Walking Training Research Articles

Application of an adjustable medical foot support pillow to prevent foot drop in patients with stroke.

Foot drop is one of the most common complications after stroke. This study investigates the role of an adjustable medical foot support pillow in preventing foot drop and improving the lower limb function of patients after stroke. A total of 88 patients with strokes admitted to our hospital from September 2019 to September 2020 were selected and categorised into the control (n= 44) and intervention groups (n= 44) using a random number table. The control group received routine rehabilitation nursing, while the intervention group adopted a self-made adjustable medical foot support pillow based on routine rehabilitation nursing. After four weeks, the simplified Fugl Meyer Assessment (FMA) and the modified activities of daily living (ADL) scales were used to measure the ankle range of motion of the lower limbs. The lower limb motor function, ADL, and ankle mobility before and after treatment, as well as the incidence of foot ptosis, were compared between the two groups. After the procedure, the intervention group was superior to the control group in the FMA score of the lower extremities, ADL score, and ankle joint mobility in the lower limbs, indicating statistically significant differences (P< 0.05). The incidence rate of foot drop was lower in the intervention group than in the control group, and the difference was statistically significant (P< 0.05). The adjustable medical foot support pillow can prevent foot drop in patients after stroke, improve lower limb function, provide a favourable basis for walking training, and improve the ADL of patients.

Investigation of the effects of 8-week Nordic and traditional walking training on blood pressure in prehypertensive postmenopausal women

Objective: This study aimed to investigate the effects of Nordic walking (NW) and traditional walking (TW) training on blood pressure and resting heart rate in prehypertensive postmenopausal women. Materials and Methods: Twenty women aged 57.9 ± 7.2 years participated in the study. Participants were divided into two groups of 10: NW and TW. Exercises were performed three days a week for eight weeks and 50 min/day at 40-60% of the maximum heart rate. Body composition, blood pressure, and resting heart rate values of the participants were measured before and after the 8-week exercise program. Results: Upon comparing the values before and after exercise; body weight, body mass index, hip circumference, systolic and diastolic pressure values decreased significantly (p&lt;0.05), while there was no significant change in the resting heart rate (p&gt;0.05) in the NW group. In the TW group; body weight, body mass index, waist circumference, hip circumference, systolic and diastolic pressure decreased significantly (p&lt;0.05). No significant changes were found in other parameters (p&gt;0.05). The effect size of NW training was found to be higher in body weight, BMI, and systolic and diastolic pressure values. Conclusion: NW training is more effective than TW training in the regulation of blood pressure in prehypertensive postmenopausal women.

Blood Flow Restricted Training as the Last-Opportunity, Non-Invasive Treatment for a Patient Suffering from Peripheral Arterial Disease Without Possibility for Implementing Conventional Walking Exercise Rehabilitation a Case Report

Introduction and Objectives: We report a non-invasive and innovative treatment method with blood flow restricted training (BFR) in a 62-year-old man with short-distance claudication of the right calf (Rutherford 3), and post-thrombotic deep vein syndrome of the same limb. This is the first described case of BFR training used in the rehabilitation of a patient with lower limb ischaemia.Material and Methods: The patient, undertaking frequent physical activity, a previous cigarette smoker, with a history of deep vein thrombosis, was diagnosed with occlusion of the popliteal and anterior tibial arteries causing intermittent, short-distance claudication. An invasive approach was not possible, as the patient refused any vascular surgery interventions, open or endovascular. Due to recently diagnosed hip joint degeneration, accompanied by degeneration and dyscopathy of the lumbosacral vertebral column, regular supervised walking training could not be implemented. Experimental blood flow restricted low-intensity training, with the use of a cross-trainer tool accompanied by cooling, was introduced. The 21-minute training, 3 times per week for 3 months, was performed in a seated position with a special low-pressure cuff placed on the arms and legs.Results: The patients limb symptoms were promptly reduced and the vascular parameters significantly improved, allowing surgical treatment of the right hip joint. The patient continued the non-invasive treatment for peripheral arterial disease in the form of walking training.Conclusions: Blood flow restriction training may be individually considered for patients with peripheral arterial disease having limited possibilities of classic walking training and revascularization, but this should be done with great caution and after detailed consultation with a vascular medicine specialist.

