Clinic of Neurology, University Hospital of Zürich, Zürich, Switzerland.
Neurorehabil Neural Repair. 2012 Jan;26(1):85-95. doi: 10.1177/1545968311418675. Epub 2011 Sep 1.
Ambulatory subjects after stroke may benefit from gait-oriented cardiovascular fitness training, but trials to date have not primarily assessed older persons.
Thirty-eight subjects (age >60 years) with residual hemiparetic gait were enrolled >6 months after stroke. Participants were randomized to receive 3 months (3×/week) progressive graded, high-intensity aerobic treadmill exercise (TAEX) or conventional care physiotherapy. Primary outcome measures were peak exercise capacity (Vo(2peak)) and sustained walking capacity in 6-minute walks (6MW). Secondary measures were gait velocity in 10-m walks, Berg Balance Scale, functional leg strength (5 chair-rise), self-rated mobility (Rivermead Mobility Index), and quality of life (SF-12).
Thirty-six participants completed the study (18 TAEX, 18 controls). TAEX but not conventional care improved Vo(2peak) (difference 6.4 mL/kg/min, P < .001) and 6MW (53 m, P < .001). Likewise, maximum walking speed (0.13 m/s, P = .01), balance (P < .05), and the mental subscore of the SF-12 (P < .01) improved more after TAEX. Gains in Vo(2peak) correlated with the degree at which training intensity could be progressed in the individual participant (P < .01). Better walking was related to progression in treadmill velocity and training duration (P < .001). Vo(2peak) and 6MW performances were still higher 1 year after the end of training when compared with the baseline, although endurance walking (6MW) at 1 year was lower than immediately after training (P < .01).
This trial demonstrates that TAEX effectively improves cardiovascular fitness and gait in persons with chronic stroke.
脑卒中后能活动的患者可能会受益于针对步态的心血管适能训练，但迄今为止的试验并未主要评估老年人。
38 名（年龄＞60 岁）有残余偏瘫步态的脑卒中后患者入选，入选时间＞6 个月。参与者被随机分为接受 3 个月（每周 3 次）渐进性分级高强度有氧跑步机运动（TAEX）或常规康复物理治疗。主要结局指标为峰值运动能力（Vo 2peak）和 6 分钟步行（6MW）的持续步行能力。次要结局指标为 10 米步行速度、伯格平衡量表、功能性腿部力量（5 次坐起）、自我评定的移动能力（Rivermead 移动指数）和生活质量（SF-12）。
36 名参与者完成了研究（18 名 TAEX，18 名对照组）。TAEX 而非常规护理可改善 Vo 2peak（差异 6.4mL/kg/min，P＜0.001）和 6MW（53m，P＜0.001）。同样，最大步行速度（0.13m/s，P=0.01）、平衡（P＜0.05）和 SF-12 的心理子评分（P＜0.01）在 TAEX 后改善更明显。Vo 2peak 的提高与个体参与者可进展的训练强度程度相关（P＜0.01）。更好的步行与跑步机速度和训练时间的进展相关（P＜0.001）。与基线相比，尽管在 1 年时的耐力步行（6MW）低于训练后立即（P＜0.01），但在训练结束 1 年后，Vo 2peak 和 6MW 仍更高。
该试验表明，TAEX 可有效改善慢性脑卒中患者的心血管适能和步态。
