Overground Walking Training Research Articles

Effects of low-intensity endurance and resistance training on mobility in chronic stroke survivors: a pilot randomized controlled study.

Chronic stroke survivors are exposed to long-term disability and physical deconditioning, effects that may impact their independence and quality of life. Community-based programs optimizing the dose of exercise therapy that are simultaneously low risk and able to achieve high adherence should be identified. We tested the hypothesis that an 8-week, community-based, progressive mixed endurance-resistance exercise program at lower cardiovascular and muscular load yielded more mobility benefits than a higher-intensity program in chronic stroke survivors. A two-arm, parallel-group, pilot randomized, controlled clinical trial. Hospital (recruitment); community-based adapted physical activity center (training). Thirty-five chronic stroke patients (mean age: 68.4±10.4 years; 27 males). Participants were randomized to a low-intensity experimental (LI-E; N.=18) or a high-intensity active control group (HI-C; N.=17). Patients in the LI-E group performed over-ground intermittent walking (weeks 1-8) and muscle power training with portable tools (weeks 5-8); patients in the HI-C group executed treadmill walking (weeks 1-8) and strength training with gym machines (weeks 5-8). Changes in mobility, assessed using the 6-Minute Walking Distance test, were the primary outcome. Secondary outcomes included quality of life (Short-Form-36 Questionnaire), gait speed (10-Meter Walking Test), balance (Berg Balance Scale) and muscle performance of the lower limbs (strength and power of the quadriceps and femoral biceps). After 8 weeks, the 6MWD revealed more improvement for the LI-E group than the HI-C group (P=0.009). The SF36 physical activity domain (P=0.012) and peak power of the femoral quadriceps and biceps were also significantly improved for the LI-E group (P=0.008 and P<0.001, respectively) compared with the HI-C. Gait speed, balance and lower-limb strength increased in both groups; no significant differences were noted. The muscle power of the affected limb was the muscle parameter most correlated with mobility in the entire population. A low-intensity exercise program exhibited better results in terms of mobility, quality of life and muscle power compared with a higher-intensity program. Data need to be confirmed in a larger trial. The effectiveness, low-intensity and possible implementation in poorly equipped community-based settings make the LI-E program potentially suitable for stroke survivors and frail individuals.

Overground walking training with the i-Walker, a robotic servo-assistive device, enhances balance in patients with subacute stroke: a randomized controlled trial.

BackgroundPatients affected by mild stroke benefit more from physiological overground walking training than walking-like training performed in place using specific devices. The aim of the study was to evaluate the effects of overground robotic walking training performed with the servo-assistive robotic rollator (i-Walker) on walking, balance, gait stability and falls in a community setting in patients with mild subacute stroke.MethodsForty-four patients were randomly assigned to two different groups that received the same therapy in two daily 40-min sessions 5 days a week for 4 weeks. Twenty sessions of standard therapy were performed by both groups. In the other 20 sessions the subjects enrolled in the i-Walker-Group (iWG) performed with the i-Walker and the Control-Group patients (CG) performed the same amount of conventional walking oriented therapy. Clinical and instrumented gait assessments were made pre- and post-treatment. The follow-up observation consisted of recording the number of fallers in the community setting after 6 months.ResultsTreatment effectiveness was higher in the iWG group in terms of balance improvement (Tinetti: 68.4 ± 27.6 % vs. 48.1 ± 33.9 %, p = 0.033) and 10-m and 6-min timed walking tests (significant interaction between group and time: F(1,40) = 14.252, p = 0.001; and F(1,40) = 7.883, p = 0.008, respectively). When measured, latero-lateral upper body accelerations were reduced in iWG (F = 4.727, p = 0.036), suggesting increased gait stability, which was supported by a reduced number of falls at home.ConclusionsA robotic servo-assisted i-Walker improved walking performance and balance in patients affected by mild/moderate stroke, leading to increased gait stability and reduced falls in the community.Trial registrationThis study was registered on anzctr.org.au (July 1, 2015; ACTRN12615000681550).

