Question: Does high-intensity aerobic treadmill exercise improve cardiovascular fitness and gait function in people with chronic stroke?
Design: Randomised, controlled trial.
Setting: An outpatient rehabilitation centre in Germany.
Participants: Individuals with chronic stroke >60 years of age with residual gait impairment, and ability to walk on the treadmill at ≥0.3km/h for 3 minutes were eligible. Serious cardiovascular conditions (eg, angina pectoris, heart failure, valvular dysfunction, peripheral arterial occlusive disease), dementia, aphasia, and major depression were exclusion criteria. Randomisation of 38 participants allocated 20 to the intervention group and 18 to the usual care group.
Interventions: The intervention group underwent treadmill training (3 times/week) for 3 months. The program was intended to achieve 30-50 minutes of treadmill training at 60-80% of the maximum heart rate reserve as determined by a maximum effort exercise test. The training was supervised by a physician and/or physiotherapist. The usual care group received conventional care physiotherapy for 1 hour 1-3 times a week without any aerobic training.
Outcome measures: The primary outcomes were peak oxygen consumption rate and the 6-minute walk test. Secondary outcome measures were self-selected and maximum walking speeds as measured in the 10-m walk test, Berg balance score, 5-Chair-Rise test, Rivermead Mobility Index, and Medical Outcomes Study Short-Form 12 (SF- 12). The outcomes were measured at baseline, immediately after completion of training, and at 12 months.
Results: 36 participants completed the study. After the 3-month training period, the change in peak oxygen consumption rate was significantly more in the treatment group, by 6.3mL/kg/min (95% CI 5.7 to 6.9). The change in distance achieved in the 6-minute walk test was also significantly more in the treatment group by 53 metres (95% CI 32 to 75). Among the secondary outcomes, maximum walking speed (by 0.14m/s, 95% CI 0.08 to 0.20), Berg balance score (by 2.6 points, 95% CI 0.5 to 4.7), and SF-12 Mental score (by 4.0 points, 95% CI 3.4 to 4.6) improved significantly more in the treadmill training group than the usual care group after the treatment period. The groups did not differ significantly on the remaining secondary outcomes. It was reported that compared to baseline peak oxygen consumption rate and 6-minute walk test distance were significantly improved at 12 months.
Conclusion: A high-intensity treadmill training program improves cardiovascular fitness and gait in older adults with chronic stroke.
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