High-intensity treadmill training and self-management for stroke patients undergoing rehabilitation: a feasibility study

Abstract

Background Physical activity undertaken by stroke survivors is generally low. This trial investigated the feasibility of delivering a high-intensity treadmill and self-management program to people with stroke undergoing inpatient rehabilitation and determine whether physical activity, walking ability and cardiorespiratory fitness could be increased. Method A phase I, single-group, pre-post intervention study was conducted with stroke survivors undergoing inpatient rehabilitation who could walk. Participants undertook a high-intensity treadmill and self-management program for up to 30 min, three times a week for 8 weeks under the supervision of their usual physiotherapist. Feasibility was determined by examining compliance, satisfaction and adverse events. Clinical outcomes were amount of physical activity, walking ability, and cardiorespiratory fitness collected pre-training (week 0), post-training (week 8), and at follow-up (week 26). Results Forty stroke survivors participated, completing 10 (SD 6) sessions, 94% at the specified training intensity, with high satisfaction and no adverse events related to the intervention. At week 8, participants completed 2749 steps/day (95% CI 933 to 4564) more physical activity than at week 0. Walking distance increased by 110 m (95% CI 23 to 196), walking speed by 0.24 m/s (95% CI 0.05 to 0.42), and VO2 peak by 0.29 ml/kg/min (95% CI 0.03 to 0.56). At week 26, increases in physical activity, walking distance and speed, and cardiorespiratory fitness were maintained. Conclusions A high-intensity treadmill training program embedded within a self-management approach during inpatient rehabilitation appears feasible and potentially may offer sustained improvements in physical activity, walking ability, fitness, and quality of life. A randomised trial is warranted. Trial registration This feasibility study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12613000764730).

Aerobic Fitness of Elderly Community and Non-Community Individuals After Chronic Stroke

“…10 Previous studies have found evidence to incorporate post-stroke cardiorespiratory training to improve fitness, balance, speed, and walking ability, and that a cardiorespiratory care program can provide improvements in walking ability and fitness, and when the goal is to improve walking ability after stroke, it is important to consider aerobic capacity training. 9,33,34 The fitness levels in non-community ambulators post stroke can be improved not just by walking but also by graded walking, stationary cycle ergometer, resistance and strength training, among other possibilities. 35 Walking speed is considered a vital sign and an indicator of general health 31 and is important for community integration.…”

IMproving Physical ACtivity after stroke via Treadmill training (IMPACT) and self-management: A randomized trial

“…The experimental group received treadmill training and self-management education for 30 min, three times a week for 8 weeks, and usual gait training for 2 days a week. The treadmill training was based on our pilot program 6,7 of up to 30 min walking on a treadmill at an intensity of 40–60% HRR or a Borg Rating of Perceived Exertion 12 of 11–14. Target heart rates were calculated according to the Karvonen method 13 adjusting for beta-blockers.…”

“…In piloting this study, we found that treadmill training to this intensity during inpatient rehabilitation is feasible, is not detrimental to walking pattern, and may result in improved walking ability. 6,7 Furthermore, benefits in cardiorespiratory fitness are often only partially maintained beyond the period of intervention. 4 It is therefore important to support stroke International Journal of Stroke, 17 (10) survivors to exercise independently in the long term.…”

Treadmill Exercise and its Effect on Rehabilitation of Patients after Ischemic strok: A Narrative Study

“…High-Intensity Treadmill Training (HITT) has a positive effect on walking ability, quality of life, cardiorespiratory fitness, compared to Low-Intensity Treadmill Training (LITT) , increased maximal VO2, and the cost of walking in people with chronic stroke [81] . Doing high-intensity exercise on a treadmill as a self-management approach during inpatient rehabilitation can lead to sustained improvement in physical activity, walking ability, fitness, and quality of life [82] . Treadmill exercise with a focus on intensive task-specific training is also a way to facilitate neural plastic brain changes and to strengthen associated motor behavior gains following nerve damage [50] .…”