This Article Full Text Full Text (PDF) All Versions of this Article: 39/12/3341    most recent STROKEAHA.108.527531v1 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 HighWire Citing Articles via Google Scholar Google Scholar Articles by Luft, A. R. Articles by Hanley, D. F. Search for Related Content PubMed PubMed Citation Articles by Luft, A. R. Articles by Hanley, D. F. Related Collections Exercise/exercise testing/rehabilitation Rehabilitation, Stroke

(Stroke. 2008;39:3341.)
© 2008 American Heart Association, Inc.

Original Contributions

Treadmill Exercise Activates Subcortical Neural Networks and Improves Walking After Stroke

A Randomized Controlled Trial

Andreas R. Luft, MD; Richard F. Macko, MD; Larry W. Forrester, PhD; Federico Villagra, PhD; Fred Ivey, MD; John D. Sorkin, MD, PhD; Jill Whitall, PhD; Sandy McCombe-Waller, PT, PhD; Leslie Katzel, MD, PhD; Andrew P. Goldberg, MD Daniel F. Hanley, MD

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.

Correspondence to Dr Andreas Luft, Department of General Neurology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany. 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.

Key Words: exercise • rehabilitation • plasticity • locomotion • fitness

This article has been cited by other articles:

				B. M. Quaney, L. A. Boyd, J. M. McDowd, L. H. Zahner, Jianghua He, M. S. Mayo, and R. F. Macko Aerobic Exercise Improves Cognition and Motor Function Poststroke Neurorehabil Neural Repair, November 1, 2009; 23(9): 879 - 885. [Abstract] [PDF]

				C. Enzinger, H. Dawes, H. Johansen-Berg, D. Wade, M. Bogdanovic, J. Collett, C. Guy, U. Kischka, S. Ropele, F. Fazekas, et al. Brain Activity Changes Associated With Treadmill Training After Stroke Stroke, July 1, 2009; 40(7): 2460 - 2467. [Abstract] [Full Text] [PDF]

				B. H. Dobkin Progressive Staging of Pilot Studies to Improve Phase III Trials for Motor Interventions Neurorehabil Neural Repair, March 1, 2009; 23(3): 197 - 206. [Abstract] [PDF]