There may be more effective options than the short-term therapy given to most patients after a stroke, a new study shows. Even years later, intensive exercise therapy focused on using a treadmill can significantly improve a stroke patient's physical skills.
"These were people who were told, 'you don't have anything more to gain from therapy, go home,'" said Dr. Richard Macko, assistant director of the Baltimore VA Geriatric Research Education and Clinical Center,
While there are no formal guidelines, stroke rehabilitation generally lasts only the first few weeks after a stroke and focuses on retraining the patient to perform everyday tasks. With this type of therapy, improvement in walking ability normally plateaus 11 weeks after stroke. However, recent findings show that more strides can be made if therapy is continued, or even restarted, and made more intense.
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Even though a stroke causes neurological impairments to the brain, Macko explained that there is growing evidence showing that the brain has the ability to relearn basic tasks, such as walking, as long as a decade after a stroke.
In an October 2005 study published in Stroke, researchers recruited 61 men and women who had persisting walking problems anywhere from six months to 10 years after their stroke.
Half of the patients were assigned to a training program that consisted of 40-minute treadmill sessions, three times a week. The difficulty of the treadmill exercise was increased in both length and intensity every two weeks, or less if the patient could not keep up. The other patients were assigned to more traditional post-stroke exercises normally given immediately after one's hospital stay: 35 minutes of stretching and 5 minutes of treadmill walking at a pace held constant for the duration of the study.
After six months, the patients who participated in the intensive treadmill program increased their aerobic fitness, as measured by the amount of carbon dioxide they exhaled, six times more than the traditional rehab group. Additionally, the treadmill exercisers reported a 56 percent improvement in walking ability, compared to a 12 percent improvement reported by the traditional therapy group.
The treadmill helps more than other exercise routines because the treadmill directly interacts with the foot and leg, Macko said. The repetitive motion of the treadmill belt and the ability to increase the intensity level, he added, retrains the body to walk more efficiently. In contrast, the typical rehabilitation programs, noted for long stretching sessions, are often too short and not rigorous enough to produce the same effect.
"Conventional rehab does not provide the intensity or repetition to improve function," said Macko.
However, even the modest improvements seen in the regular rehab group was greater than that seen in typical stroke patients, who often report that, without therapy, walking skills decline as time passes. So, the addition of a moderate exercise routine seems to offer patients some degree of effective therapy.
With further research, Macko hopes to change the way doctors think about stroke rehabilitation. "The message is even if you do simple stuff—even if you had the stroke ten years ago—you can improve your muscle strength and abilities," he explained.