Effect of Nordic Walking Training on Physical Fitness and Self-Assessment of Health of People with Chronic Non-Specific Lower Back Pain

In order to determine the impact of a four-week cycle of Nordic Walking (NW) training on the physical fitness of people with chronic non-specific lower back pain and the impact of this form of activity on their self-assessment of health quality, the study included 80 men and women aged 29 to 63 years. The subjects were divided into two equal (40-person) groups: experimental and control. In both study groups the degree of disability in daily activities caused by back pain was assessed with the FFb-H-R questionnaire, the physical fitness was evaluated with the modified Fullerton test and the sense of health quality was assessed with the SF-36 questionnaire. The same tests were repeated after four weeks. In the experimental group NW training was applied between the two studies. During four weeks, 10 training units were carried out, and each training session lasted 60 min with a two-day break between each training. The four-week NW training resulted in a statistically significant sense of disability due to back pain (p < 0.001), significant improvement of physical fitness expressed by improvement in upper (p < 0.001) and lower (p < 0.01) body strength, upper and lower body flexibility (p < 0.001) and ability to walk a longer distance in a 6-min walk test (p < 0.001). The training participants also showed significant improvements in health quality in both physical (p < 0.001) and mental (p < 0.001) components. The four-week NW training has a positive impact on the physical fitness of men and women with chronic lower back pain. Participation in NW training also contributes to a significant reduction in the sense of disability caused by back pain and improvement in the self-assessment of health quality.

How sport changed my life? Description of the perceived effects of the experiences of young Colombians throughout a sport for development and peace program.

This study contributes to the advancement of the field of Sport for Development and Peace (SDP) research in Latin America and the Caribbean (LAC). There are still few studies on SDP programs in this region and it is important to document and understand the impacts of these programs on participants. The present study is the result of a collaborative research that aims to describe the experiences and perceptions of Colombian youth and program managers who participated in an SDP program that took them from a local community sports club to the Olympic Games. Seven semi-structured interviews were conducted with key actors (administrators, coaches, and athletes) who participated in a triple and transversal (local, district and national) Olympic walking training program. The results provided a better understanding of the program dynamics in the local, regional, and national level, as well as of the short- and long-term effects perceived by the actors of the process on their development, education, health, and career. Recommendations are made for SDP organizations in LAC. Future studies should continue to investigate the SDP initiative in LAC to understand how sport can help development and peace building in this region.

Backward Walking Training Induces Structural Changes in the Superior Cerebellar Peduncle: A Pilot Myelin Water Imaging Study

Background and Purpose Multiple sclerosis (MS) is a complex neurodegenerative disease that is identifiable by the loss of myelin in the central nervous system (CNS), leading to motor decline. Our lab has shown that backward walking (BW) speed in addition to MRI measures may improve fall prediction for persons with MS (pwMS). Myelin Water Imaging (MWI), a novel technique for assessing the myelin microstructure, has not been examined in relation to BW. This study examines the impact of an 8-week BW training program on the superior cerebellar peduncle (SCP) utilizing MWI, as well as the relation of the change in the SCP to the change in function. Methods Eight individuals with relapsing-remitting MS participated in this pilot study. Participants completed functional tests and a 3T MRI before and after the 8-week intervention, consisting of treadmill and overground BW 1x/week and home exercises 2x/week. Falls were monitored for 6 months after the intervention. The MWI metrics, which included the Myelin Water Fraction (MWF) reflecting myelin content and the geomT2IEW reflecting axon size/packing density, were estimated from the SCP. T-tests were used to examine differences in SCP pre/post and Spearman correlations were used to examine relations among changes in SCP and changes in function. Due to the pilot nature of this study, effect sizes and rho values were prioritized. Results MWF and geomT2IEW values increased after training, with effect sizes of -0.16 and -0.53, respectively. The change in geomT2IEW was strongly correlated with improvements in balance measured with wearable sensors (r=0.61), BW speed (r=0.79), forward walking speed (r=0.52) and prospective falls at 6 months (r=0.46). Discussion Our pilot data suggests that BW training induces both structural (SCP) and functional (balance, gait, falls) changes over 8 weeks and shows potential for future larger-scale studies exploring efficacy. Multiple sclerosis (MS) is a complex neurodegenerative disease that is identifiable by the loss of myelin in the central nervous system (CNS), leading to motor decline. Our lab has shown that backward walking (BW) speed in addition to MRI measures may improve fall prediction for persons with MS (pwMS). Myelin Water Imaging (MWI), a novel technique for assessing the myelin microstructure, has not been examined in relation to BW. This study examines the impact of an 8-week BW training program on the superior cerebellar peduncle (SCP) utilizing MWI, as well as the relation of the change in the SCP to the change in function. Eight individuals with relapsing-remitting MS participated in this pilot study. Participants completed functional tests and a 3T MRI before and after the 8-week intervention, consisting of treadmill and overground BW 1x/week and home exercises 2x/week. Falls were monitored for 6 months after the intervention. The MWI metrics, which included the Myelin Water Fraction (MWF) reflecting myelin content and the geomT2IEW reflecting axon size/packing density, were estimated from the SCP. T-tests were used to examine differences in SCP pre/post and Spearman correlations were used to examine relations among changes in SCP and changes in function. Due to the pilot nature of this study, effect sizes and rho values were prioritized. MWF and geomT2IEW values increased after training, with effect sizes of -0.16 and -0.53, respectively. The change in geomT2IEW was strongly correlated with improvements in balance measured with wearable sensors (r=0.61), BW speed (r=0.79), forward walking speed (r=0.52) and prospective falls at 6 months (r=0.46). Our pilot data suggests that BW training induces both structural (SCP) and functional (balance, gait, falls) changes over 8 weeks and shows potential for future larger-scale studies exploring efficacy.