The Effect of Body Weight Support Treadmill Training on Gait Recovery, Proximal Lower Limb Motor Pattern, and Balance in Patients with Subacute Stroke.

Objective. Gait performance is an indicator of mobility impairment after stroke. This study evaluated changes in balance, lower extremity motor function, and spatiotemporal gait parameters after receiving body weight supported treadmill training (BWSTT) and conventional overground walking training (CT) in patients with subacute stroke using 3D motion analysis. Setting. Inpatient department of rehabilitation medicine at a university-affiliated hospital. Participants. 24 subjects with unilateral hemiplegia in the subacute stage were randomized to the BWSTT (n = 12) and CT (n = 12) groups. Parameters were compared between the two groups. Data from twelve age matched healthy subjects were recorded as reference. Interventions. Patients received gait training with BWSTT or CT for an average of 30 minutes/day, 5 days/week, for 3 weeks. Main Outcome Measures. Balance was measured by the Brunel balance assessment. Lower extremity motor function was evaluated by the Fugl-Meyer assessment scale. Kinematic data were collected and analyzed using a gait capture system before and after the interventions. Results. Both groups improved on balance and lower extremity motor function measures (P < 0.05), with no significant difference between the two groups after intervention. However, kinematic data were significantly improved (P < 0.05) after BWSTT but not after CT. Maximum hip extension and flexion angles were significantly improved (P < 0.05) for the BWSTT group during the stance and swing phases compared to baseline. Conclusion. In subacute patients with stroke, BWSTT can lead to improved gait quality when compared with conventional gait training. Both methods can improve balance and motor function.

Varied Overground Walking Training Versus Body-Weight-Supported Treadmill Training in Adults Within 1 Year of Stroke

Background: Although task-related walking training has been recommended after stroke, the theoretical basis, content, and impact of interventions vary across the literature. There is a need for a comparison of different approaches to task-related walking training after stroke. Objective: To compare the impact of a motor-learning-science–based overground walking training program with body-weight-supported treadmill training (BWSTT) in ambulatory, community-dwelling adults within 1 year of stroke onset. Methods: In this rater-blinded, 1:1 parallel, randomized controlled trial, participants were stratified by baseline gait speed. Participants assigned to the Motor Learning Walking Program (MLWP) practiced various overground walking tasks under the supervision of 1 physiotherapist. Cognitive effort was encouraged through random practice and limited provision of feedback and guidance. The BWSTT program emphasized repetition of the normal gait cycle while supported on a treadmill and assisted by 1 to 3 therapy staff. The primary outcome was comfortable gait speed at postintervention assessment (T2). Results: In total, 71 individuals (mean age = 67.3; standard deviation = 11.6 years) with stroke (mean onset = 20.9 [14.1] weeks) were randomized (MLWP, n = 35; BWSTT, n = 36). There was no significant between-group difference in gait speed at T2 (0.002 m/s; 95% confidence interval [CI] = −0.11, 0.12; P > .05). The MLWP group improved by 0.14 m/s (95% CI = 0.09, 0.19), and the BWSTT group improved by 0.14 m/s (95% CI = 0.08, 0.20). Conclusions: In this sample of community-dwelling adults within 1 year of stroke, a 15-session program of varied overground walking-focused training was not superior to a BWSTT program of equal frequency, duration, and in-session step activity.

Body weight-supported treadmill training vs. overground walking training for persons with chronic stroke: a pilot randomized controlled trial

