Approximately 5000,000 individuals in the U.S. suffer a stroke each year; many have residual neurological deficits which promote physical deconditioning and worsening functional capacity. Health impacts of sedentary habitus are greatest in the neurologically disabled elderly where age-associated declines in strength and cardiovascular fitness compound neurological deficits, limiting the capacity to met the high energy demands of hemiparetic gait. Sedentary habitus may also increase cardiovascular risk by impairment of endogenous fibrinolysis, increasing atherogenic lipid profiles, and glucose intolerance, factors linked to insulin resistance and potentially modifiable by exercise training. Hypothesis: This randomized trial investigates the hypothesis that aerobic exercise using a task specific gait training modality will improve cardiovascular fitness profiles and functional mobility in older stroke patients with chronic hemiparetic gait, when compared to matched controls performing only stretching.
Aims :
Specific aims are to determine whether 6 months graded treaded endurance training: 1) improves cardiovascular fitness levels and reduces the energy demands of hemiparetic gait, as define by oxygen consumption levels during peak and submaximal exercise ambulation task; 2) increases free living physical activity in the non-exercise time as measured by kinematic recording and quantitative in vivo determination of energy expenditure using stable isotopes; and, 3) improves endogenous fibrinolysis, as determined by measures of circulating tissue plasminogen activator (t-PA) and its main inhibitor (plasminogen activator inhibitor-1). Measurements of fasting lipid profiles, oral glucose tolerance and insulin responses, and body composition by dual-energy x-ray absorptimetry at baseline and after 6 months training will determine whether endurance training reduces abdominal obesity and metabolic risk factors for cardiovascular disease. A longitudinal follow-up to 1 year will establish whether exercise therapy fosters sustained improvements in cardiovascular health, reversal of sedentary habitus, and improved patient rate functional outcomes related to quality of life findings which would support a rationale for exercise therapy in this population.
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