Document Detail


Treadmill exercise activates subcortical neural networks and improves walking after stroke: a randomized controlled trial.
MedLine Citation:
PMID:  18757284     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Stroke often impairs gait thereby reducing mobility and fitness and promoting chronic disability. Gait is a complex sensorimotor function controlled by integrated cortical, subcortical, and spinal networks. The mechanisms of gait recovery after stroke are not well understood. This study examines the hypothesis that progressive task-repetitive treadmill exercise (T-EX) improves fitness and gait function in subjects with chronic hemiparetic stroke by inducing adaptations in the brain (plasticity). METHODS: A randomized controlled trial determined the effects of 6-month T-EX (n=37) versus comparable duration stretching (CON, n=34) on walking, aerobic fitness and in a subset (n=15/17) on brain activation measured by functional MRI. RESULTS: T-EX significantly improved treadmill-walking velocity by 51% and cardiovascular fitness by 18% (11% and -3% for CON, respectively; P<0.05). T-EX but not CON affected brain activation during paretic, but not during nonparetic limb movement, showing 72% increased activation in posterior cerebellar lobe and 18% in midbrain (P<0.005). Exercise-mediated improvements in walking velocity correlated with increased activation in cerebellum and midbrain. CONCLUSIONS: T-EX improves walking, fitness and recruits cerebellum-midbrain circuits, likely reflecting neural network plasticity. This neural recruitment is associated with better walking. These findings demonstrate the effectiveness of T-EX rehabilitation in promoting gait recovery of stroke survivors with long-term mobility impairment and provide evidence of neuroplastic mechanisms that could lead to further refinements in these paradigms to improve functional outcomes.
Authors:
Andreas R Luft; Richard F Macko; Larry W Forrester; Federico Villagra; Fred Ivey; John D Sorkin; Jill Whitall; Sandy McCombe-Waller; Leslie Katzel; Andrew P Goldberg; Daniel F Hanley
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2008-08-28
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  39     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-11-25     Completed Date:  2009-01-06     Revised Date:  2010-09-21    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3341-50     Citation Subset:  IM    
Affiliation:
Department of General Neurology, University of Maryland, School of Medicine, Baltimore, MD, USA. aluft@jhu.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Brain / physiopathology*
Cerebellum / physiopathology
Exercise Therapy*
Female
Gait Disorders, Neurologic / etiology,  therapy*
Humans
Magnetic Resonance Imaging
Male
Mesencephalon / physiopathology
Middle Aged
Nerve Net / physiopathology*
Stroke / complications,  rehabilitation*
Walking / physiology*
Grant Support
ID/Acronym/Agency:
#M01-00052//PHS HHS; 1R01 NS 24282-08/NS/NINDS NIH HHS; P60 AG012583-10/AG/NIA NIH HHS; P60AG 12583/AG/NIA NIH HHS
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