title: Predictors of response to treadmill exercise in stroke survivors.
abstract: BACKGROUND
  Aerobic treadmill exercise (T-EX) therapy has been shown to benefit walking and cardiorespiratory fitness in stroke survivors with chronic gait impairment even long after their stroke. The response, however, varies between individuals.
  
  
  OBJECTIVE
  The purpose of this post hoc analysis of 2 randomized controlled T-EX trials was to identify predictors for therapy response.
  
  
  METHODS
  In all, 52 participants received T-EX for 3 (Germany) or 6 (United States) months. Improvements in overground walking velocity (10 m/6-min walk) and fitness (peak VO(2)) were indicators of therapy response. Lesion location and volume were measured on T1-weighted magnetic resonance scans.
  
  
  RESULTS
  T-EX significantly improved gait and fitness, with gains in 10-m walk tests ranging between +113% and -25% and peak VO(2) between -12% and 88%. Baseline walking impairments or fitness deficits were not predictive of therapy response; 10-m walk velocity improved more in those with subcortical rather than cortical lesions and in patients with smaller lesions. Improvements in 6-minute walk velocity were greater in those with more recent strokes and left-sided lesions. No variable other than training intensity, which was different between trials, predicted fitness gains.
  
  
  CONCLUSIONS
  Despite proving overall effectiveness, the response to T-EX varies markedly between individuals. Whereas intensity of aerobic training seems to be an important predictor of gains in cardiovascular fitness, lesion size and location as well as interval between stroke onset and therapy delivery likely affect therapy response. These findings may be used to guide the timing of training and identify subgroups of patients for whom training modalities could be optimized.
authors.affiliation: University of Zürich, Zürich, Switzerland.
authors.forename: Judith M
authors.initials: JM
authors.lastname: Lam
authors.forename: Christoph
authors.initials: C
authors.lastname: Globas
authors.forename: Joachim
authors.initials: J
authors.lastname: Cerny
authors.forename: Benjamin
authors.initials: B
authors.lastname: Hertler
authors.forename: Kamil
authors.initials: K
authors.lastname: Uludag
authors.forename: Larry W
authors.initials: LW
authors.lastname: Forrester
authors.forename: Richard F
authors.initials: RF
authors.lastname: Macko
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Hanley
authors.forename: Clemens
authors.initials: C
authors.lastname: Becker
authors.forename: Andreas R
authors.initials: AR
authors.lastname: Luft
mesh_terms: D000368:Aged; D005080:Exercise Test / Q000295:instrumentation / Q000379:methods*; D005081:Exercise Therapy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005684:Gait / Q000502:physiology; D020233:Gait Disorders, Neurologic / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010291:Paresis / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D010809:Physical Fitness / Q000502:physiology; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D020521:Stroke / Q000473:pathology / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology
references.citation: JAMA. 2004 Oct 20;292(15):1853-61
references.pmid: 15494583
references.citation: Neurorehabil Neural Repair. 2009 Nov;23(9):879-85
references.pmid: 19541916
references.citation: Arch Phys Med Rehabil. 2003 Sep;84(9):1308-12
references.pmid: 13680566
references.citation: Stroke. 2007 Jan;38(1):194-7
references.pmid: 17122428
references.citation: Arch Phys Med Rehabil. 2002 Aug;83(8):1060-9
references.pmid: 12161826
references.citation: Neurorehabil Neural Repair. 2008 Nov-Dec;22(6):649-60
references.pmid: 18971380
references.citation: Neuroreport. 2001 Dec 21;12(18):3883-6
references.pmid: 11742203
references.citation: Stroke. 1995 Nov;26(11):2023-6
references.pmid: 7482642
references.citation: Phys Ther. 2006 Jun;86(6):825-32
references.pmid: 16737408
references.citation: Stroke. 2000 Jun;31(6):1210-6
references.pmid: 10835434
references.citation: Eur J Neurosci. 2005 Feb;21(4):989-99
references.pmid: 15787705
references.citation: Mov Disord. 2008 Feb 15;23(3):329-42; quiz 472
references.pmid: 18058946
references.citation: Neuroimage. 2005 May 15;26(1):184-94
references.pmid: 15862218
references.citation: Stroke. 1997 Oct;28(10):2060-5; discussion 2066
references.pmid: 9341719
references.citation: J Neurol. 2002 Jul;249(7):888-95
references.pmid: 12140674
references.citation: Disabil Rehabil. 2006 Aug 30;28(16):977-83
references.pmid: 16882637
references.citation: Int Disabil Stud. 1990 Jul-Sep;12(3):119-22
references.pmid: 2096120
references.citation: Clin Neurol Neurosurg. 2007 Nov;109(9):763-9
references.pmid: 17766038
references.citation: Arch Phys Med Rehabil. 2000 Apr;81(4):447-52
references.pmid: 10768534
references.citation: Age Ageing. 1995 Nov;24(6):515-8
references.pmid: 8588543
references.citation: Stroke. 2007 Jul;38(7):2108-14
references.pmid: 17540966
references.citation: Stroke. 2008 Dec;39(12):3335-40
references.pmid: 18988910
references.citation: Stroke. 2008 Dec;39(12):3341-50
references.pmid: 18757284
references.citation: Stroke. 2005 Oct;36(10):2206-11
references.pmid: 16151035
references.citation: Stroke. 2000 Mar;31(3):672-9
references.pmid: 10700503
references.citation: Exp Brain Res. 2008 Mar;186(2):325-33
references.pmid: 18157670
references.citation: Brain Res. 1991 May 3;547(2):249-57
references.pmid: 1884199
references.citation: Arch Phys Med Rehabil. 2001 Jan;82(1):2-8
references.pmid: 11239278
references.citation: J Stroke Cerebrovasc Dis. 2009 Jan;18(1):60-7
references.pmid: 19110147
references.citation: Electroencephalogr Clin Neurophysiol. 1996 Aug;101(4):316-28
references.pmid: 8761041
references.citation: J Neurol Phys Ther. 2009 Mar;33(1):2-13
references.pmid: 19265766
references.citation: Arch Phys Med Rehabil. 2008 Sep;89(9):1686-92
references.pmid: 18760152
references.citation: Circulation. 2001 Oct 2;104(14):1694-740
references.pmid: 11581152
references.citation: Neurorehabil Neural Repair. 2009 May;23(4):336-42
references.pmid: 18984830
references.citation: Behav Neurol. 2000;12(4):191-200
references.pmid: 11568431
references.citation: Stroke. 1995 Dec;26(12):2272-6
references.pmid: 7491649
references.citation: Cerebrovasc Dis. 2006;21(4):229-34
references.pmid: 16446535