McCartney Kiersten M, Pohlig Ryan T, Tulimieri Duncan Thibodeau, Boyne Pierce, Morton Susanne M, Reisman Darcy S
Department of Physical Therapy (K.M.M., S.M.M., D.S.R.), Biomechanics and Movement Science Program (K.M.M., S.M.M., D.S.R.), and Biostatistics Core (R.T.P), University of Delaware, Newark, Delaware; New Age Alpha, Rye, New York (D.T.); Department of Rehabilitation, Exercise Science and Nutrition Sciences, University of Cincinnati, Cincinnati, Ohio (P.B.).
J Neurol Phys Ther. 2025 Jul 1;49(3):153-161. doi: 10.1097/NPT.0000000000000517. Epub 2025 May 5.
There has been a substantial increase in the number of studies demonstrating improvements in walking capacity in people with chronic stroke following moderate-to-high intensity walking exercise interventions. Yet, there is significant variability in response to these interventions. This is likely due to the heterogeneity in this population and the variability in the exercise dose parameters actually attained within these walking interventions. Exercise prescription can be optimized by understanding how individual variables impact walking exercise dose. This study leveraged a large, clinical dataset to classify people with chronic stroke into homogeneous groups (called classes) and compare classes on the walking exercise dose achieved in a walking intervention.
One hundred sixty-nine people with chronic (>6-Months) stroke completed clinical evaluations and a 12-week high-intensity treadmill intervention. Baseline measures of walking capacity, physical health, and psychosocial factors were used in a latent variable mixture model to assess if latent, homogeneous classes existed within the dataset. Objective criteria determined the optimal number of classes, which were compared to the walking exercise dose attained across the intervention.
Four homogeneous classes were distinguished by differences in baseline walking capacity, steps-per-day, comorbidity burden, and balance self-efficacy. Despite clear "clinical profiles" of people with chronic stroke, these classes did not differ on the walking exercise dose attained.
Prior literature and clinical intuition suggest individuals with lower baseline walking capacity, physical health, and self-efficacy are less likely to tolerate high-intensity exercise, however our results demonstrate this is not true for people with chronic stroke.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A524 .
越来越多的研究表明，中高强度步行运动干预可改善慢性卒中患者的步行能力。然而，这些干预措施的效果存在显著差异。这可能是由于该人群的异质性以及这些步行干预中实际达到的运动剂量参数的变异性。通过了解个体变量如何影响步行运动剂量，可以优化运动处方。本研究利用一个大型临床数据集，将慢性卒中患者分为同质组（称为类别），并比较各类别在步行干预中实现的步行运动剂量。
169名慢性（>6个月）卒中患者完成了临床评估和为期12周的高强度跑步机干预。在潜在变量混合模型中使用步行能力、身体健康和心理社会因素的基线测量值，以评估数据集中是否存在潜在的同质类别。客观标准确定了类别的最佳数量，并将其与整个干预过程中达到的步行运动剂量进行比较。
根据基线步行能力、每日步数、合并症负担和平衡自我效能的差异，区分出四个同质类别。尽管慢性卒中患者有明确的“临床特征”，但这些类别在达到的步行运动剂量上没有差异。
先前的文献和临床直觉表明，基线步行能力、身体健康和自我效能较低的个体不太可能耐受高强度运动，然而我们的结果表明，对于慢性卒中患者并非如此。可查看视频摘要以获取作者更多见解（见视频，补充数字内容1，网址：http://links.lww.com/JNPT/A524 ）。
