ORIGINAL PAPER
Exploring the impact of performance-based high-intensity treadmill training in chronic stroke patients: a group-matched, single-blind pilot trial with a 3-month follow-up
1
Department of Physical Therapy, Seosong Hospital, Beongil, Kyungmyung-gil, Kyeygang-gu, Incheon, Republic of Korea
2
Department of Physical Therapy, College of Health and Medical Science, Cheongju University, Cheongju, Chungcheongbuk-do, Republic of Korea
Submission date: 2023-10-21
Acceptance date: 2024-04-30
Publication date: 2025-06-18
Corresponding author
Duck-Won Oh
Department of Physical Therapy, College of Health and Medical Science, Cheongju University, 298, Daesung-ro, Cheongwon-gu, Cheongju, Republic of Korea, 360-764
Department of Physical Therapy, College of Health and Medical Science, Cheongju University, 298, Daesung-ro, Cheongwon-gu, Cheongju, Republic of Korea, 360-764
Physiother Quart. 2025;33(2):18-24
KEYWORDS
TOPICS
ABSTRACT
Introduction:
In recent years, the benefits of treadmill training for patients with post-stroke hemiparesis have been increasingly recognised, particularly with the incorporation of higher training speeds tailored to patients’ performance levels. This study aimed to investigate the effects of performance-based high-intensity treadmill training on balance and walking in patients with chronic stroke.
Methods:
With the allocation of participants based on location convenience, 20 patients with chronic stroke were assigned to either the experimental group (n1 = 10), which underwent performance-based high-intensity treadmill training at a pace individually adjusted according to their walking ability, or the control group (n2 = 10), which underwent treadmill training at a self-selected speed. The intervention was conducted twice daily for 5 days over a 2-week period, with a follow-up measurement taken 3 months after the intervention. Balance function was measured using the Berg Balance Scale and Activity-Specific Balance Confidence Scale, and walking function was assessed using the 10-metre walk test and 6-minute walk test.
Results:
After the intervention, participants in the experimental group showed significantly greater improvements in all variables compared to participants in the control group (p < 0.05). Gains in walking variables were maintained at the 3-month follow-up (p < 0.05).
Conclusions:
These findings suggest that performance-based high-intensity treadmill training may be a beneficial intervention to enhance balance and walking functions in patients with post-stroke hemiparesis.
In recent years, the benefits of treadmill training for patients with post-stroke hemiparesis have been increasingly recognised, particularly with the incorporation of higher training speeds tailored to patients’ performance levels. This study aimed to investigate the effects of performance-based high-intensity treadmill training on balance and walking in patients with chronic stroke.
Methods:
With the allocation of participants based on location convenience, 20 patients with chronic stroke were assigned to either the experimental group (n1 = 10), which underwent performance-based high-intensity treadmill training at a pace individually adjusted according to their walking ability, or the control group (n2 = 10), which underwent treadmill training at a self-selected speed. The intervention was conducted twice daily for 5 days over a 2-week period, with a follow-up measurement taken 3 months after the intervention. Balance function was measured using the Berg Balance Scale and Activity-Specific Balance Confidence Scale, and walking function was assessed using the 10-metre walk test and 6-minute walk test.
Results:
After the intervention, participants in the experimental group showed significantly greater improvements in all variables compared to participants in the control group (p < 0.05). Gains in walking variables were maintained at the 3-month follow-up (p < 0.05).
Conclusions:
These findings suggest that performance-based high-intensity treadmill training may be a beneficial intervention to enhance balance and walking functions in patients with post-stroke hemiparesis.
REFERENCES (41)
1.
Oh DW, Won SH. Therapeutic strategy for improving ambulatory function in patients with chronic stroke: literature review. Kor J Neuromuscul Rehabil. 2017;7(1):61–85.
2.
Bensoussan L, Viton JM, Barotsis N, Delarque A. Evaluation of patients with gait abnormalities in physical and rehabilitation medicine settings. J Rehabil Med. 2008;40(7):497–507; doi: 10.2340/16501977-0228.
3.
Chang MC, Lee BJ, Joo N-Y, Park D. The parameters of gait analysis related to ambulatory and balance functions in hemiplegic stroke patients: a gait analysis study. BMC Neurol. 2021;21(1):38; doi: 10.1186/s12883-021-02072-4.
4.
Yang Y-R, Chen Y-C, Lee C-S, Cheng S-J, Wang R-Y. Dual-task-related gait changes in individuals with stroke. Gait Posture. 2007;25(2):185–90; doi: 10.1016/j.gaitpost.2006.03.007.
5.
Cha HG, Ji SG. The effects of community ambulation training on muscle activity of the lower extremities and dynamic balance ability, gait scale in stroke patients. J Special Educ Rehabil Sci. 2012;51(4):159–75.
