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High-intensity training improves post-stroke walking, balance
High-intensity step training resulted in better improvements in walking, gait and balance confidence compared with low-intensity training, in patients with chronic stroke.
According to the study published in Stroke, all walking gains were greater in patients assigned high-intensity training than in patients assigned low-intensity training (P < .001), and improvements were correlated with the stepping amount and rate of high-intensity training (r = 0.48–60; P < .01). Additional improvements were seen in spatiotemporal symmetry as well as balance confidence, the latter seen only in patients with severe impairments.
“The primary take-home message for cardiologists is that patients post-stroke can safely tolerate higher aerobic intensities of exercise that we typically provide in the clinical setting (including both physical therapy or cardiopulmonary rehabilitation) or in most research settings,” T. George Hornby, PhD, professor of physical medicine and rehabilitation at the Indiana University School of Medicine, told Healio. “Gains in walking speed and distance were significant only in the training groups that reached an average of 110% greater than baseline heart rates. Additional gains were observed with high-intensity training of variable walking tasks that may be more relevant to patients when discharged back to the community setting.”
In this phase 2, blinded assessor clinical trial, 90 patients with chronic stroke were randomly assigned one of three groups; high-intensity stepping with variable, difficult stepping tasks at 70% to 80% heart rate reserve (mean age, 59 years; 82% men; 68% white); high-intensity stepping performing only forward walking (mean age, 60 years; 57% men; 70% white); and low-intensity stepping in variable contexts at 30% to 40% heart rate reserve (mean age, 56 years; 56% men; 66% white).
“The present results suggest that high intensity and difficulty of stepping tasks can be safely utilized and integrated into clinical practice, which would require a larger-scale implementation strategy to minimize clinical practice of activities that are traditionally considered helpful, but it actuality provide little therapeutic benefits,” Hornby said.
Enrolled patients received up to 30 training sessions over the course of 2 months and were tested at baseline, post-training, and a 3-month follow-up, according to the study.
The primary outcomes were walking speeds and timed distance.
“Despite nonsignificant differences in adverse events, future studies should further identify the potential risks for this patient population,” the authors wrote. “The relative contributions of volume, intensity, and variability may be important, and future studies are needed to further define optimal training parameters.” – by Scott Buzby
For more information:
T. George Hornby, PhD, can be reached at: tghornby@iu.edu
Disclosures: The authors report no relevant financial disclosures.