Objective: To evaluate the immediate and long-term effects of aerobic treadmill plus Bobath walking training in subacute stroke survivors compared with Bobath walking training alone.
Design: Randomized controlled trial.
Setting: Rehabilitation unit.
Subjects: Fifty patients, first-time supratentorial stroke, stroke interval less than six weeks, Barthel Index (0 / 100) from 50 to 80, able to walk a minimum distance of 12 m with either intermittent help or stand-by while walking, cardiovascular stable, minimum 50 W in the bicycle ergometry, randomly allocated to two groups, A and B.
Interventions: Group A 30 min of treadmill training, harness secured and minimally supported according to patients' needs, and 30 min of physiotherapy, every workday for six weeks, speed and inclination of the treadmill were adjusted to achieve a heart rate of HR: (Hrmax / HRrest)*0.6 / HRrest; in group B 60 min of daily physiotherapy for six weeks.
Main outcome measures: Primary outcome variables were the absolute improvement of walking velocity (m/s) and capacity (m), secondary were gross motor function including walking ability (score out of 13) and walking quality (score out of 41), blindly assessed before and after the intervention, and at follow-up three months later.
Results: Patients tolerated the aerobic training well with no side-effects, significantly greater improvement of walking velocity and capacity both at study end (p / 0.001 versus p / 0.002) and at follow-up (p < 0.001 versus p<0.001) in the experimental group. Between weeks 0 and 6, the experimental group improved walking speed and capacity by a mean of.31 m/s and 91 m, the control group by a mean of 0.16 m/s and 56 m. Between weeks 0 and 18, the experimental group improved walking speed and capacity by a mean of 0.36 m/s and 111 m, the control group by a mean of 0.15 m/s and 57 m. Gross motor function and walking quality did not differ at any time.
Conclusions: Aerobic treadmill plus Bobath walking training in moderately affected stroke patients was better than Bobath walking training alone with respect to the improvement of walking velocity and capacity. The treatment approach is recommended in patients meeting the inclusion criteria. A multicentre trial should follow to strengthen the evidence.
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References
1.
1 Barbeau H, Wainberg W, Finch L. Description and application of a system for locomotor rehabilitation. Med Biol Eng Comput1987; 25: 341-344.
2.
2 Hesse S, Bertelt C, Schaffrin A, Malezic M, Mauritz KH. Restoration of gait in non-ambulatory hemiparetic patients by treadmill training with partial body weight support. Arch Phys Med Rehabil1994; 75: 1087-1093.
3.
3 Visintin M, Barbeau H, Korner-Bitensky N, Mayo NE. A new approach to retrain gait in stroke patients through body weight support and treadmill stimulation. Stroke1998; 29: 1122-1128.
4.
4 Moseley AM, Stark A, Cameron ID, Pollock A. Treadmill training and body weight support for walking after stroke. Cochrane Database Syst Rev. 2003; 3: CD002840.
5.
5 Kosak MC, Reding MJ. Comparison of partial body weight-supported treadmill gait training versus aggressive bracing assisted walking post stroke. Neurorehabil Neural Repair2000; 14:13-19.
6.
6 Nilsson L, Carlsson J, Danielsson A et al. Walking training of patients with hemiparesis at an early stage after stroke: a comparison of walking training on a treadmill with body weight support and walking training on the ground. Clin Rehabil2001; 15: 515-525.
7.
7 Da Cunha IT, Lim PA, Qureshy H, Henson H, Monga T, Protas EJ. Gait outcomes after acute stroke rehabilitation with supported treadmill ambulation training: a randomized controlled trial. Arch Phys Med Rehabil2002; 83: 1258-1265.
8.
8 Macko RF, DeSouza CA, Tretter LD et al. Treadmill aerobic exercise training reduces the energy expenditure and cardiovascular demands of hemiparetic gait in chronic stroke patients. A preliminary report. Stroke1997; 28: 326-330.
9.
9 Ada L, Dean CM, Hall JM, Bampton J, Crompton S. A treadmill and overground walking program improves walking in persons residing in the community after stroke: a placebo-controlled, randomized trial. Arch Phys Med Rehabil2003; 84: 1486-1491.
10.
10 Pohl M, Mehrholz J, Ritschel C, Rückriem S. Speed-dependent treadmill training in ambulatory hemiparetic stroke patients. A randomized controlled trial. Stroke2002; 33: 553-558.
11.
11 Sullivan KJ, Knowlton BJ, Dobkin BH. Step training with body weight support: effect of treadmill speed and practice paradigms on poststroke locomotor recovery. Arch Phys Med Rehabil2002; 83: 683-691.
12.
12 Lipkin DP, Scriven AJ, Crake T, Poole-Wilson PA. Six minute walking test for assessing exercise capacity in chronic heart failure. BMJ1988; 292: 653-655.
13.
13 Lincoln N, Leadbitter D. Assessment of motor function in stroke patients. Physiotherapy1979; 65: 48-51.
14.
14 The Pathokinesiology Department and The Physical Therapy Department, Rancho Los Amigos Medical Center. Observational gait analysis handbook. The Professional Staff Association, Rancho Los Amigos Medical Center, Downey, CA 90242, 1989.
15.
15 Bitzer EM, Aster-Schenck IU, Klosterhuis H, Dörning H, Röse S. Entwicklung einer evidenzbasierten Leitlinie zur kardiologischen Rehabilitation. Rehabilitation2002; 41: 226-236.
16.
16 MacKay-Lyons M, Makrides L. Cardiovascular stress during contemporary stroke rehabilitation program: is the intensity adequate to induce a training effect. Arch Phys Med Rehabil2002; 83: 1378-1383.
17.
17 Potempa KL; Lopez M, Barun LT, Szidon P, Fogg L, Tincknell T. Physiologic outcomes of aerobic exercise training in hemiparetic stroke patients. Stroke1995; 26: 101-105.
18.
18 Katz-Leurer M, Carmeli E, Sochina M. The effect of early aerobic training on independence six months post stroke. Clin Rehabil2003; 17: 735-741.
19.
19 Hassid E, Rose D, Commisarow J, Guttry M, Dobkin BH. Improved gait symmetry in hemiparetic stroke patients during body weight-supported treadmill stepping. J Neuro Rehabil1997; 11:21-26.
20.
20 Hesse S, Konrad M, Uhlenbrock D. Treadmill walking with partial body weight support versus floor walking in hemiparetic subjects. Arch Phys Med Rehabil1999; 80: 421-427.
21.
21 Hesse S, Werner C, Paul T, Bardeleben A, Chaler J. The influence of walking speed on lower limb muscle activity and energy consumption during treadmill walking of hemiparetic patients. Arch Phys Med Rehabil2001; 82: 1547-1550.
