Treadmill exercise rehabilitation improves ambulatory function and cardiovascular fitness in patients with chronic stroke - A randomized, controlled trial

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), O-2 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%, delta% 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.