The Value of High Intensity Locomotor Training Applied to Patients With Acute-Onset Neurologic Injury.
Meghan Fahey, Gabrielle Brazg, Christopher E Henderson and 5 others
PMID 33383032WHAT IT FOUND
High-intensity walking training improves cardiovascular capacity and walking endurance in stroke and spinal cord injury patients, often without adverse events.
Therapists can use step counts or perceived exertion to guide intensity when heart rate monitoring is unavailable, though achieving high intensities remains difficult for severely impaired patients.
Key findings
01High-intensity training matched for total work produces greater gains in walking endurance and cardiovascular capacity than lower-intensity training.
02Implementing high-intensity training in inpatient settings is safe and associated with substantial locomotor gains, even without specialized exercise testing equipment.
03Step counts can serve as a proxy for exercise intensity, with specific cadence thresholds identified for different levels of walking ability.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
This is a narrative review, not a systematic review, so the selection of studies may reflect author bias. The evidence is drawn from heterogeneous studies with varying definitions of 'high intensity' and different control groups. Most data come from stroke and incomplete spinal cord injury populations; applicability to other neurologic conditions is uncertain. Achieving high intensities is significantly harder in severely impaired patients, limiting generalizability to the most dependent populations. The relationship between perceived exertion (RPE) and actual physiological intensity is inconsistent in neurologic populations, making RPE a potentially unreliable sole guide.
Declared interests
The paper acknowledges research support from the U.S. Government, Non-U.S. Government, and N.I.H. Extramural sources. Specific author conflicts of interest are not detailed in the provided text.
The easy way to misread this
Do not assume that high-intensity training is safe or feasible for all patients without monitoring. The review notes that severely impaired patients rarely reach high intensities, and standard heart rate predictions may be inaccurate due to medications or autonomic dysfunction. Always verify safety with appropriate monitoring, especially in patients with cardiovascular risk factors.