Article

Poststroke guidelines recommend moderate-intensity, continuous
aerobic training (MCT) to improve aerobic capacity and mobility after stroke.
High-intensity interval training (HIT) has been shown to be more effective than
MCT among healthy adults and people with heart disease. However, HIT and MCT have
not been compared previously among people with stroke.
The purpose of
this study was to assess the feasibility and justification for a definitive
randomized controlled trial (RCT) comparing HIT and MCT in people with chronic
stroke. DESIGN: A preliminary RCT was conducted. SETTING: The study was conducted
in a cardiovascular stress laboratory and a rehabilitation research laboratory.
PATIENTS: Ambulatory people at least 6 months poststroke participated.
INTERVENTION: Both groups trained 25 minutes, 3 times per week, for 4 weeks. The
HIT strategy involved 30-second bursts at maximum-tolerated treadmill speed
alternated with 30- to 60-second rest periods. The MCT strategy involved
continuous treadmill walking at 45% to 50% of heart rate reserve. MEASUREMENTS:
Measurements included recruitment and attendance statistics, qualitative HIT
acceptability, adverse events, and the following blinded outcome variables: peak
oxygen uptake, ventilatory threshold, metabolic cost of gait, fractional
utilization, fastest treadmill speed, 10-Meter Walk Test, and Six-Minute Walk
Test. RESULTS: During the 8-month recruitment period, 26 participants consented
to participate. Eighteen participants were enrolled and randomly assigned to
either the HIT group (n=13) or the MCT group (n=5). Eleven out of the 13 HIT
group participants attended all sessions. Participants reported that HIT was
acceptable and no serious adverse events occurred. Standardized effect size
estimates between groups were moderate to very large for most outcome measures.
Only 30% of treadmill speed gains in the HIT group translated into overground
gait speed improvement. LIMITATIONS: The study was not designed to definitively
test safety or efficacy. CONCLUSIONS: Although further protocol optimization is
needed to improve overground translation of treadmill gains, a definitive RCT
comparing HIT and MCT appears to be feasible and warranted.
CI - (c) 2016 American Physical Therapy Association.

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