Objective: To compare the effects of body weight-supported treadmill training and overground walking training when matched for task and dose (duration/frequency/intensity) on improving walking function, activity, and participation after stroke. Design: Single-blind, pilot randomized controlled trial with three-month follow-up. Settings: University and community settings. Subjects: A convenience sample of participants (N = 20) at least six months post-stroke and able to walk independently were recruited. Interventions: Thirty-minute walking interventions (body weight-supported treadmill training or overground walking training) were administered five times a week for two weeks. Intensity was monitored with the Borg Rating of Perceived Exertion Scale at five-minute increments to maintain a moderate training intensity. Main Measures: Walking speed (comfortable/fast 10-meter walk), walking endurance (6-minute walk), spatiotemporal symmetry, and the ICF Measure of Participation and ACTivity were assessed before, immediately after, and three months following the intervention. Results: The overground walking training group demonstrated significantly greater improvements in comfortable walking speed compared with the body weight-supported treadmill training group immediately (change of 0.11 m/s vs. 0.06 m/s, respectively; p = 0.047) and three months (change of 0.14 m/s vs. 0.08 m/s, respectively; p = 0.029) after training. Only the overground walking training group significantly improved comfortable walking speed (p = 0.001), aspects of gait symmetry (p = 0.032), and activity (p = 0.003) immediately after training. Gains were maintained at the three-month follow-up (p < 0.05) for all measures except activity. Improvements in participation were not demonstrated. Conclusion: Overgound walking training was more beneficial than body weight-supported treadmill training at improving self-selected walking speed for the participants in this study.

Physiological responses and energy cost of walking on the Gait Trainer with and without body weight support in subacute stroke patients

BackgroundRobotic-assisted walking after stroke provides intensive task-oriented training. But, despite the growing diffusion of robotic devices little information is available about cardiorespiratory and metabolic responses during electromechanically-assisted repetitive walking exercise. Aim of the study was to determine whether use of an end-effector gait training (GT) machine with body weight support (BWS) would affect physiological responses and energy cost of walking (ECW) in subacute post-stroke hemiplegic patients.MethodsParticipants: six patients (patient group: PG) with hemiplegia due to stroke (age: 66 ± 15y; time since stroke: 8 ± 3 weeks; four men) and 6 healthy subjects as control group (CG: age, 76 ± 7y; six men).Interventions: overground walking test (OWT) and GT-assisted walking with 0%, 30% and 50% BWS (GT-BWS0%, 30% and 50%). Main Outcome Measures: heart rate (HR), pulmonary ventilation, oxygen consumption, respiratory exchange ratio (RER) and ECW.ResultsIntervention conditions significantly affected parameter values in steady state (HR: p = 0.005, V’E: p = 0.001, V'O2: p < 0.001) and the interaction condition per group affected ECW (p = 0.002). For PG, the most energy (V’O2 and ECW) demanding conditions were OWT and GT-BWS0%. On the contrary, for CG the least demanding condition was OWT. On the GT, increasing BWS produced a decrease in energy and cardiac demand in both groups.ConclusionsIn PG, GT-BWS walking resulted in less cardiometabolic demand than overground walking. This suggests that GT-BWS walking training might be safer than overground walking training in subacute stroke patients.

Daily intermittent hypoxia enhances walking after chronic spinal cord injury

Objectives:To test the hypothesis that daily acute intermittent hypoxia (dAIH) and dAIH combined with overground walking improve walking speed and endurance in persons with chronic incomplete spinal cord injury (iSCI).Methods:Nineteen subjects completed the randomized, double-blind, placebo-controlled, crossover study. Participants received 15, 90-second hypoxic exposures (dAIH, fraction of inspired oxygen [Fio2] = 0.09) or daily normoxia (dSHAM, Fio2 = 0.21) at 60-second normoxic intervals on 5 consecutive days; dAIH was given alone or combined with 30 minutes of overground walking 1 hour later. Walking speed and endurance were quantified using 10-Meter and 6-Minute Walk Tests. The trial is registered at ClinicalTrials.gov (NCT01272349).Results:dAIH improved walking speed and endurance. Ten-Meter Walk time improved with dAIH vs dSHAM after 1 day (mean difference [MD] 3.8 seconds, 95% confidence interval [CI] 1.1–6.5 seconds, p = 0.006) and 2 weeks (MD 3.8 seconds, 95% CI 0.9–6.7 seconds, p = 0.010). Six-Minute Walk distance increased with combined dAIH + walking vs dSHAM + walking after 5 days (MD 94.4 m, 95% CI 17.5–171.3 m, p = 0.017) and 1-week follow-up (MD 97.0 m, 95% CI 20.1–173.9 m, p = 0.014). dAIH + walking increased walking distance more than dAIH after 1 day (MD 67.7 m, 95% CI 1.3–134.1 m, p = 0.046), 5 days (MD 107.0 m, 95% CI 40.6–173.4 m, p = 0.002), and 1-week follow-up (MD 136.0 m, 95% CI 65.3–206.6 m, p < 0.001).Conclusions:dAIH ± walking improved walking speed and distance in persons with chronic iSCI. The impact of dAIH is enhanced by combination with walking, demonstrating that combinatorial therapies may promote greater functional benefits in persons with iSCI.Classification of evidence:This study provides Class I evidence that transient hypoxia (through measured breathing treatments), along with overground walking training, improves walking speed and endurance after iSCI.