MS Rehabilitation Research During the COVID Pandemic: Participant and Therapist Satisfaction with Remote Delivery (P12-8.004)

<h3>Objective:</h3> To understand participant and physical therapist (PT) satisfaction with virtual delivery of a multiple sclerosis (MS) rehabilitation research intervention. <h3>Background:</h3> Rehabilitation interventions in people with MS are usually in-person, although virtual delivery can improve access and relevance to patient’s daily lives. We planned a randomized controlled trial of a standardized physical therapy intervention for walking aid selection, fitting and training, (Assistive Device Selection, Training and Education Program [ADSTEP]), to prevent falls in MS. Due to the COVID-19 pandemic we transitioned to virtual delivery by video-teleconference. <h3>Design/Methods:</h3> ADSTEP, piloted as an in-person in-clinic program, consists of six 40-minute one-on-one sessions with a PT. We transitioned to virtual delivery to patients’ homes at the beginning of our full-scale randomized controlled trial. At intervention completion for each subject, we examined subject and PT satisfaction with virtual delivery using a nine-question survey. We analyzed survey responses and associations. <h3>Results:</h3> Forty-eight subjects completed ADSTEP delivered by four therapists; 46 subjects and all therapists completed the survey. For almost all session, subjects and therapists reported no difficulties seeing each other or following instructions, and all found the platform secure and private. 63% of subjects, a higher proportion of women than men (71% vs 50%) and more so for those with fewer falls in the past year (median 5 vs 12 falls), found the virtual visits as good as in-person sessions. 59% of subjects, a higher proportion of women than men (64% vs 50%) and more so for those with fewer falls in the past year (median 5 vs 8), preferred the virtual visits. <h3>Conclusions:</h3> This study supports that PTs and people with MS find virtual delivery of a rehabilitation research intervention feasible and acceptable, with women and those who fall less often being more likely to find virtual visits as good as or preferable to in-person visits. <b>Disclosure:</b> Dr. Cameron has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Greenwich Biosciences/Jazz . Dr. Cameron has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Adamas Pharmaceuticals. Dr. Cameron has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer. The institution of Dr. Cameron has received research support from National MS Society. The institution of Dr. Cameron has received research support from Department of Veterans Affairs. Dr. Cameron has received publishing royalties from a publication relating to health care. The institution of Ms. Hildebrand has received research support from National MS Society. Ms. Serdar has nothing to disclose. Mr. Schlimgen has nothing to disclose. Ms. Hugos has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GW Pharmaceuticals. Ms. Hugos has received personal compensation in the range of $0-$499 for serving as a Consultant for Evidera, Inc.. Ms. Hugos has received personal compensation in the range of $0-$499 for serving as a Consultant for Techspert.io Ltd.. Ms. Hugos has received research support from Portland VA. Ms. Hugos has received research support from Oregon Health &amp; Science University. Ms. Hugos has received research support from Oregon Health &amp; Science University. Ms. Hugos has received publishing royalties from a publication relating to health care.

