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Effects of Task-Specific Locomotor and Strength Training in Adults Who Were Ambulatory After Stroke: Results of the STEPS Randomized Clinical Trial

KJ Sullivan, PT, PhD, is Associate Professor of Physical Therapy, Division of Biokinesiology and Physical Therapy at the School of Dentistry, University of Southern California, 1540 E Alcazar St, CHP-155, Los Angeles CA 90089 (USA).
DA Brown, PT, PhD, is Associate Professor, Department of Physical Therapy and Human Movement Sciences, The Feinberg School of Medicine, Northwestern University, Chicago, Ill.
T Klassen, PT, MS, NCS, is Clinical Instructor, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
S Mulroy, PT, PhD, is Director, Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, Downey, Calif.
T Ge, MS, is Doctoral Student, Department of Preventive Medicine, Keck School of Medicine, University of Southern California.
SP Azen, PhD, is Professor, Department of Preventive Medicine, Keck School of Medicine, University of Southern California.
CJ Winstein, PT, PhD, FAPTA, is Professor, Division of Biokinesiology and Physical Therapy at the School of Dentistry, and Department of Neurology, Keck School of Medicine, University of Southern California.

kasulliv{at}usc.edu

Background and Purpose: A phase II, single-blinded, randomized clinical trial was conducted to determine the effects of combined task-specific and lower-extremity (LE) strength training to improve walking ability after stroke.

Subjects: The participants were 80 adults who were ambulatory 4 months to 5 years after a unilateral stroke.

Method: The exercise interventions consisted of body-weight-supported treadmill training (BWSTT), limb-loaded resistive leg cycling (CYCLE), LE muscle-specific progressive-resistive exercise (LE-EX), and upper-extremity ergometry (UE-EX). After baseline assessments, participants were randomly assigned to a combined exercise program that included an exercise pair. The exercise pairs were: BWSTT/UE-EX, CYCLE/UE-EX, BWSTT/CYCLE, and BWSTT/LE-EX. Exercise sessions were 4 times per week for 6 weeks (total of 24 sessions), with exercise type completed on alternate days. Outcomes were self-selected walking speed, fast walking speed, and 6-minute walk distance measured before and after intervention and at a 6-month follow-up.

Results: The BWSTT/UE-EX group had significantly greater walking speed increases compared with the CYCLE/UE-EX group; both groups improved in distance walked. All BWSTT groups increased walking speed and distance whether BWSTT was combined with LE strength training or not.

Discussion and Conclusion: After chronic stroke, task-specific training during treadmill walking with body-weight support is more effective in improving walking speed and maintaining these gains at 6 months than resisted leg cycling alone. Consistent with the overtraining literature, LE strength training alternated daily with BWSTT walking did not provide an added benefit to walking outcomes.

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