Effects of task-specific locomotor and strength training in adults who were ambulatory after stroke: results of the STEPS randomized clinical trial...including commentary by Carey JR, and author response by Sullivan KJ, Brown DA, Mulroy S, and Winstein CJ

  • KJ S
  • DA B
  • Klassen T
 et al. 
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Abstract

BACKGROUND AND PURPOSE: A phase II, single-blinded, randomized clinical trial was conducted to determine the effects of combined task-specific and lower-extremity (LE) strength training to improve walking ability after stroke. SUBJECTS: The participants were 80 adults who were ambulatory 4 months to 5 years after a unilateral stroke. METHOD: The exercise interventions consisted of body-weight-supported treadmill training (BWSTT), limb-loaded resistive leg cycling (CYCLE), LE muscle-specific progressive-resistive exercise (LE-EX), and upper-extremity ergometry (UE-EX). After baseline assessments, participants were randomly assigned to a combined exercise program that included an exercise pair. The exercise pairs were: BWSTT/UE-EX, CYCLE/UE-EX, BWSTT/CYCLE, and BWSTT/LE-EX. Exercise sessions were 4 times per week for 6 weeks (total of 24 sessions), with exercise type completed on alternate days. OUTCOMES: were self-selected walking speed, fast walking speed, and 6-minute walk distance measured before and after intervention and at a 6-month follow-up. RESULTS: The BWSTT/UE-EX group had significantly greater walking speed increases compared with the CYCLE/UE-EX group; both groups improved in distance walked. All BWSTT groups increased walking speed and distance whether BWSTT was combined with LE strength training or not. DISCUSSION AND CONCLUSION: After chronic stroke, task-specific training during treadmill walking with body-weight support is more effective in improving walking speed and maintaining these gains at 6 months than resisted leg cycling alone. Consistent with the overtraining literature, LE strength training alternated daily with BWSTT walking did not provide an added benefit to walking outcomes.

Author-supplied keywords

  • Adult
  • Aged
  • Aged, 80 and Over
  • Analysis of Covariance
  • Analysis of Variance
  • Chi Square Test
  • Chronic Disease
  • Clinical Assessment Tools
  • Cycling
  • Female
  • Fisher's Exact Test
  • Funding Source
  • Gait Training
  • Human
  • Kruskal-Wallis Test
  • Male
  • Middle Age
  • Muscle Strengthening
  • Paired T-Tests
  • Physical Endurance
  • Physical Therapy
  • Randomized Controlled Trials
  • Recovery
  • Repeated Measures
  • Scales
  • Short Form-36 Health Survey (SF-36)
  • Single-Blind Studies
  • Stroke -- Physiopathology
  • Stroke -- Rehabilitation
  • Therapeutic Exercise -- Methods
  • Torque
  • Treadmills
  • Treatment Outcomes
  • Walking
  • Weight Lifting
  • Wilcoxon Rank Sum Test

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Authors

  • Sullivan KJ

  • Brown DA

  • T Klassen

  • S Mulroy

  • T Ge

  • Azen SP

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