P068 The effects of exercise and physical activity in inflammatory rheumatic diseases: a scoping literature review

Abstract Background/Aims Physical activity and exercise for the management of inflammatory rheumatic diseases is well described in the literature and is recommended in the EULAR 2018 physical activity and 2021 self-management guidelines. However, the extent to which physical activity and exercise is beneficial or detrimental in these patients is unclear. The aim of this review is to critically appraise the effects of physical activity and exercise interventions on patient-centred outcomes in a range of inflammatory rheumatic diseases in order to help guide clinical practice. Methods Pre-defined search terms were used to identify randomised controlled trials or systematic reviews published in English, studying any form of physical activity/exercise interventions for inflammatory rheumatic diseases. This included seronegative spondyloarthritis (including axial/psoriatic/enteropathic/reactive arthritis), rheumatoid arthritis, and broadly grouped connective tissue diseases including systemic lupus erythematosus, systemic sclerosis and myositis. Databases included MEDLINE via PubMed, CINAHL, Embase and Cochrane Database of systematic reviews from January 2018 onwards. Quantitative data regarding types of physical activity, any primary or secondary outcome measures and the quality of the evidence was compiled independently by two authors. 427 studies were identified and screened of which 160 were included in the final analysis. Results Numerous benefits of various quality in a range of physical activities across the diseases were identified. Interventions included swimming, aquatic exercises, global posture retraining and land based aerobic exercises (including walking, Nordic walking, Pilates, Tai Chi and High Intensity Interval Training). In terms of high-quality evidence, for seronegative spondyloarthritis, benefits were found for functional outcome scores, fatigue levels and disease activity scores. In rheumatoid arthritis, benefits were seen in fitness, disease activity scores, quality of life, muscle strength and pain reduction. Across the studied connective tissue diseases, benefits were seen in fitness, ability to carry out activities of daily living, muscle strength and fatigue. Low to moderate quality evidence for improvement was seen across all diseases in areas such as mood, sleep quality and flexibility/stiffness. However, there was significant heterogeneity amongst the dose and type of exercise interventions used between identified studies. This therefore precluded a meta-analysis which meant that this review was unable to recommend one specific exercise over another. Importantly, no adverse outcomes to physical activity were found in any of the identified studies. Conclusion It is evident that a range of exercise and physical activity interventions can have an important role in the management of inflammatory rheumatic diseases. Moreover, the wider well-established benefits of physical activity seen in the general population, including those of mental wellbeing and in cardiovascular disease, may be pertinent to the comorbidities associated with inflammatory rheumatic diseases. Future research would benefit from comparing doses and types of exercise interventions against each other in order to help further guide clinical practice. Disclosure R. Amarnani: None. M. Hadjidemetriou: None. A. Mundell: None. S. Katti: None. F. Chiwah: None. K. Ainsworth: None. G.S. Metsios: None. C. Lester: None.

A Standing Low-frequency Vibration Exercise Device for Improving Balance in Community-dwelling Older Adults: A Single-blind Randomized Controlled Trial.

This study aimed to compare the effects of the standing low-frequency vibration exercise device (SLVED) and walking training on balance ability on an unstable surface in community-dwelling elderly people. Thirty-eight older adults were randomly allocated to the SLVED sessions: the intervention group (n = 19), and the walking sessions: the control group (n = 19). Each group session lasted 20 min and was performed twice a week for 12 weeks. Standing balance was assessed by the change in center-of-gravity sway of the participant standing on foam rubber with eyes open (EO) and eyes closed (EC). The primary outcome measures were the root mean square (RMS) values of the center of foot pressure in the mediolateral and anteroposterior directions and the RMS area. Secondary outcome measures were the results of the 10-m walking time test (10 MWT), five-times sit-to-stand (5T-STS) test, and timed up-and-go (TUG) test. Analysis of variance showed a significant group × time interaction for the TUG test. Significant improvements were observed in Y-RMS for EO condition; RMS, X-RMS, Y-RMS, and RMS area for EC condition; and 10 MWT, 5T-STS test, and TUG test for the main effect of the time factor. SLVED for intervention in community-dwelling older adults showed a greater improvement than walking training in the TUG test. In addition, SLVED improved the Y-RMS for the EO condition on foam rubber; RMS, X-RMS, Y-RMS, and RMS area for the EC condition on foam rubber in standing balance; and the 10 MWT and 5T-STS test, suggesting that it has similar effects to walking training.

