Walk Away from Stroke's Side-Effects
There may be more effective options than the short-term therapy given to most
patients after a stroke, a new study shows. Even years later, intensive exercise
therapy focused on using a treadmill can significantly improve a stroke
patient’s physical skills.
"These were people who were told, ’you don’t have anything more to gain from
therapy, go home,’" said Dr. Richard Macko, assistant director of the Baltimore
VA Geriatric Research Education and Clinical Center,
While there are no formal guidelines, stroke rehabilitation generally lasts only
the first few weeks after a stroke and focuses on retraining the patient to
perform everyday tasks. With this type of therapy, improvement in walking
ability normally plateaus 11 weeks after stroke. However, recent findings show
that more strides can be made if therapy is continued, or even restarted, and
made more intense.
Even though a stroke causes neurological impairments to the brain, Macko
explained that there is growing evidence showing that the brain has the ability
to relearn basic tasks, such as walking, as long as a decade after a stroke.
In an October 2005 study published in Stroke, researchers recruited 61 men and
women who had persisting walking problems anywhere from six months to 10 years
after their stroke.
Half of the patients were assigned to a training program that consisted of
40-minute treadmill sessions, three times a week. The difficulty of the
treadmill exercise was increased in both length and intensity every two weeks,
or less if the patient could not keep up. The other patients were assigned to
more traditional post-stroke exercises normally given immediately after one’s
hospital stay: 35 minutes of stretching and 5 minutes of treadmill walking at a
pace held constant for the duration of the study.
After six months, the patients who participated in the intensive treadmill
program increased their aerobic fitness, as measured by the amount of carbon
dioxide they exhaled, six times more than the traditional rehab group.
Additionally, the treadmill exercisers reported a 56 percent improvement in
walking ability, compared to a 12 percent improvement reported by the
traditional therapy group.
The treadmill helps more than other exercise routines because the treadmill
directly interacts with the foot and leg, Macko said. The repetitive motion of
the treadmill belt and the ability to increase the intensity level, he added,
retrains the body to walk more efficiently. In contrast, the typical
rehabilitation programs, noted for long stretching sessions, are often too short
and not rigorous enough to produce the same effect.
"Conventional rehab does not provide the intensity or repetition to improve
function." said Macko.
However, even the modest improvements seen in the regular rehab group was
greater than that seen in typical stroke patients, who often report that,
without therapy, walking skills decline as time passes. So, the addition of a
moderate exercise routine seems to offer patients some degree of effective
With further research, Macko hopes to change the way doctors think about stroke
rehabilitation. "The message is even if you do simple stuff—even if you had the
stroke ten years ago—you can improve your muscle strength and abilities." he