Longer training at vigorous intensity may be best for patients with chronic stroke

Walking at a vigorous intensity for a minimum of 12 weeks is needed to maximize immediate gains in patients with chronic stroke, according to a study.

In this multicenter randomized clinical trial, 55 survivors of a single stroke (aged 40 to 80 years) with persistent walking limitations ≥6 months after the stroke were randomized to high-intensity interval training (HIIT; n = 27) or moderate-intensity aerobic training (MAT; n = 28), involving 45 minutes of walking practice 3 times per week for 12 weeks

The HIIT protocol used repeated 30-second bursts of walking at a maximum safe speed, alternated with 30- to 60-second rest periods, targeting a mean aerobic intensity above 60% of the heart rate reserve (HRR). The MAT protocol used continuous walking with speed adjusted to maintain an initial target of 40% of the HRR, progressing up to 60% of the HRR as tolerated.

At baseline, the mean 6-minute walk test distance was 239 m. Participants attended most planned treatment visits and planned testing visits (84.6% and 89.5%, respectively). After 4 weeks, both groups had similar 6-minute walk test distance changes, however, after 8 weeks and 12 weeks of training, participants in the HIIT groups had greater gains.

Secondary measures of gait speed and fatigue were also more improved in participants undergoing HIIT.

Reference

Boyne P, Billinger SA, Reisman DS, et al. Optimal Intensity and Duration of Walking Rehabilitation in Patients With Chronic Stroke: A Randomized Clinical Trial. JAMA Neurol. Published online February 23, 2023. doi:10.1001/jamaneurol.2023.0033