Effect of Treadmill Backward Walking Training on Motor Capacity in Cerebral Palsy: A Randomized Controlled Study

To evaluate treadmill backward walking training (BWT) effects on walking speed, balance, mobility, and walking endurance in children with cerebral palsy (CP). The study evaluated 41 children with CP (age, 6-18; Gross Motor Function Classification System levels I and II). They were randomly allocated into control and BWT groups. BWT was applied (two sessions/week, 15 min/session for 8-week) to BWT group after the neurodevelopmental-based physiotherapy program routinely followed by all participants while the control group did not receive BWT. 10-Meter Walk Test (10MWT), Pediatric Balance Scale (PBS), Timed Up and Go Test (TUG), and Two-Minute Walk Test (2MWT) were selected as outcome measures for assessing walking speed, balance, mobility and endurance respectively. In BWG, 2MWT distance (3.5%), PBS (3.5%) increased significantly, and TUG decreased by 5.1% (all p<0.001) after training, 10MWT was shorter by 6.1% for BWG, corresponding to 7.4% faster walking speed (p<0.01). Control group assessment variations were stationary and not statistically significant. Backward treadmill walking training induces small but statistically significant motor capacity improvements in children with CP.

Incremental Step Test Results are related to the Six-Minute Walk Distance in Adults with Chronic Obstructive Pulmonary Disease: An Experimental Study

Background: The incremental step test (IST) could potentially be used to prescribe exercise training in people with COPD. Objective: To examine the relationship between IST total step count (ISTC) and 6MWT distance (6MWD) to determine whether an appropriate walking training prescription can be inferred from the ISTC. Methods: People with COPD were recruited after a PR assessment (including two 6MWTs) and performed one IST. Pearson’s correlation coefficient (r) assessed the relationship between ISTC, 6MWD and other independent variables. An estimated 6MWD equation from ISTC was derived through stepwise linear regression analysis and Bland Altman plots determined agreement between predicted 6MWD based on ISTC and actual 6MWD. Results: Thirty participants (mean [SD] age 74 [7] and FEV1 58 [21] % predicted) completed testing. Mean [SD] ISTC and 6MWD was 86 (40) and 462 (94) metres respectively. A strong positive correlation was found between ISTC and 6MWD (r = 0.82, p&lt;0.001). ISTC and height (r = 0.32, p &lt;0.001) and age (r = 0.22, p &lt;0.003) were weakly associated. The estimated 6MWD equation from the stepwise regression was 6MWD (m) = 1.92 (ISTC) + 296.7. Conclusion: The IST could estimate 6MWD in people with COPD as the tests are strongly correlated.

Effects of Tai Chi Chuan on Cognitive Function in Adults 60 Years or Older With Type 2 Diabetes and Mild Cognitive Impairment in China

Type 2 diabetes (T2D) is associated with the progression of cognitive dysfunction. Physical activity benefits cognition, but no evidence from randomized clinical trials has shown whether tai chi chuan has better long-term benefits than fitness walking in cognitive function for patients with T2D and mild cognitive impairment (MCI). To compare the effectiveness of tai chi chuan, a mind-body exercise, for improving cognitive function in older adults with T2D and MCI, with fitness walking. This randomized clinical trial was conducted between June 1, 2020, and February 28, 2022, at 4 sites in China. Participants included 328 adults (aged ≥60 years) with a clinical diagnosis of T2D and MCI. Participants were randomized in a 1:1:1 ratio to a tai chi chuan group, a fitness walking group, or a control group. The tai chi chuan group received 24-form simplified tai chi chuan. The fitness walking group received fitness walking training. Both exercise groups took the training for 60 min/session, 3 times/wk, for 24 weeks in a supervised setting. All 3 groups were provided with a 30-minute diabetes self-management education session, once every 4 weeks for 24 weeks. The participants were followed up for 36 weeks. The primary outcome was the global cognitive function measured at 36 weeks by the Montreal Cognitive Assessment (MoCA). Secondary outcomes included MoCA at 24 weeks and other cognitive subdomain measures and blood metabolic indices at 24 and 36 weeks. A total of 328 participants (mean [SD] age, 67.55 [5.02] years; mean [SD] T2D duration, 10.48 [6.81] years; 167 [50.9%] women) were randomized to the tai chi chuan group (n = 107), fitness walking group (n = 110), or control group (n = 111) and included in the intention-to-treat analysis. At 36 weeks, the tai chi chuan group showed improved MoCA scores compared with the fitness walking group (mean [SD], 24.67 [2.72] vs 23.84 [3.17]; between-group mean difference, 0.84 [95% CI, 0.02-1.66]; P = .046) in the intention-to-treat analysis. The per-protocol analysis data set and subgroup analysis at 36 weeks showed similar results. Based on the generalized linear models, the treatment effects were similar in each group after adjusting for self-reported dietary calories and physical activity. There were 37 nonserious adverse events (tai chi chuan group, 8; fitness walking group, 13; control group, 16) unrelated to the study with no statistically significant difference among the 3 groups (P = .26). In this randomized clinical trial including older adults with T2D and MCI, tai chi chuan was more effective than fitness walking in improving global cognitive function. The findings support a long-term benefit, suggesting the potential clinical use of tai chi chuan as an exercise intervention to improve cognitive function for older adults with T2D and MCI. ClinicalTrials.gov Identifier: NCT04416841.