6.
Ada L, Dean CM, Hall JM, Bampton J, Crompton S. A treadmill and overground walking program improves walking in persons residing in the community after stroke: a placebo-controlled, randomised trial. Arch Phys Med Rehabil. 2003;84(10):1486–91; doi: 10.1016/s0003-9993(03)00349-6.
7.
Mehrholz J, Thomas S, Elsner B. Treadmill training and body weight support for walking after stroke. Cochrane Database Syst Rev. 2017;8(8):CD002840; doi: 10.1002/14651858.CD002840.pub4.
8.
Hegazy RM, Alkhateeb AM, Abdelmohsen AM. Impact of a virtual reality program on post-stroke upper limb function: a randomised controlled trial. Physiother Q. 2022;30(4):81–6; doi: 10.5114/pq.2021.111210.
9.
Ivey FM, Hafer-Macko CE, Macko RF. Task-oriented treadmill exercise training in chronic hemiparetic stroke. J Rehabil Res Dev. 2008;45(2):249–59; doi: 10.1682/JRRD.2007.02.0035.
10.
Pohl M, Mehrholz J, Ritschel C, Rückriem S. Speed-dependent treadmill training in ambulatory hemiparetic stroke patients: a randomised controlled trial. Stroke. 2002;33(2):553–8; doi: 10.1161/hs0202.102365.
11.
Strømmen AM, Christensen T, Jensen K. Intensive treadmill training in the acute phase after ischemic stroke. Int J Rehabil Res. 2016;39(2):145–52; doi: 10.1097/MRR.0000000000000158.
12.
Madhavan S, Lim HS, Sivaramakrishnan A, Iyer P. Effects of high intensity speed-based treadmill training on ambulatory function in people with chronic stroke: a preliminary study with long-term follow-up. Sci Rep. 2019;9(1):1985; doi: 10.1038/s41598-018-37982-w.
13.
Lima DF, Levy RB, Luiz OC. Recommendations for physical activity and health: Consensus, controversies, and ambiguities. Rev Panam Salud Publica. 2014;36(3):164–70.
14.
Kim S-T, Oh D-W, Lee J-H. Initial evidence on the impact of performance-based treadmill training on pulmonary function and physical performance in a child with bronchopulmonary dysplasia: Single-subject experimental study. Phys Occup Ther Pediatr. 2020;40(4):384–94; doi: 10.1080/01942638.2019.1705455.
15.
Kollen B, Kwakkel G, Lindeman E. Hemiplegic gait after stroke: Is measurement of maximum speed required?. Arch Phys Med Rehabil. 2006;87(3):358–63; doi: 10.1016/j.apmr.2005.11.007.
16.
Lee I-H. Does the speed of the treadmill influence the training effect in people learning to walk after stroke? A double-blind randomised controlled trial. Clin Rehabil. 2015;29(3):269–76; doi: 10.1177/0269215514542637.
17.
Gjellesvik TI, Becker F, Tjønna AE, Indredavik B, Lundgaard E, Solbakken H, Brurok B, Tørhaug T, Lydersen S, Askim T. Effects of high-intensity interval training after stroke (The HIIT Stroke Study) on physical and cognitive function: a multicenter randomised controlled trial. Arch Phys Med Rehabil. 2021;102(9):1683–91; doi: 10.1016/j.apmr.2021.05.008.
18.
Lee JS, Oh DW. Effects of fast-speed treadmill training with on balance and walking ability of patients with chronic stroke. Kor J Neural Rehabil. 2011;1(2):31–9.
20.
Folstein MF, Folstem SE, McHugh PR. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98; doi: 10.1016/0022-3956(75)90026-6.
21.
Miller A, Reisman DS, Billinger SA, Dunning K, Doren S, Ward J, Wright H, Wagner E, Carl D, Gerson M, Awosika O, Khoury J, Kissela B, Boyne P. Moderate-intensity exercise versus high-intensity interval training to recover walking post-stroke: protocol for a randomised controlled trial. Trials. 2021;22(1):457; doi: 10.1186/s13063-021-05419-x.
22.
Flansbjer UB, Holmbäck AM, Downham D, Patten C, Lexell J. Reliability of gait performance tests in men and women with hemiparesis after stroke. J Rehabil Med. 2005;37(2):75–82; doi: 10.1080/16501970410017215.
23.
Macchiavelli A, Giffone A, FerrarelloF, Paci M. Reliability of the six-minute walk test in individuals with stroke: Systematic review and meta-analysis. Neurol Sci. 2021;42(1):81–7; doi: 10.1007/s10072-020-04829-0.
24.
Kudlac M, Sabol J, Kaiser K, Kane C, Phillips RS. Reliability and validity of the Berg balance scale in the stroke population: a systematic review. Phys Occup Ther Geriatr. 2019;37(3):196–221; doi: 10.1080/02703181.2019.1631423.