The effects of treadmill or overground walking training program on gait in Parkinson's disease

BackgroundGait impairment in Parkinson's disease (PD) patients is characterized by the inability to generate appropriate stride length. Treadmill training has been proposed as a therapeutic tool for PD patients. However, it remains unknown whether treadmill training effects are different from overground walking training. Thus, our goal was to explore the effects of two training programs, walking on a treadmill and walking overground, in PD patients. Methods22 PD patients were randomly assigned to a treadmill or overground training group. The training program consisted of 5 weeks (3 sessions/week). Before and after the program we evaluated gait kinematics during walking at preferred and maximal speed; Timed Up and Go (TUG); static posturography and knee extensors strength. Gait parameters were reevaluated in the treadmill training group one month after the cessation of the training. ResultsPreferred speed walking improved in both groups after the training program. The treadmill training program, but not the overground, led to an improvement in the stride length at the preferred and maximal walking speed in the PD patients. In addition, the treadmill training group showed improvement of the TUG and static posturography tests. The improvement in gait parameters was maintained one month after the cessation of the treadmill training. ConclusionsThis study provides evidence of a specific therapeutic effect of treadmill training on Parkinsonian gait and balance. Walking on a treadmill may be used as an easy, effective and accessible way to improve the stride length and balance in PD patients.

Immediate effects of obstacle crossing training in independent ambulatory patients with spinal cord injury

A 2 × 2 cross-over design. To compare immediate effects of obstacle crossing training and conventional overground walking training on functional ability among independent ambulatory patients with spinal cord injury (SCI). A tertiary rehabilitation center, Thailand. Twenty independent ambulatory participants with SCI received a 1-day overground walking training and a 1-day obstacle crossing training program in a randomized cross-over design with a 2-day washout period. Immediately prior and after each training program, the functional ability of all participants was measured using the timed up and go test (TUGT), five times sit-to-stand test (FTSST) and 10-m walk test (10MWT). The TUGT, FTSST and 10MWT data were significantly better after obstacle crossing training (P<0.001) but not after the overground walking training (P>0.05). The improvement following obstacle crossing training was also significantly different from that of the overground walking training (P<0.05). Obstacle crossing training immediately enhanced functional ability related to walking of ambulatory participants with SCI. However, a further longitudinal study using a randomized controlled trial is needed to support benefits of incorporation of obstacle crossing training into rehabilitation practice.

Poster 75 Body Weight-Supported Treadmill Training vs. Over-Ground Walking Training for Persons With Chronic Stroke: A Randomized Controlled Trial

Poster 75 Body Weight-Supported Treadmill Training vs. Over-Ground Walking Training for Persons With Chronic Stroke: A Randomized Controlled Trial

Robotic-Assisted Step Training (Lokomat) Not Superior to Equal Intensity of Over-Ground Rehabilitation in Patients With Multiple Sclerosis