Functional outcomes and associated factors of individuals with unilateral traumatic lower limb amputation in Sri Lanka: An observational study.

Rehabilitation is important after an amputation surgery. This study was conducted to find the level of functional outcomes of individuals with unilateral traumatic lower limb amputation and the impact of sociodemographic, amputation, and rehabilitation characteristics on functional outcomes. An observational cross-sectional study was conducted with 48 participants (aged 20-60 years) who visited the Center for Handicapped from across the country. Functional outcomes were measured using the Locomotor Capabilities Index, Amputee Mobility Predictor with Prosthesis, 6-minute walk distance, and spirometry test and sociodemographic, amputation, and rehabilitation characteristics using a self-constructed questionnaire. Amputee Mobility Predictor with Prosthesis K levels showed 65% had the ability to ambulate in the community and could master environmental barriers. Locomotor Capabilities Index scores showed 96% could independently perform basic daily activities with or without using assistive devices and 83% could perform advanced daily activities. None of the individuals had achieved their predicted 6-minute walk distance, but 52% had "good and above" level of maximum oxygen consumption; restrictive respiratory pattern was indicated among 31%. Amputee Mobility Predictor with Prosthesis and Locomotor Capabilities Index scores were significantly ( p < 0.005) affected by mobility hours/day, amputation level, prosthesis usage, and satisfaction. Six-minute walk distance was significantly ( p < 0.005) related to income, time since amputation, duration of rehabilitation, mobility hours/day, sex, job engagement, previous job, amputation level, K levels, and satisfaction with prosthesis. Rehabilitation in Sri Lanka mainly focuses on basic walking training, not on long-term survival, distance walking, and cardiorespiratory endurance, which can lead to future comorbidities. Raising awareness in the society about rehabilitation services and more effective rehabilitation programs are recommended.

Comparative efficacy of gait training for balance outcomes in patients with stroke: A systematic review and network meta-analysis.

Growing evidence suggests that gait training can improve stroke patients' balance outcomes. However, it remains unclear which type of gait training is more effective in improving certain types of balance outcomes in patients with stroke. Thus, this network meta-analysis (NMA) included six types of gait training (treadmill, body-weight-supported treadmill, virtual reality gait training, robotic-assisted gait training, overground walking training, and conventional gait training) and four types of balance outcomes (static steady-state balance, dynamic steady-state balance, proactive balance, and balance test batteries), aiming to compare the efficacy of different gait training on specific types of balance outcomes in stroke patients and determine the most effective gait training. We searched PubMed, Embase, Medline, Web of Science, and Cochrane Library databases from inception until 25 April 2022. Randomized controlled trials (RCTs) of gait training for the treatment of balance outcomes after stroke were included. RoB2 was used to assess the risk of bias in the included studies. Frequentist random-effects network meta-analysis (NMA) was used to evaluate the effect of gait training on four categories of balance outcomes. A total of 61 RCTs from 2,551 citations, encompassing 2,328 stroke patients, were included in this study. Pooled results showed that body-weight-support treadmill (SMD = 0.30, 95% CI [0.01, 0.58]) and treadmill (SMD = 0.25, 95% CI [0.00, 0.49]) could improve the dynamic steady-state balance. Virtual reality gait training (SMD = 0.41, 95% CI [0.10, 0.71]) and body-weight-supported treadmill (SMD = 0.41, 95% CI [0.02, 0.80]) demonstrated better effects in improving balance test batteries. However, none of included gait training showed a significant effect on static steady-state balance and proactive balance. Gait training is an effective treatment for improving stroke patients' dynamic steady-state balance and balance test batteries. However, gait training had no significant effect on static steady-state balance and proactive balance. To achieve maximum efficacy, clinicians should consider this evidence when recommending rehabilitation training to stroke patients. Considering body-weight-supported treadmill is not common for chronic stroke patients in clinical practice, the treadmill is recommended for those who want to improve dynamic steady-state balance, and virtual reality gait training is recommended for those who want to improve balance test batteries. Missing evidence in relation to some types of gait training is supposed to be taken into consideration. Moreover, we fail to assess reactive balance in this NMA since few included trials reported this outcome. PROSPERO, identifier CRD42022349965.

