Published Online
on September 8, 2005

A more recent version of this article appeared on October 1, 2005

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Submitted on March 2, 2005
Accepted on March 29, 2005

Treadmill Exercise Rehabilitation Improves Ambulatory Function and Cardiovascular Fitness in Patients With Chronic Stroke. A Randomized, Controlled Trial

Richard F. Macko MD^*; Frederick M. Ivey PhD; Larry W. Forrester PhD; Daniel Hanley MD; John D. Sorkin MD, PhD; Leslie I. Katzel MD, PhD; Kenneth H. Silver MD; and Andrew P. Goldberg MD

From the Veterans Affairs Medical Center Geriatrics Research, Education, and Clinical Center (R.F.M., F.M.I., J.D.S., L.I.K., A.P.G.); the Departments of Neurology (R.F.M.), Gerontology (R.F.M., F.M.I., L.I.K., A.P.G.), and Physical Therapy (L.W.F.), University of Maryland School of Medicine, Baltimore, Md; the Departments of Neurology, Division of Brain Injury Recovery (D.H.) and Physical Medicine and Rehabilitation (K.H.S.), Johns Hopkins University, Baltimore, Md; and Good Samaritan Hospital of Baltimore (K.H.S.), Baltimore, Md.

^* To whom correspondence should be addressed. E-mail: rmacko{at}grecc.umaryland.edu.

Background and Purpose--Physical inactivity propagates disability after stroke through physical deconditioning and learned nonuse. We investigated whether treadmill aerobic training (T-AEX) is more effective than conventional rehabilitation to improve ambulatory function and cardiovascular fitness in patients with chronic stroke.

Methods--Sixty-one adults with chronic hemiparetic gait after ischemic stroke (>6 months) were randomized to 6 months (3x/week) progressive T-AEX or a reference rehabilitation program of stretching plus low-intensity walking (R-CONTROL). Peak exercise capacity (VO₂ peak), O₂ consumption during submaximal effort walking (economy of gait), timed walks, Walking Impairment Questionnaire (WIQ), and Rivermead Mobility Index (RMI) were measured before and after 3 and 6 months of training.

Results--Twenty-five patients completed T-AEX and 20 completed R-CONTROL. Only T-AEX increased cardiovascular fitness (17% versus 3%, % T-AEX versus R-CONTROL, P<0.005). Group-by-time analyses revealed T-AEX improved ambulatory performance on 6-minute walks (30% versus 11%, P<0.02) and mobility function indexed by WIQ distance scores (56% versus 12%, P<0.05). In the T-AEX group, increasing training velocity predicted improved VO₂ peak (r=0.43, P<0.05), but not walking function. In contrast, increasing training session duration predicted improved 6-minute walk (r=0.41, P<0.05), but not fitness gains.

Conclusions--T-AEX improves both functional mobility and cardiovascular fitness in patients with chronic stroke and is more effective than reference rehabilitation common to conventional care. Specific characteristics of training may determine the nature of exercise-mediated adaptations.

Key words: exercise • hemiplegia • rehabilitation • stroke

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