Background. Robot-assisted gait training (RAGT) has been suggested as an intervention to improve walking capacity in patients with multiple sclerosis (MS). Objective. This study aimed to evaluate whether RAGT (Lokomat) is superior to over-ground walking training in terms of quality of life, activity level, and gait. Methods. A total of 67 patients with MS with the Expanded Disability Status Scale (EDSS) 3.0 to 6.5 were randomized to walking or RAGT, in addition to multimodal rehabilitation. Primary outcomes were walking speed, activity level (estimated metabolic equivalent, metabolic equivalents [METs], using an accelerometer), and quality of life (Well-Being Visual Analogue Scale (VAS) and EQ-5D European VAS. Results. In all, 49 patients finished the interventions. Mean age was 56 years (range 36-74 years), mean EDSS was 5.8 (3.0-6.5), and the preferred walking speed at baseline was 0.56 m/s (0.06-1.43 m/s). Before rehabilitation, participants spent on average 68 min/d at an MET ≥3. The walking group improved gait speed nonsignificantly more than the RAGT; the upper bound of the confidence interval (CI) did not exclude a clinically relevant benefit (defined as a difference of 0.05 m/s) in favor of the walking group; the lower bound of the CI did exclude a clinically important benefit in favor of the Lokomat. Quality of life improved in both groups, with a nonsignificant between-group difference in favor of the walking group. Both groups had reduced their activity by 8 weeks after the rehabilitation. Conclusion. It is unlikely that RAGT is better than over-ground walking training in patients with an EDSS between 3.0 and 6.5.

Effects of 12-week overground walking training at ventilatory threshold velocity in type 2 diabetic women

This study analyzed the effects of overground walking training at ventilatory threshold (VT) velocity on glycaemic control, body composition, physical fitness and lipid profile in DM2 women. Nineteen sedentary patients were randomly assigned to a control group (CG; n=10, 55.9±2.2 years) or a trained group (TG; n=9, 53.4±2.3 years). Both groups were subjected to anthropometric measures, a 12-h fasting blood sampling and a graded treadmill exercise test at baseline and after a 12-week period, during which TG followed a training program involving overground walking at VT velocity for 20–60min/session three times/week. Significant group×time interactions (P<0.05) in glycated hemoglobin (HbA1c), body mass, body mass index (BMI), peak oxygen uptake (VO2peak) and exercise duration were observed as effects of training exercise, whereas intervention did not induced significant changes (P>0.05) in fasting blood glucose, submaximal fitness parameters and lipid profile. Our results suggest that overground walking training at VT velocity improves long term glycaemic control, body composition and exercise capacity, attesting for the relevance of this parameter as an effective strategy for the exercise intensity prescription in DM2 population.

Comparison of elliptical training, stationary cycling, treadmill walking and overground walking. Electromyographic patterns

The most common functional motor goal of lower extremity rehabilitation is to improve walking ability. For reasons of feasibility, safety or intensity, devices are frequently used to facilitate or augment gait training. The objective of this study was to compare the muscle activity patterns of the rectus femoris and semitendinosus muscles during four conditions: overground walking, treadmill walking, stationary cycling, and elliptical training. Ten healthy adults (six male, four female; mean age 22.7±2.9 years, range 20–29) participated and surface electromyographic data were recorded. Linear envelope curves were generated and time normalized from 0 to 100% cycle. The mean plus three standard deviations from a static trial was used as the threshold for muscle activity. Repeated measures analysis of variance procedures were used to detect differences between conditions. Elliptical training demonstrated greater rectus femoris activity and greater rectus femoris/semitendinosus coactivation than all other conditions. Consistent with previous work, treadmill walking demonstrated greater rectus femoris activity than overground walking. Minimal differences in semitendinosus activation were observed between conditions, limited to lower peak activity during cycling compared to treadmill walking. These results provide normative values for rectus femoris and semitendinosus activation for different locomotor training methods and may assist in selecting the most appropriate training device for specific patients. Clinicians and researchers should also consider the kinematic and kinetic differences between tasks, which cannot necessarily be inferred from muscle activation patterns.