Retro walking treadmill training reduces C-reactive protein levels in overweight and obese young adults: A randomized comparative study.

Retro walking has been shown to acquire a greater metabolic cost, placing a higher cardiopulmonary demand on the body, when compared with forward walking at a similar speed. The aim of this study was to compare the effect of retro walking with that of forward walking on C-reactive protein (CRP) levels, body mass index (BMI) and blood pressure (BP) and to understand the influence of independent factors namely systolic blood pressure (SBP), diastolic blood pressure (DBP) and BMI on CRP in untrained overweight and obese young adults. This was a randomised controlled trial whereby 106participants underwent either retro walking (n = 53) or forward walking (n = 53) treadmill training four times a week for 12 weeks before and after which CRP, BMI, and BP levels were measured. Comparison of the measured values before and after intervention and between the groups was done and influence of BMI and BP on CRP levels was determined. Both groups recorded a significant decrease (p < 0.001) in CRP, BMI, and BP levels postintervention. The participants who underwent retro walking training showed a significantly (p < 0.001) higher decrease in all the outcomes as compared with the forward walking group. C-reactive protein levels were seen to be influenced by BMI and DBP. Retro-walking training leads to greater decrease in CRP, BMI, and BP when compared with forward walking, andCRP levels are influenced by BMI and DBP. Retro walking treadmill training can be used preferentially to bring about reduction in cardiovascular risk factors.

Immediate effects of a buffered knee orthosis on gait in stroke patients with knee hyperextension.

Patients exhibit considerable variations in gait patterns especially in knee hyperextension in the stance phase after stroke. If knee hyperextension is untreated it may lead to pain, reduced independence in activities of daily living, deformities and instability. The aim of this study was to investigate the immediate effects of a buffered knee orthosis on gait of stroke patients with knee hyperextension. A total of nine patients with knee hyperextension after stroke were selected to wear buffered knee orthosis developed by Zhongshan Traditional Chinese Medicine Hospital and Ruike Medical Technology (Shanghai) Co., Ltd during walking training and daily walking. Then the gait analysis system of Motionanalysis was used to analyze and evaluate kinematic and spatiotemporal parameters of the gait in patients with independent walking or walking with a buffered knee orthosis. After wearing the buffered knee brace, initial contact, maximum and minimum angles of support phase, the toe off the ground, maximum and minimum angles of swing phase on the injured side of knee and ankle increased. Minimum angle of support phase and maximum angle of swing phase on the uninjured side of ankle decreased, while the toe off the ground and minimum angles of swing phase increased significantly (all P< 0.05); There was no significant difference in other kinematics, in parameters between time and space, in walking speed among subjective gait parameters (P> 0.05). Walking distance, confidence, sense of security, and the feeling of walking hyperextension were all improved. In addition, the number of asymmetric kinematic parameters and spatiotemporal parameters decreased. The buffered knee orthosis can effectively prevent knee hyperextension after stroke, improve the knee and ankle sagittal motion, gait asymmetry, gait subjective feeling, and does not affect gait space-time parameters.

The Effect of Exercise Modalities on Walking Capacity in Patients With Intermittent Claudication: A NETWORK META-ANALYSIS.

