Predictors of response to treadmill exercise in stroke survivors.
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.
Lam
Judith M
JM
University of Zürich, Zürich, Switzerland.
Globas
Christoph
C
Cerny
Joachim
J
Hertler
Benjamin
B
Uludag
Kamil
K
Forrester
Larry W
LW
Macko
Richard F
RF
Hanley
Daniel F
DF
Becker
Clemens
C
Luft
Andreas R
AR
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
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