Dual Effects of Body-Weight Supported Treadmill Training on Cardiovascular Fitness and Walking Ability Early After Stroke: A Randomized Controlled Trial

Background. Body-weight-supported treadmill training (BWSTT) to train both fitness and ambulation has not been investigated. Objective. To compare the effectiveness of BWSTT to dose-equivalent usual care (UC) in improving cardiovascular fitness and walking early after stroke. Methods. Participants were randomly assigned to 1 of 2 interventions: BWSTT + UC or UC. All individuals participated in 60-minute physiotherapy sessions 5 times weekly as inpatients for 6 weeks and 3 times weekly as outpatients for another 6 weeks. Baseline, posttraining, 6-, and 12-month follow-up outcome measures were as follows: primary, fitness (peak oxygen consumption, VO2peak) and walking ability (6-Minute Walk Test [6MWT] and 10-m walk); secondary, Berg Balance Scale (BBS) and motor impairment (Chedoke-McMaster Stages of Recovery [CMSR] Leg and Foot). Results. In all, 50 individuals (mean age, 60 +/- 14 years; mean event-to-randomization, 23 +/- 5 days; 29 men) participated. No adverse events occurred. BWSTT improved VO2peak by 30%, which was significantly greater than the 8% improvement observed for UC (P = .004 between groups). Similarly, there were significant Time x Group interactions for 6MWT and CMSR Foot, with BWSTT outperforming UC for gains in distance (P = .15; 48% vs 19%, respectively) and stage (P = .01; 1.0 vs 0.3, respectively). No group effect was seen for 10-m walk speed, BBS, or CMSR Leg, with both groups demonstrating significant gains. In general, gains observed were preserved for 12 months. Conclusions. BWSTT elicits greater improvements in cardiovascular fitness and walking endurance than UC in the subacute poststroke period. These gains are largely sustained for 1 year.