Task-oriented Training for Stroke: Impact on Function Mobility

Study Overview
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Brief Summary
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Residual neurological deficits from stroke lead to gait inefficiencies, resulting in an extremely high energy cost of movement and contributing to overall disability and lower quality of life. Therefore, interventions targeting movement economy should be developed for those in the chronic phase of stroke recovery. This study is designed to compare the effect of two distinctly different exercise paradigms (a higher-intensity treadmill training program and a lower-intensity group exercise program) on economy of movement during over-ground walking and activities of daily living, as well as the extent to which gains in muscular strength, muscular endurance, and balance predict changes in movement economy.

Official Title
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Task-oriented Training for Stroke: Impact on Function Mobility

Conditions
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Cerebrovascular Accident, Stroke

Intervention / Treatment
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* Behavioral: High-intensity Treadmill Exercise
* Behavioral: Low-intensity Lifestyle Intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Stroke > 6 months prior with residual hemiparetic gait in women or men aged 40-85 years. Completion of all regular post-stroke physical therapy Adequate language and neurocognitive function to participate in testing and training and to give adequate informed consent. Able to rise from a chair unaided. Able to walk 10 meters without human assistance. Exclusion Criteria: Regular structured aerobic exercise (> 2x week). Alcohol consumption > 3 oz. liquor, or 3 x 4 oz glasses of wine, or 3 x 12 oz. beers per day, by self-report. Clinical history of unstable angina, recent (< 3 months) myocardial infarction or congestive heart failure (NYHA category II), hemodynamically significant valvular dysfunction, Peripheral Arterial Obstructive Disease with claudication, major orthopedic, chronic pain, or non-stroke neuromuscular disorders restricting exercise, pulmonary or renal failure, poorly controlled hypertension (>190/110), measured on at least two separate occasions recent hospitalization for severe disease or surgery severe or global receptive aphasia which confounds reliable testing and training. Untreated major depression as documented by a Center for Epidemiological Studies-Depression score of >16 and confirmed by clinical interview. Pregnancy.

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Arm 1: High-Intensity Program<br>High-intensity treadmill-based exercise | Behavioral: High-intensity Treadmill Exercise<br>* High-intensity treadmill walking program<br>|
| Other: Arm 2: Low-Intensity Program<br>Low-intensity lifestyle intervention (group exercise) | Behavioral: Low-intensity Lifestyle Intervention<br>* A low-intensity lifestyle intervention targeted towards group exercises incorporating balance, coordination, and strength.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Economy of Gait | Over-ground gait economy measured using a portable metabolic monitoring system, K4b2 during a 6 minute walk, with subjects walking at their comfortable self-selected walking speed while open circuit spirometry collects break-by-break data. The K4b2 consists of a small battery pack and portable gas analyser (weighing less than 1 kg) that participants wear on their chest. Attached to the portable system is a flexible rubber facemask with flowmeter used for breath-by-breath analysis. The mean rate of oxygen consumption (VO2) will be calculated based on the final 3 minutes of a 6-minute walk under steady state oxygen consumption conditions. A 6 minute walk is a distance most representative of community-based ambulatory capacity and is a sensitive outcome measure in exercise studies in chronic stroke subjects. The higher the VO2 used during the 6 minute walk, represents a less efficient economy of gait. | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Muscular Strength | Strength measured by torque of isokinetic maximal concentric knee extensor volitional contractions of paretic and non-paretic leg at multiple angular velocities (30, 90, and 120°/sec). The higher the number the higher the muscular strength. Also performed on resistance equipment for both the Leg Press and Leg Extension. The higher the number the stronger a person is. | 3 months | 
| Muscular Endurance | Muscular endurance performed on Leg Press and assessed by a force transducer, while seated. The longer the amount of time participant can maintain a force the better their muscular endurance. | 3 months | 
| Balance | Dynamic Gait Index - another measure related to balance and general function. It includes items of walking while changing speed, turning the head, pivot turning, walking over and around obstacles, and stair climbing. This index ranges from 0 - 24, with 24 representing a high level of balance and general function (the higher the score the better the balance). | 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Exercise, Rehabilitation, Stroke