Treadmill Exercise may Retrain Body and Brain after Stroke

Researchers have found that regularly exercising on a treadmill may help stroke patients learn to walk correctly again by rewiring parts of the brain – even if the stroke happened years ago. Using a treadmill may also improve walking and overall fitness better than stretching, the standard exercise prescribed after a stroke.

After a stroke, many patients develop abnormal walking patterns that may or may not be corrected with physical rehabilitation programs. Most programs focus on short-term therapy, ending several months after a stroke.

This new study involved patients who had strokes several years earlier. Study participants had weakness on one side of the body at least six months after having a stroke. They had all completed standard rehabilitation programs before enrolling in the six-month-long study.

Subjects were divided into two groups, regardless of their disabilities. Thirty-seven patients were in the treadmill group and were assigned three, 40-minute exercise sessions per week at 60 percent of their heart rate reserve. Patients were supported with a harness, if needed. They increased duration and intensity every two weeks. The remaining 34 participants performed a variety of traditional stretching exercises for the same length of time.   

The results were measured using brain scans, called MRIs, and by evaluating the participants’ walking abilities and overall fitness. People in the treadmill group had better scores in all categories.

MRIs were performed while patients did knee exercises that mimicked walking. In certain parts of the brain, activity increased by 72 percent in patients who exercised on the treadmills. In these patients, blood oxygenation and blood flow increased in the brain stem and cerebellum. According to the authors, this may indicate that brain stem and cerebellum were now controlling some of the walking functions that the cortical brain had been responsible for before it was damaged by a stroke. Brain activity remained unchanged in the stretching group.

Both walking speed and fitness increased significantly more in the treadmill group compared to the stretching group. This is important because if stroke survivors are immobile, they have an increased risk of developing heart disease and diabetes.

For more information about integrative therapies for stroke, please visit Natural Standard’s Medical Conditions database.

Comments

[Amy Lee Ann]

This is exciting information to me. However, I assumed before reading this article, that after a stroke, the obvious thing to do for rehabilitation would be to try to relearn how to walk and perform regular tasks again. I do not see how stretching would help, since stretching is such a useless motion in daily life. How often do we do static stretches in daily life? Maybe when I lean back on my chair to stretch my lower back after typing this sentence - otherwise, not so much. It would make more sense to practice a motion such as walking, which is used much more than stretching. Stretching could help to increase range of motion, but the actual motion seems much more important.

My thought on this is, if one is trying to learn how to walk, one will never figure out how to do this if that person is doing stretches and not actually attempting to walk. It is a matter of retraining the brain. Since neurons have died during a stroke, new neuronal pathways will hopefully replaced the dead ones. The only way to create new neuronal pathways is to try to learn it again, similar to how a person learns any task, by repetition and practice. Similar to a gymnast trying to learn a new trick. It is important to stretch the body and be more flexible so that you have the range of motion to perform the proposed new gymnastic move; however, in order to actually learn the motion, attempts at the gymnastic move and repetition of the motion are needed.

[Tasha Hill]

Score another point for walking! With so much evidence already piled up about how walking benefits physical health (controlling weight, boosting fitness, lowering risk for diseases like type 2 diabetes and heart problems), it’s exciting to see the power of walking to boost brain activity for stroke patients. It’s also interesting to consider this, alongside evidence that walking has also been shown to lower depressive symptoms and control stress in other studies.

[Chad Park]

Amazing. This truly shows the power our bodies have to recuperate and recover. We are able to grow and adapt to even the direst of obstacles. New neurons form, existing neurons learn new tasks; it is truly a beautiful thing. I must agree with Amy Lee Ann about the standard therapy of stretching after a stroke. I would think that it is only obvious to incorporate walking into a therapeutic regimen of a stroke patient. Either way, I hope this study will encourage physicians, physical therapists and other healthcare providers to include more walking exercises into the regimens of stroke patients.

[Pete]

It is important to stay active. Not only does walking and physical exercise cut down the risk of heart attacks, it helps decrease our cholesterol levels, sugar levels and blood pressure. Physical exercise is better than prescription medication alone. Even if a stroke does occur, this is no reason to give up. Keep walking and exercising is still the key.

