Alterations in Aerobic Exercise Performance and Gait Economy Following High-Intensity Dynamic Stepping Training in Persons With Subacute Stroke.
Abigail L Leddy, Mark Connolly, Carey L Holleran and 5 others
PMID 27632078WHAT IT FOUND
High-intensity stepping training did not reduce oxygen cost of walking in subacute stroke, but it increased highest oxygen use during treadmill testing and improved walking speed and distance compared with conventional therapy.
Key findings
01In the RCT, high-intensity stepping training increased the highest oxygen use achieved during treadmill testing compared with conventional therapy, and the gain was maintained at follow-up.
02Experimental training did not reduce oxygen cost of treadmill walking or overground walking more than conventional therapy.
03Experimental training improved self-selected walking speed, fastest walking speed, and 6 minute walking distance more than conventional therapy, and these gains were maintained at follow-up.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only 33 participants were analysed, and the report is a secondary analysis of a small randomized trial plus a pilot study. The pilot study had no control group and assessors were not blinded. Treadmill testing was submaximal because many participants stopped before reaching 85% of predicted maximum heart rate due to gait instability or subjective termination. Only participants able to walk with at least moderate assistance and at 0.1 m/s on a treadmill were included, so it says nothing about people who could not meet those walking requirements. Control therapy was partly usual clinical care, and records from other centers were often not accessible or well described, so the exact amount and type of control therapy is uncertain. Some eligible participants were excluded because they could not walk 0.1 m/s on a treadmill, and one subject was excluded because assessor blinding failed. The experimental programme included treadmill, overground, and stair tasks, so the contribution of any single task cannot be separated.
Declared interests
The authors reported no conflicts of interest.
The easy way to misread this
Do not conclude that high-intensity stepping made walking more economical. The oxygen cost of walking did not improve more than conventional therapy, even though peak oxygen use and walking speed increased.