25.
Jang SN, Cho SI, Ou SW et al. The validity and reliability of Korean fall efficacy scale (FES) and activities specific balance confidence scale (ABC). Ann Geriatr Med Res. 2003;7(4):255–68.
26.
Cohen J. Statistical Power Analysis for the Behavioural Sciences. 2nd ed. Hillsdale: Lawrence Erlbaum Associates; 1988.
27.
Oh D-W. Current trend of gait rehabilitation after stroke: bottom-up versus top-down approaches. Kor J Neuromuscul Rehabil. 2020;10(2):57–80; doi: 10.37851/kjnr.2020.10.2.7.
28.
Yamada S, Tomida K, Tanino G, Suzuki A, Kawakami K, Kubota S, Yanohara R, Katoh Y, Wada Y, Teranishi T, Orand A, Tomita Y, Sonoda S. How effective is the early fast treadmill gait speed training for stroke patients at the 2nd week after admission: comparison with comfortable gait speed at the 6th week. J Phys Ther Sci. 2015;27(4):1247–50; doi: 10.1589/jpts.27.1247.
29.
Park SH. Change on walking ability and pulmonary functions of stroke patients according to the method of changing treadmill speed. Master’s Thesis. Daejeon: Graduate School of Daejeon University; 2017.
30.
Brauer SG, Kuys SS, Paratz JD, Ada L. High-intensity treadmill training and self-management for stroke patients undergoing rehabilitation: a feasibility study. Pilot Feasibility Stud. 2021;7:215; doi: 10.1186/s40814-021-00941-w.
31.
Häkkinen K, Komi PV, Alén M. Effect of explosive type strength training on electromyographic and force production characteristics of leg extensor muscles during concentric and various stretch-shortening cycle exercises. Scand J Sports Sci. 1985;7(2):65–76; doi: 10.1111/j.1748-1716.1985.tb07759.x.
32.
Alghadir AH, Al-Eisa ES, Anwer S, Sarkar B. Reliability, validity, and responsiveness of three scales for measuring balance in patients with chronic stroke. BMC Neurol. 2018;18(1):141; doi: 10.1186/s12883-018-1146-9.
33.
Roth EJ, Merbitz C, Mroczek K, Dugan SA, Suh WW. Hemiplegic gait: relationships between walking speed and other temporal parameters. Am J Phys Med Rehabil. 1997;76(2):128–33; doi: 10.1097/00002060-199703000-00008.
34.
Van de Port IG, Kwakkel G, Lindeman E. Community ambulation in patients with chronic stroke: how is it related to gait speed? J Rehabil Med. 2008;40(1):23–27; doi: 10.2340/16501977-0114.
35.
Blum L, Korner-Bitensky N. Usefulness of the Berg balance scale in stroke rehabilitation: a systematic review. Phys Ther. 2008;88(5):559–66; doi: 10.2522/ptj.20070205.
36.
Asghar M, Fatima A, Ahmed U, Ahmad A, Hanif K. Effects of gait training with and without proprioceptive neuromuscular facilitation on balance and gait in chronic stroke patients. Physiother Q. 2023;31(2):39–44; doi: 10.5114/pq.2023.125746.
37.
Mohammadi R, Ershad N, Rezayinejad M, Fatemi E, Phadke CP. Functional effects of treadmill-based gait training at faster speeds in stroke survivors: a prospective, single-group study. Int J Rehabil Res. 2017;40(3):275–8; doi: 10.1097/MRR.0000000000000231.
38.
Luo L, Meng H, Wang Z, Zhu S, Yuan S, Wang Y, Wang Q. Effect of high-intensity exercise on cardiorespiratory fitness in stroke survivors: a systematic review and meta-analysis. Ann Phys Rehabil Med. 2020;63(1):59–68; doi: 10.1016/j.rehab.2019.07.006.
39.
Kuys SS, Brauer SG, Ada L. Higher-intensity treadmill walking during rehabilitation after stroke in feasible and not detrimental to walking pattern or quality: a pilot randomised trial. Clin Rehabil. 2011;25(4):316–26; doi: 10.1177/0269215510382928.
40.
Tang A, Eng JJ, Rand D. Relationship between perceived and measured changes in walking after stroke. J Neurol Phys Ther. 2012;36(3):115–21; doi: 10.1097/NPT.0b013e318262dbd0.
41.
França C, Santos F, Caldeira R, Marques A, Ihle A, Lopes H, Gouveia ER. Strength and conditioning programs in youth athletes: a systematic review. Human Mov. 2023;24(3):1–16; doi: 10.5114/hm.2023.127970.
Share
RELATED ARTICLE
| eISSN: | 2544-4395 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