[HC]

This study just confirms how beneficial it is to exercise and walk. I am not surprised these results were found in this patient population. An excellent way to get people to walk more is to use a pedometer. It is great tool for people to use because the goal steps per day can be individualized to the person using it, and it is an inexpensive way to track how far you walk each day. For the elderly, even small trips like walking to the mailbox or visiting a neighbor will increase steps per day. Walking also strengthens your heart, improves bone health and increases overall fitness.

[Ree]

I'm guessing that the patients included in the study were somewhat healthy at the start of the trial. Forty minutes of walking can be quite exhausting for someone who is not used to physical exertion. Not to mention the participants included had experienced a stroke years before they started treadmill therapy. Perhaps there is potential for both therapies. Start slow with stretching to get the body moving and adjusted; and then begin walking, which may be rigorous to a patient who has experienced a stroke.

[Melanie]

What an interesting study. How difficult it must be to lose mobility after a stroke. Research like this supports long-term rehabilitation, and maybe if more studies like this come out, insurance companies will start to cover therapy longer than just a few months.

[judy]

What I love about this is that people can continue to do this long term. They don’t need to rely on special machines or instruction. In addition, walking may help correct some of the issues that may lead to a second stroke. Because diet and exercise often work in concert, I would be curious to see what the results would be if another arm were added to the study: one in which subjects followed the walking regimen and a Mediterranean or other heart-healthy diet.

[Terri]

I agree with Amy Lee Ann about the importance of actually doing physical activity. Other studies have shown that things, such as brain teasers and other types of games and riddles, can help the brain stay active. Areas of the brain are activated and those neuronal pathways are replaced.

[Jerry]

It seems obvious to incorporate walking into a rehabilitation program after recovering from a stroke, but surprisingly it is not always included. My grandfather became progressively worse after his stroke and later on was barely able to walk. Maybe walking and doing more physical activity after his stroke would have given him a better quality of life. Does anyone know how soon after a stroke people can begin these sorts of programs?

[kay kelley]

Finally, a report to help other stroke victims get more cardiovascular therapy. My niece suffered a debilitating stroke at age 22, and her doctor said she would never walk again. Her parents spent every day with her in rehab ensuring she walked several times every day; just standing at first, then one step, a few steps, then down the hall. Her ability to talk and walk returned within six months, and I believe it was not only the encouragement, but also the activity itself of walking that helped restore her motor skills. She danced up a storm at her wedding four years later.

[liz]

I agree with Amy that stretching helps body to be flexible and increases range of motion, but more is needed to gain back physical activity. The study is quite interesting and encouraging for stroke victims. Treadmill exercise should be part of the standard rehabilitation program.

[Anna]

I agree with Ree in the fact that 40 minutes of walking can be quite exhausting. Although it is great to hear that treadmill exercise could improve gait pattern even if the stroke happened years ago. It is all about people having the willpower and perseverance to better their quality of life. Also, we all know that cardiovascular exercises are part of any loss-weight program and help prevent future strokes.

[J.O.]

It is amazing that treadmill walking could still be effective for someone who suffered from a stroke years before! I hope this research continues and provides people who have suffered from strokes hope for recovery and regaining some of their physical movement.

[Raine]

This study confirms what I would have assumed -- that walking is superior to stretching. This is true for even those who haven’t had a stroke. If I was to spend 30 minutes walking or 30 minutes stretching at lunchtime, it seems obvious that the walking would be more beneficial to my health.

Anna is right about the will-power aspect. People will only do as much as they want to do. Sometimes, even if they are able to do more, they won’t. Strokes are very serious and debilitating, and stroke patients have a long road to recovery. If walking helps this recovery, then that can only be good.

[cure depression]

I believe there are so many depressed people in our society because they aren’t happy with themselves. There are so many outside pressures, including the ones we let in through the media etc., that we are bombarded with how we should act, feel, work, play and so on. Come on people -- forget the status quo!!!

[Jason]

This study is not surprising to me since it’s important for stroke patients to regain their mobility, and what better way to achieve that than through walking? I personally don’t see how stretching could be even more beneficial than walking. I agree with Ree that 40 minutes seems pretty exhausting, unless the participants were otherwise healthy. This study was also done in subjects who experienced strokes years ago, so I wonder if the same results hold true for more recent strokes.