I always did, it allowed me to get to a higher speed, but then I haven't done treadmills in over a decade. I now consider them to be vastly inferior to overground walking. You get no perturbations from treadmills. Overground greatly increases your balance ability. And you want to walk in the real world, so have your therapist take you there! None of this treadmill crapola.
Should you hold onto the treadmill handrails or not? Cortical evidence at different walking speeds
Journal of NeuroEngineering and Rehabilitation volume 22, Article number: 5 (2025)
Abstract
Background
Treadmill-based gait training is part of rehabilitation programs focused on walking abilities. The use of handrails embedded in treadmill systems is debated, and current literature only explores the issue from a behavioral perspective.
Methods
We examined the cortical correlates of treadmill walking in healthy participants using functional near-infrared spectroscopy. We investigated whether the utilization of treadmill handrails at varying walking speeds could affect cortical activation associated with the task, and we evaluated potential differences in task-based functional connectivity across the various walking conditions.
Results
Significant differences in cortical activation were found between the two walking speeds (3 and 5 km/h) in the unsupported condition; these differences were reduced when using the handrails. Specifically, cortical activation was significantly higher when the participants swung their arms freely while walking at a speed of 5 compared to 3 km/h in several Brodmann’s Areas (BA): left BA10, BA3 and BA39, and right BA10, BA9, BA8, BA3, and BA40. No significant differences were found when participants were holding onto the handrails. A significant difference was found in the left BA40 between the two speeds, regardless of whether the participants were holding onto the handrails. Furthermore, at the higher speed and without the use of handrails, a wider pattern of task-based functional connectivity was observed, with significantly stronger connectivity between the left BA10 and BA40.
Conclusions
We suggest that speed and handrails use play a role in walking cortical activity patterns, therefore they are key ingredients to take into account when planning a rehabilitation program.
Background
Gait abnormalities during old age and as a result of neurological diseases are very debilitating and can increase the risk of falls [1], negatively affect independence and quality of life [2], and increase health care costs [3]. For this reason, walking abilities are often considered a primary focus for rehabilitation programs.
To create controlled setups in rehabilitation, several studies recommend treadmill-based gait training paradigms [4], and body weight support systems are allowed in order to minimize the delay in starting gait training for neurological patients and to increase safety without the use of walking aids [5]. The use of handrails embedded in treadmill systems helps to stabilize the body by increasing afferent somatosensory signals through haptic contact with the handrails [6,7,8].
Some controversial results have been reported in the literature on the use of treadmill handrails during rehabilitation. First of all, it should be considered that holding the hands onto the handrails of the treadmill might not imply a representative walking pattern, in terms of an ecological perspective, since it encourages bad posture and prevents the natural stride [9,10,11]. It has been reported that supporting on the handrails lightens the workload since it requires less muscular activation without resulting in substantial neuromuscular re-organization. In fact, it increases the base of support, resulting in greater stability, reduces uncertainty leading to a better balance, and improves ability to generate corrective forces to compensate for perturbations [12]. Also, handrail use during treadmill walking in a split-belt adaptation training reduced locomotor learning in healthy young subjects, suggesting that this balance support may ease, or alter the task demand [6].
It has been shown that the effect of gait rehabilitation can be improved by holding handrails [13], especially when participants used a firm rather than a light touch on the handrails [12]. It should be noted, however, that Bello and colleagues attributed the improvements seen during the rehabilitation of patients with Parkinson’s disease to the belts used in combination with the treadmill, instead of the handrails themselves [14].
Nevertheless, all these studies explored the issue from a behavioral perspective. To our knowledge, the effects of holding handrails during treadmill walking have never been investigated with neuroimaging techniques.
In general, in order to propose effective rehabilitation paradigms, it is necessary to reach a better understanding of the mechanisms underlying the gait under various conditions [15]. Walking has long been regarded as predominantly automatic process, however functional magnetic resonance imaging (fMRI) studies based on motor imagery of gait have demonstrated a cortical control even during simple walking processes in healthy elderly, pathological subjects, as well as healthy young individuals [16,17,18]. The areas mainly involved in gait are the prefrontal cortex, supplementary motor, premotor and primary motor areas, sensorimotor areas; their activity has been found to be modulated by task demand [17, 19]. Bakker and colleagues asked their participants to (visually) imagine a normal gait or a precision gait over a narrower path, finding an increased cortical activity in cortical structures outside primary motor regions during the harder task, thus emphasizing greater cortical activity when an increased postural control is required [16].
Portable neuroimaging techniques, such as functional near-infrared spectroscopy (fNIRS), led to identify cortical activation patterns and locomotor networks involved in walking, providing new insight into cortical control of actual human locomotion [20,21,22]. In fact, this technique made it possible to study walking during its actual performance and to modulate the difficulty of the task [19], the somatosensory feedback from different peripheral stimuli [23], or to assess the difference between walking and running [24].
In this vein, we investigated the cortical correlates of treadmill walking by means of fNIRS in a group of healthy participants. We were interested in understanding whether the use of treadmill handrails, at different walking speeds, could modulate cortical activation related to the task. Specifically, we carried on an fNIRS study while walking on a treadmill at two different speeds (3 and 5 km/h - lower or equal with respect to the spontaneous walking speed of young healthy subjects [25]), with or without holding onto the handrails. Furthermore, one published study based on fMRI showed that individuals with faster gait speed have stronger resting-state functional connectivity (FC) within the frontoparietal control network, and that gait variability is correlated with between-network functional connectivity [26]. As a step forward, here using fNIRS we were able to assess possible differences in task-based FC among the task conditions during walking to better understand how task performance modulated the connectivity between cortical regions, providing a more comprehensive view of cortical function beyond isolated regional activity.
It has been reported that, during comfortable walking, lower extremity muscle activity had a strong correlation with cortical activation [27]. Therefore, we expected to find differences in cortical activation between the two walking speeds in the unsupported condition. Given that walking with handrails can lighten the workload of walking requiring less muscular activation [12], we hypothesized that this condition would be associated with a reduced brain resource demand and that the use of the handrails could mitigate the differences in cortical activity due to the walking speed.
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