Larry W Forrester

Publication Detail

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Treadmill exercise rehabilitation improves ambulatory function and cardiovascular fitness in patients with chronic stroke: a randomized, controlled trial.

Richard F Macko; Frederick M Ivey; Larry W Forrester; Daniel Hanley; John D Sorkin; Leslie I Katzel; Kenneth H Silver; Andrew P Goldberg (Profiled Authors: Larry W Forrester; Andrew P Goldberg; Frederick Ivey; Leslie I Katzel; Richard F Macko; John D Sorkin)

Veterans Affairs Medical Center Geriatrics Research, Education, and Clinical Center, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA. rmacko@grecc.umaryland.edu
Stroke; a journal of cerebral circulation 2005;36(10):2206-11.

BACKGROUND AND PURPOSE: Physical inactivity propagates disability after stroke through physical deconditioning and learned nonuse. We investigated whether treadmill aerobic training (T-AEX) is more effective than conventional rehabilitation to improve ambulatory function and cardiovascular fitness in patients with chronic stroke. METHODS: Sixty-one adults with chronic hemiparetic gait after ischemic stroke (>6 months) were randomized to 6 months (3x/week) progressive T-AEX or a reference rehabilitation program of stretching plus low-intensity walking (R-CONTROL). Peak exercise capacity (Vo2 peak), o2 consumption during submaximal effort walking (economy of gait), timed walks, Walking Impairment Questionnaire (WIQ), and Rivermead Mobility Index (RMI) were measured before and after 3 and 6 months of training. RESULTS: Twenty-five patients completed T-AEX and 20 completed R-CONTROL. Only T-AEX increased cardiovascular fitness (17% versus 3%, delta% T-AEX versus R-CONTROL, P<0.005). Group-by-time analyses revealed T-AEX improved ambulatory performance on 6-minute walks (30% versus 11%, P<0.02) and mobility function indexed by WIQ distance scores (56% versus 12%, P<0.05). In the T-AEX group, increasing training velocity predicted improved Vo2 peak (r=0.43, P<0.05), but not walking function. In contrast, increasing training session duration predicted improved 6-minute walk (r=0.41, P<0.05), but not fitness gains. CONCLUSIONS: T-AEX improves both functional mobility and cardiovascular fitness in patients with chronic stroke and is more effective than reference rehabilitation common to conventional care. Specific characteristics of training may determine the nature of exercise-mediated adaptations.

3 Originating Grant

• 1.

  Macko, Richard F

  EXERCISE OF PATIENTS WITH HEMIPARETIC STROKE

  1 May 1997 - 30 April 2003

  NATIONAL INSTITUTE ON AGING

• 2.

  Goldberg, Andrew P

  Claude D. Pepper Older Americans Independence Center (O*

  15 July 1994 - 31 August 2006

  NATIONAL INSTITUTE ON AGING

• 3.

  GOLDBERG, ANDREW P

  The Biology of Exercise, Metabolism and Aging

  30 September 1992 - 30 April 2014

  NATIONAL INSTITUTE ON AGING

Scientific Context

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