Effect of an overground walking training on gait performance in healthy 65- to 80-year-olds

The aim of this study was to examine the effect of an individualized overground walking interval training on gait performance [ i.e., speed and energy cost ( C w)] in healthy elderly individuals. Twenty-two older adults were assigned to either a training group (TG; n = 12, 73.4 ± 3.9 yr) or a non-training control group (CG; n = 10, 70.9 ± 9.6 yr). TG participated in a 7-week individualized walking interval training at intensities progressing from 50 to 100% of ventilatory threshold ( T ˙ VE ). Aerobic fitness [maximal oxygen uptake ( V ˙ O 2 max ) and T ˙ VE ], preferred walking speed (PWS), gross and net C w (GC w and NC w, respectively) and relative effort (% V ˙ O 2 max ) at PWS measured before training (PWS 1) were assessed prior and following the intervention. All outcomes were measured on a treadmill. Significant improvements in GC w (−8%; P = 0.007), NC w (−12%; P = 0.003), relative effort (% V ˙ O 2 max : −12%; P < 0.001) and PWS (+12%; P < 0.001) were observed in TG but not in CG ( P > 0.71). V ˙ O 2 max and T ˙ VE remained unchanged in both groups ( P > 0.57). Changes in GC w at PWS 1 (difference between GC w at PWS 1 measured pre and post intervention) were inversely correlated with changes in PWS (difference between pre and post PWS; r = −0.67; P = 0.02). The decreased C w at PWS 1, with no concomitant improvement in aerobic fitness, represents the main contributing factor for the reduction of the relative effort at this speed. This also allows elderly people to increase their PWS post training. Therefore, the present walking training may be an effective way to improve walking performance and delay mobility impairment in older adults.

Improving community ambulation after stroke: the AMBULATE trial

BackgroundIt has been reported that following rehabilitation, only 7% of stroke survivors are able to walk at a level commensurate with community participation. Previous research indicates that treadmill and overground walking training can improve walking capacity in people living in the community after stroke. The main objectives of the AMBULATE trial are to determine (i) whether a 4-month treadmill walking program is more effective than a 2-month program, compared to control, in improving walking capacity, health and community participation and (ii) the "threshold" walking speed that results in sufficient walking capacity that makes walking self-sustaining.Methods/DesignA prospective randomised controlled trial of unsupported treadmill training with a 12 month follow-up with concealed allocation and blinded assessment will be conducted. 210 community-dwelling people after stroke who are able to walk independently but slowly will be recruited and randomly allocated to either a 4 month training group, 2 month training group or the control (no intervention) group. Intervention for the two training groups will occur 3 days per week for 30 minutes each session. Measurements of walking, health and community participation will be taken at baseline, 2 months, 4 months, 6 months and 12 months. This study has obtained ethical approval from the relevant Human Research Ethics Committees.DiscussionBy improving stroke survivors' walking ability, it is likely also to improve their general wellbeing by promoting better health and greater community participation. Furthermore, if stroke survivors can reach a point where their walking and community participation is self-sustaining, this will reduce the burden of care on family and friends as well as the economic burden on the health system. Given the major demographic shift in developed nations involving significant growth in the aged population, this research will make an important evidence-based contribution to the promotion of healthy ageing.Trial registrationThis trial is registered with the Australian New Zealand Clinical Trials Registry, (ACTRN012607000227493)

Test-Retest Reliability and Minimal Detectable Change of Gait Speed in Individuals Undergoing Rehabilitation After Stroke

Gait speed is commonly used to assess walking ability in persons with stroke. Previous research related to the psychometric properties of gait speed has been conducted primarily with individuals who were able to walk independently and/or were in the later stages of recovery after stroke. The purpose of this research was to examine the test-retest reliability and minimal detectable change (MDC90) of gait speed in individuals with stroke who required varying levels of assistance to ambulate during rehabilitation. Patients who could ambulate with or without physical assistance and were undergoing inpatient rehabilitation were recruited. Gait speed was measured over the middle five meters of a nine-meter walk at a comfortable pace. Data were analyzed using the intraclass correlation coefficient (ICC2,1) and the MDC90. Thirty-five patients who were a mean 34.5 (standard deviation = 17.7) days post-stroke agreed to participate. For all the subjects combined, the ICC2,1 was 0.862 and MDC90 was 0.30 m/sec. For the 13 subjects who required physical assistance to walk, the ICC2,1 = 0.971 and MDC90 = 0.07 m/sec. For the 22 subjects who could walk without physical assistance, the ICC2,1 = 0.80 and MDC90 = 0.36 m/sec. Gait speed is a reliable measure of walking ability for a wide variety of patients undergoing rehabilitation after stroke. Gait speed is more sensitive to change in patients who require physical assistance to walk than in those who can walk without assistance. A change of more than 0.30 m/sec may be necessary in order to determine whether a change in gait speed exceeds measurement error and patient variability.

