Compared with moderate-intensity training, high-intensity training led to greater gains in walking speed, as well as reduced fatigue.

Many stroke patients have substantial impairments in walking, and poststroke physical therapy might lack the necessary intensity and volume to maximise improvement. In this study, researchers randomised 55 poststroke patients (age range, 40 to 80 years) with residual walking limitations at least six months (and an average of 2.5 years) after their strokes to moderate-intensity aerobic training (MAT) or high-intensity interval training (HIIT). Intensity was based on differing target heart rates in the two groups. Participants received supervised exercise therapy, including both over-ground and treadmill walking, three times weekly for 12 weeks. Patients were excluded if they had substantial cardiac, ambulatory or mental health impairments.

Baseline six-minute walking distance was 180m to 200m. Both groups had only modest improvement in six-minute walk­ing distance at four weeks, but the HIIT group improved significantly more than the MAT group at eight weeks (58m vs 29m) and 12 weeks (71m vs 27m). Fatigue was significantly improved compared with baseline in the HIIT group only. No important adverse events occurred in either group.

Comment: Stroke patients appear to benefit more from high-intensity than moderate-intensity walking training, as is true for high-intensity training for people in general. That these improvements came so long after the strokes suggests that patients can benefit at any point. The reduction in fatigue from high-intensity training might be an equally important outcome, given the considerable morbidity of poststroke fatigue.

Thomas L. Schwenk, MD
Professor Emeritus, Family and Community Medicine, University of Nevada School of Medicine, Reno, USA.

Boyne P, et al. Optimal intensity and dura­tion of walking rehabilitation in patients with chronic stroke: a randomized clinical trial. JAMA Neurol 2023 Feb 23; e-pub (https://doi.org/10.1001/jamaneurol.2023.0033).

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Neurology