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High-intensity step training improves walking skills after stroke
Patients with chronic stroke who participated in high-intensity step training had greater improvements in gait symmetry and walking ability compared with those who participated in low-intensity training, according to a study published in Stroke.
“Rehabilitation that allows walking practice without challenging the nervous system doesn’t do enough to make a statistical or clinically significant difference in a patient’s recovery after a stroke,” T. George Hornby, PhD, professor of physical medicine and rehabilitation at Indiana University School of Medicine in Indianapolis, said in a press release. “We found that when stroke patients are pushed harder, they see greater changes in less time, which translates into more efficient rehabilitation services and improves mobility.”
Researchers analyzed data from 90 patients with unilateral hemiparesis for greater than 6 months after a stroke. Patients were assigned high-intensity stepping (n = 28; mean age, 59 years; 82% men) that featured variable, difficult stepping tasks; high-intensity forward stepping (n = 30; mean age, 60 years; 57% men) that consisted of patients only performing forward walking; or low-intensity stepping (n = 32; mean age, 56 years; 56% men) that featured tasks in variable contexts at 30% to 40% heart rate reserve.
Patients underwent their assigned training for up to 30 sessions during a 2-month period, with up to 40 minutes of stepping practice in each session. Accelerometers were worn to track stepping amounts and rates per session, and both BP and heart rates were measured.
Primary outcome measures were assessed at baseline, after training and at 3-month follow-up assessments, and included self-selected speeds and fastest-possible speeds over short distances, in addition to 6-minute walk test distance performed at fastest-possible speeds. Secondary clinical measures included the five-times sit-to-stand test and the Functional Gait Assessment.
Patients assigned either training with high intensity had greater gains in heart rate and rating of perceived exertion compared with those assigned low-intensity training (P for both < .001). The high-intensity forward group had between 500 and 1,000 more steps per session compared with the high-velocity and low-velocity groups (P < .001). There were significant correlations between stepping amount and rate (r = 0.48-0.6; P < .001).
High-intensity training was linked to additional gains in spatiotemporal symmetry. Patients with severe impairments who were assigned high-variable training had an increase in balance confidence, the researchers reported.
“Despite nonsignificant differences in adverse events, future studies should further identify the potential risks for this patient population,” Hornby and colleagues wrote. “The relative contributions of volume, intensity and variability may be important, and future studies are needed to further define optimal training parameters.” – by Darlene Dobkowski
Disclosures: The authors report no relevant financial disclosures.