This Article Full Text Full Text (PDF) All Versions of this Article: 38/10/2752    most recent STROKEAHA.107.490391v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ivey, F. M. Articles by Macko, R. F. Search for Related Content PubMed PubMed Citation Articles by Ivey, F. M. Articles by Macko, R. F. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Exercise for Children Exercise for Seniors Exercise and Physical Fitness Stroke Related Collections Type 2 diabetes Glucose intolerance Exercise/exercise testing/rehabilitation

(Stroke. 2007;38:2752.)
© 2007 American Heart Association, Inc.

Original Contributions

Treadmill Aerobic Training Improves Glucose Tolerance and Indices of Insulin Sensitivity in Disabled Stroke Survivors

A Preliminary Report

Frederick M. Ivey, PhD; Alice S. Ryan, PhD; Charlene E. Hafer-Macko, MD; Andrew P. Goldberg, MD Richard F. Macko, MD

From the Departments of Medicine (F.M.I., A.S.R., A.P.G.) and Neurology (C.E.H.-M., R.F.M.), and the Division of Gerontology, University of Maryland School of Medicine, and the Baltimore Veterans Affairs Medical Center-Geriatrics Research, Education and Clinical Center (F.M.I., A.S.R., C.E.H.-M., A.P.G., R.F.M.), Baltimore, Md.

Correspondence to Frederick M. Ivey, PhD, Baltimore VA Medical Center, Geriatrics Service/GRECC BT(18) GR, 10 North Greene St, Baltimore, MD 21201-1524. E-mail fivey{at}grecc.umaryland.edu

Background and Purpose— Insulin resistance and glucose intolerance are highly prevalent after stroke, contributing to worsening cardiovascular disease risk and a predisposition to recurrent stroke. Treadmill exercise training (T-AEX) increases aerobic capacity (VO₂ peak) in chronic stroke patients, suggesting intensity levels that may be adequate to improve glucose metabolism. We compared the effects of a progressive T-AEX intervention to an attention-matched stretching intervention (CONTROL) on glucose tolerance and indices of insulin sensitivity in stroke survivors.

Methods— Participants had hemiparetic gait after remote (>6 months) ischemic stroke. They were randomized to 6-month T-AEX or a duration matched reference CONTROL program of supervised stretching exercises. Main outcome measures were glucose and insulin responses during a 3-hour oral glucose tolerance test (OGTT).

Results— Forty-six subjects (T-AEX=26, CONTROL=20) completed OGTT testing before and after the interventions. T-AEX increased VO₂ peak (+15% versus –3% , P<0.01) compared with CONTROL. There were significant reductions in fasting insulin (–23% versus +9% , P<0.05) and the total integrated 3-hour insulin response (–24% versus +3% , P<0.01) in T-AEX compared with CONTROL. In patients with abnormal glucose tolerance at baseline, T-AEX resulted in a significant 14% decrease in 3-hour glucose response (n=12, P<0.05). Fifty-eight percent of T-AEX participants with abnormal baseline OGTT (7 of 12) improved glucose tolerance status at 2 hours compared with <10% (1 of 11) of impaired CONTROLS (P<0.05).

Conclusions— These preliminary findings suggest that progressive aerobic exercise can reduce insulin resistance and prevent diabetes in hemiparetic stroke survivors. Larger clinical trials are needed to definitively establish the use of structured exercise training for stimulating metabolic improvement poststroke.

Key Words: diabetes • exercise • glucose intolerance • insulin resistance • stroke