title: High-intensity treadmill training improves gait ability, VO2peak and cost of walking in stroke survivors: preliminary results of a pilot randomized controlled trial.
abstract: BACKGROUND
  Stroke is a major cause of death and long-term disability across the globe. Previous studies have demonstrated the trainability of stroke survivors and documented beneficial effects of aerobic exercises on cardiovascular fitness and gait ability.
  
  
  OBJECTIVE
  The main aim of this study was to compare the effects of a high-intensity treadmill training (HITT) against low-intensity treadmill training (LITT) on gait ability, quality of life, cardiorespiratory fitness and cost of walking in chronic stroke subjects.
  
  
  METHODS
  Randomized, controlled pilot study.
  
  
  METHODS
  Patients were recruited among Neurorehabilitation Unit outpatient.
  
  
  METHODS
  The sample was composed of 16 subjects suffering from chronic stroke.
  
  
  METHODS
  Subjects were enrolled and randomly allocated either in the HITT (N.=8) or in the LITT (N.=8). Both groups performed 3-month training, 3 times per week. Subjects were evaluated before starting the training and after the end of the training by mean of clinical scales (Six-Minute Walk Test, Ten-Meter Walk Test, Health Survey Questionnaire SF-36, Stroke Impact Scale) and instrumental tests (gait analysis, VO2peak and walking energy cost).
  
  
  RESULTS
  Fifteen subjects completed the study and no dropouts were observed. One patient in the LITT refused to initiate the training. The HITT group produced greater improvements than LITT group on the Six-Minute Walk Test (HITT: 64.25 meters, LITT: 6 meters; p=0.005) and Ten-Meter Walk Test performances (HITT: -1.7 s, LITT: 0.6 s; P=0.007), stride length (HITT: 3.3 cm, LITT: 0.4 cm, P=0.003), step length non-paretic side (HITT: 0.5 cm, LITT: 2.4 cm, P=0.008), step length paretic side (HITT: 1.8 cm, LITT: 0.7 cm, P=0.004), cadence (HITT: 1.6 step/min, LITT: 0.6 step/min, P=0.021) and symmetry ratio (HITT: 0.04 cm, LITT: 0.01 cm, P=0.004), VO2peak (HITT: 4.6 mL/kg/min, LITT: 0.87 mL/kg/min; P=0.015) and walking energy cost at 100% of self-selected speed (HITT: -30.8 mL/kg∙km, LITT: -20 5 mL/kg∙km; P=0.021). Significant changes were found on Six-Minute Walk Test (P=0.012) and Ten-Meter Walk Test (P=0.042) performances, spatio-temporal gait parameters (stride length P=0.011, step length paretic side P=0.012, cadence P=0.037 and symmetry ratio P=0.012), VO2peak (P=0.025) and cost of walking at 100% of self-selected speed (P=0.018) in the HITT group. In the LITT no significant results were observed.
  
  
  CONCLUSIONS
  HITT could be considered a feasible training and led to improvement in gait ability and enhanced VO2peak and reduction in cost of walking compared to LITT.
  
  
  CONCLUSIONS
  Chronic stroke survivors should be encouraged to engage regular aerobic treadmill training at medium/high intensity. HITT is safe and feasible and has positive effects on gait ability, cardiovascular fitness and cost of walking in subjects with stroke in chronic phase.
authors: Neuromotor and Cognitive Rehabilitation Center, Department for Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy - daniele.munari@univr.it.
authors: Daniele
authors: D
authors: Munari
authors: Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy.
authors: Anna
authors: A
authors: Pedrinolla
authors: Neuromotor and Cognitive Rehabilitation Center, Department for Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
authors: Nicola
authors: N
authors: Smania
authors: Neuromotor and Cognitive Rehabilitation Center, Department for Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
authors: Alessandro
authors: A
authors: Picelli
authors: Neuromotor and Cognitive Rehabilitation Center, Department for Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
authors: Marialuisa
authors: M
authors: Gandolfi
authors: Research Department for Neurorehabilitation South Tyrol, Bolzano, Italy.|Department of Neurology, Hochzirl Hospital, Zirl, Austria.
authors: Leopold
authors: L
authors: Saltuari
authors: Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy.
authors: Federico
authors: F
authors: Schena
mesh_terms: D000328:Adult; D000368:Aged; D001317:Austria; D004185:Disability Evaluation; D004734:Energy Metabolism / Q000502:physiology*; D005080:Exercise Test / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D020233:Gait Disorders, Neurologic / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology*; D010809:Physical Fitness / Q000502:physiology; D010865:Pilot Projects; D011788:Quality of Life; D020521:Stroke / Q000175:diagnosis*; D000071939:Stroke Rehabilitation / Q000379:methods*; D017741:Survivors; D016896:Treatment Outcome