Treadmill Aerobic Exercise Training Reduces the Energy Expenditure and Cardiovascular Demands of Hemiparetic Gait in Chronic Stroke Patients

Macko, Richard F.; DeSouza, Christopher A.; Tretter, L. D.; Silver, Kenneth H.; Smith, Gerald V.; Anderson, Paul A.; Tomoyasu, Naomi; Gorman, Peter H.; Dengel, Donald R.

doi:10.1161/01.str.28.2.326

Cited by 234 publications

(166 citation statements)

References 20 publications

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“…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%

“…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: Task-oriented Training: Combining Locomotor Learning With Aementioning

confidence: 99%

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

confidence: 99%

Task-oriented treadmill exercise training in chronic hemiparetic stroke

Ivey

Hafer‐Macko²,

Macko³

2008

JRRD

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“…Treadmill gait training enhances the muscle strength and balance ability of the lower extremities 17,18) , and has been reported to be a more effective method than classic approaches stressing independent elements of gait 19,20) . However, there have been conflicting reports about the effects of treadmill gait training.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of the Effects of Overground Gait Training and Treadmill Gait Training According to Stroke Patients’ Gait Velocity

et al. 2013

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Abstract.[Purpose] The purpose of this study was to compare the effects of overground gait training (OGT) and treadmill gait training (TGT) on walking speed, gait endurance, and balance ability of subjects with stroke. [Subjects and Methods] The study subjects were 40 patients with stroke. They were randomly divided into two groups, the OGT group and the TGT group, and further categorized according to their individual walking speeds (slow <0.5 m/s and fast >0.5 m/s). The groups performed exercises 10 times for a week. Pre-and post-test assessments involved the measurement of walking speed, walking endurance, and balance ability, as assessed by the 10-m walking time, the 6-min walking distance, and the Berg Balance Scale (BBS).[Results] The 10-m walking times, 6-min walking distance, and BBS scores of both the OGT group and the TGT group significantly improved, but there were no significant differences between the two groups. In the slow walking speed group, the OGT subjects showed significant improvement compared to the TGT subjects in the 6-min walk test.[Conclusion] Overall, we conclude that OGT was more effective at improving the gait endurance of stroke patients than TGT. Further research is needed to verify the generalizability of these findings and to identify which stroke patients might benefit from OGT.

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“…Increased energy demand reduces movement, favoring further decline in cardiopulmonary fitness and increasing disuse atrophy and weakness, which further impairs function [5]. Despite this, rehabilitative interventions usually fail to emphasize the need to improve or to prevent further deterioration of the ability to generate aerobic work, especially for patients in the acute stages of recovery from a stroke.…”

Section: Introductionmentioning

confidence: 99%

“…Few studies have actually assessed aerobic function, especially with subacute SS, because of the lack of protocols and guidelines [5][6][7][8]. Measurement of aerobic capacity by bike or treadmill protocols with actual measures of peak oxygen consumption (VO 2 ) during maximal effort is expensive, requires specialized personnel, and demands time.…”

Section: Introductionmentioning

confidence: 99%

Reliability of measures of gait performance and oxygen consumption with stroke survivors

Cunha-Filho¹,

Henson²,

Wankadia³

et al. 2003

JRRD

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Abstract-This study assessed the reliability of gait performance with concurrent measures of oxygen consumption (VO 2 ) in stroke survivors (SS). Nine male SS (60.00 ± 15.08 yr) had a recent history of stroke (44.56 ± 51.35 days since the stroke) and were receiving rehabilitation. Four had a right cerebrovascular accident (CVA), and five had a left CVA. Subjects walked without assistance, although three used a single cane to complete the test. Within 30 minutes, subjects completed two trials of a 5 min walk while walking back and forth on a 5 m walkway wearing a portable gas analyzer to collect samples of gases. The intraclass correlation coefficient (ICC) was used to assess reliability. The ICC for gait energy expenditure, walk distance, gait speed, and gait energy cost were 0.64, 0.97, 0.95, and 0.97, respectively. Assessment of gait performance with concurrent measures of VO 2 is a reliable procedure with SS.

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Treadmill Aerobic Exercise Training Reduces the Energy Expenditure and Cardiovascular Demands of Hemiparetic Gait in Chronic Stroke Patients

Cited by 234 publications

References 20 publications

Task-oriented treadmill exercise training in chronic hemiparetic stroke

Task-oriented treadmill exercise training in chronic hemiparetic stroke

A Comparison of the Effects of Overground Gait Training and Treadmill Gait Training According to Stroke Patients’ Gait Velocity

Reliability of measures of gait performance and oxygen consumption with stroke survivors

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