Multimodal Exercise Training Poststroke
Condition: Exercise; Stroke
Study type: Interventional

Summary: 
      Individuals poststroke with gait and balance impairment are typically less active and have
      low levels of physical fitness. Improving fitness level while also improving gait and balance
      is very important. Maximizing the exercise training benefit requires the appropriate level of
      effort is achieved. Traditional exercise programs scale aerobic demand by increasing the
      walking speed or the slope of the treadmill surface. This may be difficult for individuals
      who experience decreased balance at faster speeds or on sloped surfaces and require the use
      of handrails to safely walk under these conditions. These exercise programs show limited
      improvement in walking ability after training. This project will test a novel approach,
      resistance-based treadmill walking, for maximizing improvements in fitness and ability to
      walk by individuals poststroke. The investigators previous research has shown that backward
      directed resistive force applied to the pelvis while walking is well tolerated by individuals
      poststroke. Further, these forces can be used to effectively scale aerobic demand while
      walking in a controlled manner. With traditional treadmill training approaches handrail
      support is utilized to ensure safety. However, handrail support externally stabilizes the
      individual reducing training improvements in walking capacity and balance. For this pilot
      investigation a group that aerobically trains using a standard exercise treadmill training
      paradigm will be compared to a group that experiences progressive backward directed resistive
      forces applied to an individuals' pelvis while they walk at comfortable walking speeds
      without the aid of handrails. Individuals will wear a fall harness that provides no external
      stabilization but prevents falls to the treadmill surface. This approach has the potential
      benefit of allowing individuals poststroke to meaningfully practice walking at safe speeds
      but against resistance thereby improving walking economy, dynamic balance, and walking speed.
      The proposed project is necessary to gather preliminary data for a much larger training study
      that has the potential to change the clinical approach for improving gait economy, balance,
      and walking speed for individuals poststroke.
    


Intervention name(s): Resistance Based Training; Speed Based Training
Intervention type(s): Other; Other
Intervention description(s): Resistance based training study: Each training session will begin by determining the treadmill walking speed that an individual will train. The speed of the treadmill will be incrementally increased stepwise and individuals will affirm which speed feels the most comfortable to walk. Thus, the training speed of individuals will not necessarily be fixed over the 8-week study. Heart rate will be monitored and resistive force will be applied stepwise until the heart rate reaches at least 60% heart rate reserve. Individuals will be encouraged to walk at least five minutes and then allowed to rest. Achieved heart rate reserve and time the spent training at 60-80% heart rate reserve will be quantified for each session. Subjective measures of effort will also be sampled using the Borg Scale.; Speed based training study: Individuals will train at the fastest walking speed that an individual asserts that they can maintain for five minutes. The training time will then begin. Individuals will be encouraged to walk at least five minutes and then be allowed to rest. Speed will be progressed for each individual every 1-2 weeks at increments between 0.02 m/s and 0.08 m/s. Treadmill inclination will remain at 0°. Participants will be allowed to use the handrail or forearm support while being encouraged to walk without support if possible. Achieved heart rate reserve and the time the spent training at 60-80% heart rate reserve will be quantified for each session. Subjective measures of effort will also be sampled using the Borg Scale.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Basic Science
Keywords: Exercise; Multimodal; Balance; Resistance; Mobility