Variable Intensive Early Walking Poststroke (VIEWS)

Abstract

The present study examined the efficacy of high-intensity, variable stepping training on walking and nonwalking outcomes in individuals 1 to 6 months poststroke as compared with conventional interventions. Methods Individuals with unilateral stroke (mean duration = 101 days) were randomized to receive ≤40, 1-hour experimental or control training sessions over 10 weeks. Experimental interventions consisted only of stepping practice at high cardiovascular intensity (70%-80% heart rate reserve) in variable contexts (tasks or environments). Control interventions were determined by clinical physical therapists and supplemented using standardized conventional strategies. Blinded assessments were obtained at baseline, midtraining, and posttraining with a 2-month follow-up. Results A total of 32 individuals (15 experimental) received different training paradigms that varied in the amount, intensity, and types of tasks performed. Primary outcomes of walking speed (experimental, 0.27 ± 0.22 m/s vs control, 0.09 ± 0.09 m/s) and distances (119 ± 113 m vs 30 ± 32 m) were different between groups, with stepping amount and intensity related to these differences. Gains in temporal gait symmetry and self-reported participation scores were greater following experimental training, without differences in balance or sit-to-stand performance. Conclusion Variable intensive stepping training resulted in greater improvements in walking ability than conventional interventions early poststroke. Future studies should evaluate the relative contributions of these training parameters.

Effects of Training Intensity on Locomotor Performance in Individuals With Chronic Spinal Cord Injury: A Randomized Crossover Study

“…For stepping activity, smaller differences between training groups could be due to increased loads or resistance applied to the trunk or limbs to increase HRs. For stepping intensity, however, peak HRs were separated by ~10% predicted HR (70 vs 60% during high- vs low-intensity LT), whereas previous studies manipulating LT intensity in patients post-stroke revealed greater HR differences (18 %HR differences) 35 . The relatively smaller difference was highlighted by blunted HR responses in selected participants regardless of training intensity, and by others with greater HRs than the targeted low-intensity range.…”

“…The primary measure of intensity was training HRs, which was monitored continuously using pulse-oximetry, and correlates well with oxygen consumption in intact and impaired individuals. With determination of maximum age-predicted HR (208-(0.7*age), the goal of high-intensity LT was to maintain HRs within 70–85% of predicted maximum HR (HRmax) 35,36 while low-intensity training targeted 50–65% HRmax; these HR ranges approximate those observed during conventional physical therapy 35,42 . If targeted HR zones could not be achieved during training, the Rating of Perceived Exertion (RPE) scale 43,44 was also utilized as a secondary measure of intensity, with targeted ratings of 15–17 (“hard” to “very hard”) for the high–intensity LT protocol and 11–13 (below “somewhat hard”) for low-intensity LT protocol 17,26,35 .…”

“…In patients with other acute-onset neurological injuries (i.e., patients post-stroke) , LT performed at moderate to high intensities (i.e., up to 85% of maximum HR) has been shown to improve walking function as compared to lower-intensity interventions, 32,33 even when the amount of practice is controlled 17,18 . While gains in cardiopulmonary capacity have been observed with such training 26 , improvements in neuromuscular impairments 34 and walking function 35,36 have also been demonstrated.…”

A soft robotic exosuit improves walking in patients after stroke

“…Although this study does not demonstrate a therapeutic effect, several benefits can be derived from such an immediate and substantial increase in poststroke walking performance. For example, an immediate improvement in walking capacity may increase the opportunity for walking practice of higher intensity and variability-key ingredients for effective neurorehabilitation (70,81,82). Improved walking capacity may improve self-efficacy and reduce barriers to community engagement (8,51,83).…”

Factors Influencing the Efficacy of Aerobic Exercise for Improving Fitness and Walking Capacity After Stroke

“…For example, aerobic capacity effect sizes in previous studies (AEX group change minus control group change) have ranged from −1.5 13 to +6.3 14 mL/kg/min, walking speed effect sizes have ranged from −0.09 15 to +0.25 16 m/s and walking endurance (6-minute walk test) effect sizes have ranged from −25 17 to +89 16 m. An understanding of the factors affecting these between study differences could help inform AEX prescription and prioritize future studies.…”