title: Strength Training for Skeletal Muscle Endurance after Stroke.
abstract: OBJECTIVE
  Initial studies support the use of strength training (ST) as a safe and effective intervention after stroke. Our previous work shows that relatively aggressive, higher intensity ST translates into large effect sizes for paretic and non-paretic leg muscle volume, myostatin expression, and maximum strength post-stroke. An unanswered question pertains to how our unique ST model for stroke impacts skeletal muscle endurance (SME). Thus, we now report on ST-induced adaptation in the ability to sustain isotonic muscle contraction.
  
  
  METHODS
  Following screening and baseline testing, hemiparetic stroke participants were randomized to either ST or an attention-matched stretch control group (SC). Those in the ST group trained each leg individually to muscle failure (20 repetition sets, 3× per week for 3 months) on each of three pneumatic resistance machines (leg press, leg extension, and leg curl). Our primary outcome measure was SME, quantified as the number of submaximal weight leg press repetitions possible at a specified cadence. The secondary measures included one-repetition maximum strength, 6-minute walk distance (6MWD), 10-meter walk speeds, and peak aerobic capacity (VO2peak).
  
  
  RESULTS
  ST participants (N = 14) had significantly greater SME gains compared with SC participants (N = 16) in both the paretic (178% versus 12%, P < .01) and non-paretic legs (161% versus 12%, P < .01). These gains were accompanied by group differences for 6MWD (P < .05) and VO2peak (P < .05).
  
  
  CONCLUSIONS
  Our ST regimen had a large impact on the capacity to sustain submaximal muscle contraction, a metric that may carry more practical significance for stroke than the often reported measures of maximum strength.
authors.affiliation: Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE), Geriatric Research, Education and Clinical Center (GRECC), University of Maryland School of Medicine, Baltimore, Maryland; Department of Neurology. Electronic address: fivey@grecc.umaryland.edu.
authors.forename: Frederick M
authors.initials: FM
authors.lastname: Ivey
authors.affiliation: Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE), Geriatric Research, Education and Clinical Center (GRECC), University of Maryland School of Medicine, Baltimore, Maryland; Department of Medicine, Division of Gerontology and Geriatric Medicine.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Prior
authors.affiliation: Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE), Geriatric Research, Education and Clinical Center (GRECC), University of Maryland School of Medicine, Baltimore, Maryland; Department of Neurology.
authors.forename: Charlene E
authors.initials: CE
authors.lastname: Hafer-Macko
authors.affiliation: Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE), Geriatric Research, Education and Clinical Center (GRECC), University of Maryland School of Medicine, Baltimore, Maryland; Department of Medicine, Division of Gerontology and Geriatric Medicine.
authors.forename: Leslie I
authors.initials: LI
authors.lastname: Katzel
authors.affiliation: Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE), Geriatric Research, Education and Clinical Center (GRECC), University of Maryland School of Medicine, Baltimore, Maryland; Department of Neurology.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Macko
authors.affiliation: Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE), Geriatric Research, Education and Clinical Center (GRECC), University of Maryland School of Medicine, Baltimore, Maryland; Department of Medicine, Division of Gerontology and Geriatric Medicine.
authors.forename: Alice S
authors.initials: AS
authors.lastname: Ryan
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D018482:Muscle, Skeletal / Q000503:physiopathology*; D010101:Oxygen Consumption / Q000502:physiology; D055070:Resistance Training / Q000379:methods*; D020521:Stroke / Q000473:pathology* / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D016138:Walking
keywords: Stroke recovery; endurance; exercise; strength training; stroke rehabilitation