Higher Intensity Walking Training in Individuals With Chronic Motor Incomplete Spinal Cord Injury: A Randomized Clinical Trial.

The study was done at one site, so the results may not apply everywhere. The sample was modest, with 53 participants randomized. Fourteen participants did not attend the 3-month follow-up because they lived out of state. The primary peak treadmill speed outcome was not blinded because staff monitored ECGs during testing. The primary fastest overground speed result was not statistically significant after correction. Many participants did not maintain the assigned heart-rate targets: 12 of 28 in the high-intensity group averaged below 70% heart-rate reserve, and 9 of 25 in the low-intensity group averaged above 40% heart-rate reserve. Four high-intensity participants could not reach above 50% heart-rate reserve and had very slow baseline self-selected speeds below 0.20 m/s. Five participants could not complete baseline metabolic testing at the slowest treadmill speed. The study enrolled only ambulatory individuals more than 6 months after injury, so it does not address people who cannot walk or those soon after injury.

The article reports a conflict of interest: TGH is co-owner and CEH is partially employed by the Institute for Knowledge Translation.

Do not conclude that higher-intensity walking training clearly improves fastest overground walking speed. The fastest speed difference favored higher intensity but was not statistically significant after correction, and the significant peak treadmill speed result was not blinded.