Locomotor Training and Strength and Balance Exercises for Walking Recovery After Stroke: Response to Number of Training Sessions

Abstract

Background: Evidence-based guidelines are needed to inform rehabilitation practice, including the effect of number of exercise training sessions on recovery of walking ability after stroke.

Objective: The objective of this study was to determine the response to increasing number of training sessions of 2 interventions-locomotor training and strength and balance exercises-on poststroke walking recovery.

Design: This is a secondary analysis of the Locomotor Experience Applied Post-Stroke (LEAPS) randomized controlled trial.

Setting: Six rehabilitation sites in California and Florida and participants' homes were used.

Participants: Participants were adults who dwelled in the community (N=347), had had a stroke, were able to walk at least 3 m (10 ft) with assistance, and had completed the required number of intervention sessions.

Intervention: Participants received 36 sessions (3 times per week for 12 weeks), 90 minutes in duration, of locomotor training (gait training on a treadmill with body-weight support and overground training) or strength and balance training.

Measurements: Talking speed, as measured by the 10-Meter Walk Test, and 6-minute walking distance were assessed before training and following 12, 24, and 36 intervention sessions.

Results: Participants at 2 and 6 months after stroke gained in gait speed and walking endurance after up to 36 sessions of treatment, but the rate of gain diminished steadily and, on average, was very low during the 25- to 36-session epoch, regardless of treatment type or severity of impairment.

Limitations: Results may not generalize to people who are unable to initiate a step at 2 months after stroke or people with severe cardiac disease.

Conclusions: In general, people who dwelled in the community showed improvements in gait speed and walking distance with up to 36 sessions of locomotor training or strength and balance exercises at both 2 and 6 months after stroke. However, gains beyond 24 sessions tended to be very modest. The tracking of individual response trajectories is imperative in planning treatment.

Figure 1.

Walking speed (m/s) improvements by sessions, training groups, and severity, comparing E-LTP to HEP and E-LTP to L-LTP. E-LTP=early locomotor training program, HEP=home exercise program, L-LTP=late locomotor training program, S=sessions. Gains across different groups are compared, and the significant findings are marked by ellipses.

Figure 2.

Improvements in walking distance (m) by sessions, training groups, and severity, comparing E-LTP to HEP and E-LTP to L-LTP. E-LTP=early locomotor training program, HEP=home exercise program, L-LTP=late locomotor training program, S=sessions. Gains across different groups are compared, and the significant findings are marked by ellipses.