on August 28, 2008
Published online before print August 28, 2008, doi: 10.1161/STROKEAHA.108.527531
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Submitted on June 1, 2008
From the Department of Neurology (A.R.L., R.F.M., F.I., D.F.H.), University of Maryland, School of Medicine, Baltimore, Md; the Department of Medicine, Division of Gerontology (R.F.M., L.W.F., F.I., J.D.S., L.K., A.P.G., D.F.H.), University of Maryland, School of Medicine, Baltimore, Md; the Division of Brain Injury Outcomes, Department of Neurology (A.R.L., D.F.H.), Johns Hopkins University, Baltimore, Md; the Department of Neurology (A.R.L.), University of Zurich, Switzerland; the Department of Veterans Affairs (A.R.L., R.F.M., L.W.F., F.V., F.I., J.D.S., J.W., S.M.-W., L.K., A.P.G., D.F.H.), Baltimore VA Medical Center Geriatric Research, Education and Clinical Center (GRECC), Baltimore, Md; and the Department of Physical Therapy and Rehabilitation Science (R.F.M., L.W.F., F.V., J.W., S.M.-W.), University of Maryland School of Medicine, Baltimore, Md. * To whom correspondence should be addressed. E-mail: aluft{at}jhu.edu.
Background and Purpose—Stroke often impairs gait thereby reducing mobility and fitness and promoting chronic disability. Gait is a complex sensorimotor function controlled by integrated cortical, subcortical, and spinal networks. The mechanisms of gait recovery after stroke are not well understood. This study examines the hypothesis that progressive task-repetitive treadmill exercise (T-EX) improves fitness and gait function in subjects with chronic hemiparetic stroke by inducing adaptations in the brain (plasticity). Methods—A randomized controlled trial determined the effects of 6-month T-EX (n=37) versus comparable duration stretching (CON, n=34) on walking, aerobic fitness and in a subset (n=15/17) on brain activation measured by functional MRI. Results—T-EX significantly improved treadmill-walking velocity by 51% and cardiovascular fitness by 18% (11% and -3% for CON, respectively; P<0.05). T-EX but not CON affected brain activation during paretic, but not during nonparetic limb movement, showing 72% increased activation in posterior cerebellar lobe and 18% in midbrain (P<0.005). Exercise-mediated improvements in walking velocity correlated with increased activation in cerebellum and midbrain. Conclusions—T-EX improves walking, fitness and recruits cerebellum-midbrain circuits, likely reflecting neural network plasticity. This neural recruitment is associated with better walking. These findings demonstrate the effectiveness of T-EX rehabilitation in promoting gait recovery of stroke survivors with long-term mobility impairment and provide evidence of neuroplastic mechanisms that could lead to further refinements in these paradigms to improve functional outcomes.
Accepted on June 24, 2008
Treadmill Exercise Activates Subcortical Neural Networks and Improves Walking After Stroke. A Randomized Controlled Trial
Andreas R. Luft MD*;
Key words: exercise • rehabilitation • plasticity • locomotion • fitness
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