Locomotor Training Approaches for Individuals with Spinal Cord Injury

Body weight supported (BWS) locomotor training improves overground walking ability in individuals with motor-incomplete spinal cord injury (SCI). While there are various approaches available for locomotor training, there is no consensus regarding which of these is optimal. The purpose of this ongoing investigation is to compare outcomes associated with these different training approaches. Twenty-seven subjects with chronic motor-incomplete SCI have completed training and initial and final testing at the time of this preliminary report. Subjects were randomly assigned to 1 of 4 different BWS assisted-stepping groups, including: (1) treadmill training with manual assistance (TM), (2) treadmill training with stimulation (TS), (3) overground training with stimulation (OG), or (4) treadmill training with robotic assistance (LR). Prior to and following participation we assessed walking-related outcome measures including overground walking speed, training speed, step length, and step symmetry. Data pooled across all subject groups showed a significant effect of training on walking speed. While the differences between groups were not statistically significant, there was a trend toward greater improvement in the TS and OG groups. Post hoc subgroup analysis of outcomes from subjects with slower initial walking speed (< 0.1 m/s; n = 15) compared to those with faster initial walking speeds (> or = 0.1 m/s; n = 12) identified meaningful differences in outcomes with walking speed increasing by 85% in the slower group and by only 9% in the faster group. Step length of both stronger and weaker limb increased in all groups with the exception of those in the LR group. Step symmetry was increased in the TM and LR groups. These results represent preliminary findings of changes in walking-related function associated with different forms of BWS locomotor training for individuals with chronic, motor-incomplete SCI. Early data indicates that locomotor outcomes in these individuals appear to be comparable across training approaches. For the individuals in this study sample, those with the greatest deficits in walking function benefitted the most from locomotor training.

Treadmill Vs. Overground Walking In Older Adults

Although walking programs have been effective in enhancing numerous health outcomes in older adults, questions have been raised as to the differential effects of treadmill training as compared to overground walking programs. PURPOSE Therefore, the goal of this study was to examine the attitudes of older adults walking either overground (OG) or on a treadmill (TM) after 1, 3, and 5 weeks of training and post program. METHODS Twenty participants (74.3 ± 4.1yrs) completed 6 weeks (18 sessions) of walking training, either on a treadmill (n = 9) or an indoor, flat track (n = 11), both groups exercising at the same facility at different times. Blood pressure, heart rate and rating of perceived exertion (RPE) were monitored during each session, and participants were encouraged to walk at an RPE of 12–13. A number of bipolar adjectives (eg. pleasant/unpleasant) used in previous research were employed to measure participants' attitudes toward walking training. RESULTS A 4 × 2 (time point × treatment group) mixed model repeated measures ANOVA revealed significant main effects for time, F (3, 45) = 3.50; p <.05, and experimental condition, F (1, 15) = 5.43; p <.05. Follow-up simple effects analyses indicated that attitudes towards the walking program were significantly more positive post program as compared to baseline. Furthermore, the participants in the OG condition rated their walking program more positively than their TM condition counterparts. CONCLUSIONS These results suggest that although mode of walking did not influence improvements in attitudes toward walking training, older adults reported more positive attitudes towards OG walking training than TM walking throughout the program. Future research is needed to determine whether these findings translate into differences in adherence, training effects, and health outcomes (e.g., functional improvements).