Journal
STROKE
Volume 39, Issue 12, Pages 3341-3350Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/STROKEAHA.108.527531
Keywords
exercise; rehabilitation; plasticity; locomotion; fitness
Categories
Funding
- National Institutes of Health
- NIA [P60AG 12583]
- University of Maryland Claude D. Pepper Older Americans Independence Center
- Department of Veterans Affairs
- Baltimore Veterans Affairs Medical Center Geriatrics Research, Education and Clinical Center (GRECC)
- Rehabilitation Research & Development Exercise and Robotics Center of Excellence
- VA Advanced Career Development Award [B3390K]
- Stroke REAP
- NINDS [1RO1 NS 24282-08]
- France-Merrick Foundation
- Johns Hopkins GCRC [MO1-00052]
- Eleanor Naylor Dana Charitable Trust
- Deutsche Forschungsgemeinschaft [SFB 550 C12]
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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. (Stroke. 2008; 39: 3341-3350.)
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