HOME-BASED EXERCISE TRAINING IMPROVES WALKING ENDURANCE IN CHRONIC STROKE PATIENTS

Abstract

PURPOSE This pilot study evaluated the effectiveness of two approaches of home-based exercise for improving walking endurance, gait velocity and physical fitness in chronic stroke patients. METHODS Nine chronic hemiparetic stroke patients (57 ± 11 y; 46 ± 16 d post-stroke) were randomly allocated to either AEROBIC (n=5) or STRENGTH (n=4) training, each comprising 30 exercise sessions conducted in their homes over an 8–10 week period. AEROBIC involved 30-min of isokinetic cycling at 50% VO2peak (during the initial 4 weeks) progressing to 70–75% VO2peak. Task-related STRENGTH training comprised 3-sets of 10–40 repetitions of box-stepping onto blocks of 5–30 cm height. Walking endurance was assessed, using a 6-min walk test, during a non-intervention baseline period, before training (PRE) and within 2 weeks (POST) of completion. Gait velocity, peak cardiorespiratory fitness, isometric leg muscle strength (1 RM knee-extension on impaired and non-impaired legs) and stepping ability were assessed PRE and POST training. RESULTS Exercise training increased 6-min walk distance at POST by 30.1m in all subjects, and in each group separately. However, only AEROBIC significantly increased their 6-min distance at POST (by 12%). Following exercise training, the average self-selected gait velocity increased from 0.79 to 0.93 m•s−1. Changes in peak cardiorespiratory fitness were significantly greater for AEROBIC (20% improvement) compared to STRENGTH (1% change), whereas maximal isometric leg strength was only significantly greater for STRENGTH subjects (12% increase). CONCLUSION Exercise training proved effective for increasing the capacity for community ambulation in chronic hemiparetic stroke patients by significantly increasing both walking endurance and gait velocity, and by reducing impairments in physical fitness. The results of this study suggest isokinetic aerobic cycle training was a more effective approach than task-related strength training for improving walking endurance in chronic stroke patients.