strength training effectiveness post-stroke (steps)

Conditions: Cerebrovascular Accident

Summary: the purpose of this study is to determine if treadmill training with body weight-support (bwst) is more effective at improving walking in individuals post-stroke than a resisted leg-cycling exercise program. in addition, we want to determine if training programs that combine leg strength training to treadmill walking provide an additional benefit to post-stroke walking outcomes.

impaired walking ability is a hallmark residual deficit that contributes to post-stroke walking disability . impairment in lower extremity muscle strength is a significant contributor to decreased walking speed after stroke. no studies have combined task-specific locomotor training in combination with lower extremity strength training programs designed to improve post-stroke walking outcomes. participants will include individuals who are ambulatory, but walk slower than 1.0 m/sec and are at least 6 months post unilateral stroke. participants are stratified by initial comfortable walking speed (moderate \>0.5 m/sec; severe \<= 0.5 m/sec) and randomized to one of four exercise pairs: 1) body-weight supported treadmill training (bwst) and locomotor-based strength training (resistive cycling task, lbst), 2) bwst and le muscle-specific strength training (msst), 3) bwst and upper extremity ergometry (sham), and 4) lbst and sham. training will occur 4 times per week for 6 weeks (24 total sessions). exercise type in each exercise pair is alternated daily. primary outcomes include comfortable and fast overground walking speed, and distance walked in 6-minutes measured at baseline, after 12 and 24 treatment sessions and at a 6-month follow-up.

Eligibility criteria:
inclusion criteria: * age 18 years or older * 4 months to 5 years after first-time onset of a ischemic or hemorrhagic cerebrovascular accident (cva) confirmed by ct, mri, or clinical criteria * able to ambulate at least 14 meters with assistive and/or orthotic device and one person assist (minimum functional ambulation classification level ii * self-selected walking velocity of ≤1.0 meters/second * approval of primary care physician to participate. exclusion criteria: * resting systolic blood pressure greater than 180mmhg and/or diastolic blood pressure greater than 110mmhg and/or resting heart rate greater than 100 beats/minute; * lower limb orthopedic conditions such as prior joint replacement or range of motion limitations; * spasticity management that included botox injection (\< 4 months earlier) or phenol block injection (\< 12 months earlier) to affected lower extremity and intrathecal baclofen or oral baclofen (within past 30 days); * mini-mental state exam score \< 24; * currently receiving lower extremity strengthening exercises or gait training, * past participation in any study examining the effects of long term (\>4 weeks training) body weight support treadmill training; limb loaded pedaling, or lower extremity strengthening; * plans to move out of the area in the next year, * no transportation to the study site for all evaluations and intervention sessions.

Keywords: rehabilitation hemiplegic gait exercise therapy physical therapy