Optimal Intensity and Duration of Walking Rehabilitation in Patients With Chronic Stroke : A Randomized Clinical Trial

Medientyp: E-Artikel
Titel: Optimal Intensity and Duration of Walking Rehabilitation in Patients With Chronic Stroke : A Randomized Clinical Trial : A Randomized Clinical Trial
Beteiligte: Boyne, Pierce; Billinger, Sandra A.; Reisman, Darcy S.; Awosika, Oluwole O.; Buckley, Sofia; Burson, Jamiah; Carl, Daniel; DeLange, Matthew; Doren, Sarah; Earnest, Melinda; Gerson, Myron; Henry, Madison; Horning, Alli; Khoury, Jane C.; Kissela, Brett M.; Laughlin, Abigail; McCartney, Kiersten; McQuaid, Thomas; Miller, Allison; Moores, Alexandra; Palmer, Jacqueline A.; Sucharew, Heidi; Thompson, Elizabeth D.; Wagner, Erin; [...]
Erschienen: American Medical Association (AMA), 2023
Erschienen in: JAMA Neurology
Sprache: Englisch
DOI: 10.1001/jamaneurol.2023.0033
ISSN: 2168-6149
Schlagwörter: Neurology (clinical)
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Beschreibung: <jats:sec><jats:title>Importance</jats:title><jats:p>For walking rehabilitation after stroke, training intensity and duration are critical dosing parameters that lack optimization.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>To assess the optimal training intensity (vigorous vs moderate) and minimum training duration (4, 8, or 12 weeks) needed to maximize immediate improvement in walking capacity in patients with chronic stroke.</jats:p></jats:sec><jats:sec><jats:title>Design, Setting, and Participants</jats:title><jats:p>This multicenter randomized clinical trial using an intent-to-treat analysis was conducted from January 2019 to April 2022 at rehabilitation and exercise research laboratories. Survivors of a single stroke who were aged 40 to 80 years and had persistent walking limitations 6 months or more after the stroke were enrolled.</jats:p></jats:sec><jats:sec><jats:title>Interventions</jats:title><jats:p>Participants were randomized 1:1 to high-intensity interval training (HIIT) or moderate-intensity aerobic training (MAT), each involving 45 minutes of walking practice 3 times per week for 12 weeks. The HIIT protocol used repeated 30-second bursts of walking at maximum safe speed, alternated with 30- to 60-second rest periods, targeting a mean aerobic intensity above 60% of the heart rate reserve (HRR). The MAT protocol used continuous walking with speed adjusted to maintain an initial target of 40% of the HRR, progressing up to 60% of the HRR as tolerated.</jats:p></jats:sec><jats:sec><jats:title>Main Outcomes and Measures</jats:title><jats:p>The main outcome was 6-minute walk test distance. Outcomes were assessed by blinded raters after 4, 8, and 12 weeks of training.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of 55 participants (mean [SD] age, 63 [10] years; 36 male [65.5%]), 27 were randomized to HIIT and 28 to MAT. The mean (SD) time since stroke was 2.5 (1.3) years, and mean (SD) 6-minute walk test distance at baseline was 239 (132) m. Participants attended 1675 of 1980 planned treatment visits (84.6%) and 197 of 220 planned testing visits (89.5%). No serious adverse events related to study procedures occurred. Groups had similar 6-minute walk test distance changes after 4 weeks (HIIT, 27 m [95% CI, 6-48 m]; MAT, 12 m [95% CI, −9 to 33 m]; mean difference, 15 m [95% CI, −13 to 42 m];<jats:italic>P</jats:italic> = .28), but HIIT elicited greater gains after 8 weeks (58 m [95% CI, 39-76 m] vs 29 m [95% CI, 9-48 m]; mean difference, 29 m [95% CI, 5-54 m];<jats:italic>P</jats:italic> = .02) and 12 weeks (71 m [95% CI, 49-94 m] vs 27 m [95% CI, 3-50 m]; mean difference, 44 m [95% CI, 14-74 m];<jats:italic>P</jats:italic> = .005) of training; HIIT also showed greater improvements than MAT on some secondary measures of gait speed and fatigue.</jats:p></jats:sec><jats:sec><jats:title>Conclusions and Relevance</jats:title><jats:p>These findings show proof of concept that vigorous training intensity is a critical dosing parameter for walking rehabilitation. In patients with chronic stroke, vigorous walking exercise produced significant and meaningful gains in walking capacity with only 4 weeks of training, but at least 12 weeks were needed to maximize immediate gains.</jats:p></jats:sec><jats:sec><jats:title>Trial Registration</jats:title><jats:p>ClinicalTrials.gov Identifier:<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT03760016">NCT03760016</jats:ext-link></jats:p></jats:sec>

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