Despite extensive research on the effect of supervised exercise therapy on walking performance in patients with symptomatic peripheral arterial disease (PAD), it remains unclear which training modality provides the greatest improvement in walking capacity. The objective of this study was to compare the effect of different types of supervised exercise therapy on walking capacity in individuals with symptomatic PAD. A random-effect network meta-analysis was performed. The following databases were searched from January 1966 to April 2021: SPORTDiscus, CINAHL, MEDLINE, AMED, Academic Search Complete and, Scopus. Trials had to include at least one type of supervised exercise therapy for patients with symptomatic PAD, with an intervention lasting ≥2 wk with ≥5 training sessions, and an objective measure of walking capacity. Eighteen studies were included for a total sample of 1135 participants. Interventions duration ranged from 6-24 wk and included aerobic exercise (treadmill walking, ergometer, and Nordic walking), resistance training (lower and/or upper body), a combination of both, and underwater exercise. Results showed that combined training improved treadmill walking capacity to a comparable extent to aerobic walking (+122.0 [24.2-219.8] m vs +106.8 [34.2-179.4] m), but with a larger effect size (1.20 [0.50-1.90] vs 0.67 [0.22-1.11]). Similar results were observed for the 6-min walk distance, with combined training being the most promising modality (+57.3 [16.2-98.5] m), followed by underwater training (+56.5 [22.4-90.5] m) and aerobic walking (+39.0 [12.8-65.1] m). While not statistically superior to aerobic walking, combined exercise seems to be the most promising training modality. Aerobic walking and underwater training also improved walking capacity for patients with symptomatic PAD.

Feasibility of hybrid telerehabilitation as a component of the Managed Care after Acute Myocardial Infarction (MC-AMI) program in a 12-month follow-up: experience from a single center.

Managed Care after Myocardial Infarction (MC‑AMI [KOS-Zawał]), a comprehensive care program dedicated to patients after myocardial infarction, was implemented in Poland in 2017. Hybrid cardiac telerehabilitation (HTR) is a unique component of MC‑AMI. We evaluated the feasibility of HTR as a component of MC‑AMI and assessed its safety and acceptance by patients. One‑year all‑cause mortality among the patients participating and not participating in MC‑AMI was analyzed. The MC‑AMI group included 114 patients who underwent a 5‑week HTR program comprising telemonitored Nordic walking training sessions, and who completed the entire 12‑month MC‑AMI program. The influence of HTR on the physical capacity was assessed by comparing the stress test results before and after HTR. After HTR, the patients completed a satisfaction survey to assess their acceptance of the program. The non-MC‑AMI group was formed using propensity score matching to compare 1‑year all‑cause mortality between the patients participating and not participating in MC-AMI. HTR significantly improved the functional capacity assessed in the stress test and was well‑received by the patients. In the study group, nonfatal non-ST‑segment elevation myocardial infarction, elective coronary percutaneous intervention, and cardiovascular hospitalization occurred in 0.9%, 2.6% and 6.1% of the patients, respectively. There were no deaths among the MC‑AMI participants, whereas in the non-MC‑AMI group, 1‑year all‑cause mortality was 3.5%. The log‑rank test comparing the survival probabilities of matched groups, estimated by the Kaplan-Meier method, showed heterogeneity of the curves (P = 0.04). HTR as a component of MC‑AMI was a feasible, safe, and well‑accepted form of cardiac rehabilitation. Participation in MC‑AMI including HTR was associated with a significantly lower risk of 1‑year all‑cause mortality, as compared with not taking part in the rehabilitation program.

Ground Walk Training versus Treadmill Training on Endurance Capacity and Quality of Life in COPD Patients

Ground Walk Training versus Treadmill Training on Endurance Capacity and Quality of Life in COPD Patients

시각 차단을 사용한 수행-기반 트레드밀 보행 훈련이 만성 뇌졸중 환자의 균형과 보행 능력에 미치는 영향 : 단일 사례 연구

This study aimed to examine the effects of performance-based treadmill walking training with visual deprivation on balance and walking functions in patients with chronic stroke. We performed this study with a single-subject experimental research design (A-B-C). One patient with chronic stroke participated in this study. Experimental sessions consisted of three phases (a total of 20 sessions): (1) baseline phase, (2) 1st intervention phase, and (3) 2nd intervention phase. During the two intervention phases, performance-based treadmill walking training was performed, and visual deprivation was added in the 2nd intervention phase only. Intervention was performed for an average of 60 min, twice per day for two weeks. Outcome measures included Berg Balance Scale (BBS), Timed Up-and-Go test (TUGT), 10-meter walk test (10MWT), and Dynamic Gait Index (DGI). The BBS and DGI scores improved by 11 and 6 points, respectively. Furthermore, TUGT (36.91 sec) and 10MWT (18.74 sec) improved in the 1st intervention phase, and more improvement (TUGT: 56.45 sec, and 10MWT: 45.18 sec) was observed during the 2nd intervention phase. These results indicates that the performance-based treadmill walking training might improve balance and walking functions, with more favorable outcomes when visual deprivation was added. Further studies are required to support these results.