Chronic Stroke Survivors Benefit From High-Intensity Aerobic Treadmill Exercise A Randomized Control Trial

This line from here is appalling; 50% failure rate and I bet a lot of that is because there is no solution for spasticity. Damn you Dr. William M. Landau.
Gait impairment is a major determinant of disability after stroke. At least 1 of 2 stroke survivors suffers from persistent hemiparetic gait deficits resulting in reduced mobility.<sup>1,2

http://nnr.sagepub.com/content/26/1/85.full</sup> 

1. Christoph Globas, MD1,2,3
2. Clemens Becker, MD2
3. Joachim Cerny1
4. Judith M. Lam1,3
5. Ulrich Lindemann, PhD2
6. Larry W. Forrester, PhD4
7. Richard F. Macko, MD4
8. Andreas R. Luft, MD1

1. ¹University Hospital of Zürich, Zürich, Switzerland
2. ²Robert Bosch Krankenhaus, Stuttgart, Germany
3. ³University of Tübingen, Tübingen, Germany
4. ⁴University of Maryland, Baltimore, MD, USA

1. Christoph Globas, MD, Clinic of Neurology, University Hospital of Zürich, Frauenklinikstr 26, CH-Zürich, Switzerland Email: christoph.globas@usz.ch

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Abstract

Background and objective. Ambulatory subjects after stroke may benefit from gait-oriented cardiovascular fitness training, but trials to date have not primarily assessed older persons. Methods. Thirty-eight subjects (age >60 years) with residual hemiparetic gait were enrolled >6 months after stroke. Participants were randomized to receive 3 months (3×/week) progressive graded, high-intensity aerobic treadmill exercise (TAEX) or conventional care physiotherapy. Primary outcome measures were peak exercise capacity (Vo_2peak) and sustained walking capacity in 6-minute walks (6MW). Secondary measures were gait velocity in 10-m walks, Berg Balance Scale, functional leg strength (5 chair-rise), self-rated mobility (Rivermead Mobility Index), and quality of life (SF-12). Results. Thirty-six participants completed the study (18 TAEX, 18 controls). TAEX but not conventional care improved Vo_2peak (difference 6.4 mL/kg/min, P < .001) and 6MW (53 m, P < .001). Likewise, maximum walking speed (0.13 m/s, P = .01), balance (P < .05), and the mental subscore of the SF-12 (P < .01) improved more after TAEX. Gains in Vo_2peak correlated with the degree at which training intensity could be progressed in the individual participant (P < .01). Better walking was related to progression in treadmill velocity and training duration (P < .001). Vo_2peak and 6MW performances were still higher 1 year after the end of training when compared with the baseline, although endurance walking (6MW) at 1 year was lower than immediately after training (P < .01). Conclusion. This trial demonstrates that TAEX effectively improves cardiovascular fitness and gait in persons with chronic stroke.