Task-oriented treadmill exercise training in chronic hemiparetic stroke.
Patients with stroke have elevated hemiparetic gait costs secondary to low activity levels and are often severely deconditioned. Decrements in peak aerobic capacity affect functional ability and cardiovascular-metabolic health and may be partially mediated by molecular changes in hemiparetic skeletal muscle. Conventional rehabilitation is time delimited in the subacute stroke phase and does not provide adequate aerobic intensity to reverse the profound detriments to fitness and function that result from stroke. Hence, we have studied progressive full body weight-support treadmill (TM) training as an adjunct therapy in the chronic stroke phase. Task-oriented TM training has produced measurable changes in fitness, function, and indices of cardiovascular-metabolic health after stroke, but the precise mechanisms for these changes remain under investigation. Further, the optimal dose of this therapy has yet to be identified for individuals with stroke and may vary as a function of deficit severity and outcome goals. This article summarizes the functional and metabolic decline caused by inactivity after stroke and provides current evidence that supports the use of TM training during the chronic stroke phase, with protocols and inclusion/exclusion criteria described. Our research findings are discussed in relation to associated research.
Ivey
Frederick M
FM
Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs (VA) Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD 21201, USA.
Hafer-Macko
Charlene E
CE
Macko
Richard F
RF
D000222:Adaptation, Physiological / Q000502:physiology; D001823:Body Composition; D002318:Cardiovascular Diseases / Q000378:metabolism / Q000517:prevention & control; D002908:Chronic Disease; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D020233:Gait Disorders, Neurologic / Q000503:physiopathology / Q000534:rehabilitation*; D006429:Hemiplegia / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D035002:Lower Extremity / Q000503:physiopathology*; D011379:Prognosis; D020127:Recovery of Function; D020521:Stroke / Q000503:physiopathology / Q000523:psychology; D000071939:Stroke Rehabilitation; D016474:Weight-Bearing / Q000502:physiology