Task-oriented treadmill exercise training in chronic hemiparetic stroke

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.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1

Peak aerobic fitness levels in patients with chronic stroke relative to energy requirements for activities of daily living (ADL) (N = 131). MET = metabolic equivalent. Source: Reprinted with permission from Ivey FM, Macko RF, Ryan AS, Hafer-Macko CE. Cardiovascular health and fitness after stroke. Top Stroke Rehabil. 2005;12(1):1–16. [15735997]

Figure 2

Effects of 6-month treadmill exercise intervention on peak oxygen consumption (VO2) after stroke. R-CONTROL = control group, T-AEX = treadmill aerobic exercise group. Source: Reprinted with permission from Macko RF, Ivey FM, Forrester LW, Hanley D, Sorkin JD, Katzel LI, Silver KH, Goldberg AP. Treadmill exercise rehabilitation improves ambulatory function and cardiovascular fitness in patients with chronic stroke: A randomized, controlled trial. Stroke. 2005;36(10):2206–11. [PMID: 16151035]

Figure 3

Effects of 6-month treadmill exercise intervention on 6-minute walk distance after stroke. R-CONTROL = control group, T-AEX = treadmill aerobic exercise group. Source: Reprinted with permission from Macko RF, Ivey FM, Forrester LW, Hanley D, Sorkin JD, Katzel LI, Silver KH, Goldberg AP. Treadmill exercise rehabilitation improves ambulatory function and cardiovascular fitness in patients with chronic stroke: A randomized, controlled trial. Stroke. 2005; 36(10): 2206–11. [PMID: 16151035]

Figure 4

Silver-stained gel electrophoresis of shift toward more normal myosin heavy chain isoform distribution after treadmill training in individuals with chronic stroke between (a) control and (b) treadmill training participants.