training; they reported a large effect size regarding strength improvement, but notably, there was no definitive effect at the level of activity. Further, many studies have added importantly to knowledge in the field regarding possible gait training interventions but did not report recovery to normal for gait coordination, function, and life role participation (e.g., [15][16][17][18][19][20][21]51]). This situation begs the question, "What is the missing critical ingredient(s) in gait training interventions which would be sufficient to consistently produce functional and quality of life changes?".…”

“…These clinically familiar compensatory strategies can include one or more of the following: shortened swing phase in which the involved swing limb ends swing phase early by simply 'stepping up to' the position just next to (not beyond, as would normally occur) the opposite stance limb; circumduction of the involved limb by moving the 'stiff' limb' in a rotational arc arising from the hip; excessively plantarflexing the uninvolved stance limb ankle ("vaulting") so that the abnormally straight swinging limb can clear the floor; and laterally leaning toward the uninvolved stance limb for the straight involved limb to clear the floor during its swing phase [14]. Existing evidence of strengthening exercises has shown improvement in some gait characteristics [15][16][17][18][19][20][21], but the exercises provided in these studies did not resolve dyscoordinated gait. Therefore, to address this gap in the literature, this case study of a chronic stroke survivor illustrates response to gait coordination training in the presence of baseline normal muscle strength throughout almost all lower limb muscles at baseline of the study, but also baseline swing phase, treatment-resistant gait dyscoordination.…”

Benefits of Eccentric Training with Emphasis on Demands of Daily Living Activities and Feasibility in Older Adults: A Literature Review

“…The intensity of eccentric exercise in most studies ranged from medium- to high-intensity training, whereas the intensity was typically ≥50% of the maximal eccentric strength, derived from the multiple repetition maximum of eccentric exercise or related to maximal concentric strength (>60% of concentric 1RM—one-repetition maximum) [ 19 , 21 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ]. For instance, Johnson et al [ 19 ] found significant improvements after eccentric training program with intensity ranging from 30% to 50% of the maximal eccentric strength in functional tasks such as 30 s chair raise, timed up and go test, and maximal eccentric strength in the community of dwelling older adults.…”