Effects of task-specific locomotor and strength training in adults who were ambulatory after stroke: results of the STEPS randomized clinical trial.
OBJECTIVE
A phase II, single-blinded, randomized clinical trial was conducted to determine the effects of combined task-specific and lower-extremity (LE) strength training to improve walking ability after stroke.


METHODS
The participants were 80 adults who were ambulatory 4 months to 5 years after a unilateral stroke.


METHODS
The exercise interventions consisted of body-weight-supported treadmill training (BWSTT), limb-loaded resistive leg cycling (CYCLE), LE muscle-specific progressive-resistive exercise (LE-EX), and upper-extremity ergometry (UE-EX). After baseline assessments, participants were randomly assigned to a combined exercise program that included an exercise pair. The exercise pairs were: BWSTT/UE-EX, CYCLE/UE-EX, BWSTT/CYCLE, and BWSTT/LE-EX. Exercise sessions were 4 times per week for 6 weeks (total of 24 sessions), with exercise type completed on alternate days.


RESULTS
were self-selected walking speed, fast walking speed, and 6-minute walk distance measured before and after intervention and at a 6-month follow-up.


RESULTS
The BWSTT/UE-EX group had significantly greater walking speed increases compared with the CYCLE/UE-EX group; both groups improved in distance walked. All BWSTT groups increased walking speed and distance whether BWSTT was combined with LE strength training or not.


CONCLUSIONS
After chronic stroke, task-specific training during treadmill walking with body-weight support is more effective in improving walking speed and maintaining these gains at 6 months than resisted leg cycling alone. Consistent with the overtraining literature, LE strength training alternated daily with BWSTT walking did not provide an added benefit to walking outcomes.
Sullivan
Katherine J
KJ
Division of Biokinesiology and Physical Therapy at the School of Dentistry, University of Southern California, 1540 E Alcazar St, CHP-155, Los Angeles, CA 90089, USA. kasulliv@usc.edu
Brown
David A
DA
Klassen
Tara
T
Mulroy
Sara
S
Ge
Tingting
T
Azen
Stanley P
SP
Winstein
Carolee J
CJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002908:Chronic Disease; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D018482:Muscle, Skeletal / Q000502:physiology; D010807:Physical Endurance / Q000502:physiology; D020127:Recovery of Function; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D019415:Torque; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*