Increasing intensity during treadmill walking does not adversely affect walking pattern or quality in newly-ambulating stroke patients: an experimental study

QUESTION: Does walking on a treadmill at increasing intensities adversely affect walking pattern or reduce walking quality during treadmill walking? Are any changes influenced by walking ability? DESIGN: A within-participant, repeated measures experimental study. PARTICIPANTS: 18 individuals with a first stroke who were undergoing inpatient rehabilitation. INTERVENTION: Walking on a treadmill at intensities of 30%, 40%, 50% and 60% heart rate reserve in the one session. OUTCOME MEASURES: During treadmill walking practice, walking pattern was measured as linear and angular kinematics while walking quality was measured using the Rivermead Gait Analysis scale and a visual analogue scale. RESULTS: Walking on the treadmill at 60% heart rate reserve, step length of the paretic limb was 0.05 m (95% CI 0.01 to 0.10) longer, step length of the non-paretic limb was 0.09 m (95% CI 0.05 to 0.12) longer, and hip flexion at mid swing was 4 degrees (95% CI 1 to 6) greater than at 30% heart rate reserve. At 60% heart rate reserve, hip and knee extension at mid stance were respectively 3 and 4 degrees more flexed than at 30% heart rate reserve. Walking ability did not affect changes in walking pattern. Walking quality did not change with increasing treadmill intensity. CONCLUSION: Walking on a treadmill at increasing intensity did not adversely affect walking pattern or reduce walking quality in newly-ambulating stroke patients. This study adds some support for the inclusion of walking on a treadmill at higher intensities in rehabilitation for newly-ambulating stroke patients.