Multimodal Exercise Training Poststroke

Individuals poststroke with gait and balance impairment are typically less active and have
low levels of physical fitness. Improving fitness level while also improving gait and balance
is very important. Maximizing the exercise training benefit requires the appropriate level of
effort is achieved. Traditional exercise programs scale aerobic demand by increasing the
walking speed or the slope of the treadmill surface. This may be difficult for individuals
who experience decreased balance at faster speeds or on sloped surfaces and require the use
of handrails to safely walk under these conditions. These exercise programs show limited
improvement in walking ability after training. This project will test a novel approach,
resistance-based treadmill walking, for maximizing improvements in fitness and ability to
walk by individuals poststroke. The investigators previous research has shown that backward
directed resistive force applied to the pelvis while walking is well tolerated by individuals
poststroke. Further, these forces can be used to effectively scale aerobic demand while
walking in a controlled manner. With traditional treadmill training approaches handrail
support is utilized to ensure safety. However, handrail support externally stabilizes the
individual reducing training improvements in walking capacity and balance. For this pilot
investigation a group that aerobically trains using a standard exercise treadmill training
paradigm will be compared to a group that experiences progressive backward directed resistive
forces applied to an individuals' pelvis while they walk at comfortable walking speeds
without the aid of handrails. Individuals will wear a fall harness that provides no external
stabilization but prevents falls to the treadmill surface. This approach has the potential
benefit of allowing individuals poststroke to meaningfully practice walking at safe speeds
but against resistance thereby improving walking economy, dynamic balance, and walking speed.
The proposed project is necessary to gather preliminary data for a much larger training study
that has the potential to change the clinical approach for improving gait economy, balance,
and walking speed for individuals poststroke.