Treadmill exercise retrains brain and body of stroke victims

August 28, 2008

People who walk on a treadmill even years after stroke damage can significantly improve their health and mobility, changes that reflect actual "rewiring" of their brains, according to research spearheaded at Johns Hopkins.

"This is great news for stroke survivors because results clearly demonstrate that long-term stroke damage is not immutable and that with exercise it's never too late for the brain and body to recover," says Daniel Hanley, M.D., professor of neurology at the Johns Hopkins University School of Medicine.

The study's results, published in Stroke: Journal of the American Heart Association, suggest that patients' brains may retain the capacity to rewire through a treadmill exercise program months or years after conventional physical therapy has ended.

The research was conducted by scientists at Johns Hopkins, the University of Maryland, and the Department of Veterans Affairs Maryland VA Medical Center at their Geriatric Research, Education, and Clinical Center (GRECC). Researchers at the GRECC, led by Richard F. Macko, M.D., and Andrew P. Goldberg, M.D., have developed treadmill therapy for stroke patients over the past decade. Investigators at all three institutions combined efforts to recruit 71 patients who had a stroke at least six months earlier, with an average time lapse of nearly four years. At the study's onset, half of the subjects could walk without assistance, while the rest used a cane, a walker or a wheelchair.

All of the subjects, separated into two random groups regardless of disability, were tested for mobility and aerobic capacity (also known as VO2 peak), a measure of cardiac fitness. Thirty-two patients drawn equally from both groups underwent functional magnetic resonance imaging (fMRI) to assess brain activity linked to moving their legs in a walking motion.

One group then participated in an exercise program that principally involved walking on a treadmill three times a week for up to 40 minutes, assisted by a supporting sling and tether if needed. Physical therapists assigned to each subject increased the intensity of the workouts over time by increasing the treadmills' speed and incline, though the workouts never taxed the patients beyond a moderate level of 60 percent VO2 peak.

With the second group of patients, therapists assisted the patients in performing stretching exercises for the same period of time.

After six months, patients were again tested for walking speed and VO2 peak, and the same group who had undergone fMRI was rescanned. Walking speed for the treadmill group increased 51 percent compared to about 11 percent faster for those in the stretching group. Ground walking speed among the treadmill exercisers increased 19 percent, compared to about 8 percent for the stretchers. The treadmill exercisers also were significantly more fit at study completion, with VO2 peak increasing by about 18 percent. VO2 peak decreased slightly in the stretching group.

Hoping to find evidence that improved brain activity was responsible for the results, the investigators analyzed the brain scans and found markedly increased metabolic activity in brainstem areas associated with walking among all the treadmill exercisers. Brain scans of patients in the stretching group showed no such changes.

"This suggests that the brain is responsible for the improvement we saw in patients' walking ability. It seems to be recruiting other regions to take on the job of areas damaged by stroke," says Andreas Luft, M.D., a visiting researcher who worked with all three institutions who conducted this study. Luft is currently a stroke attending physician and professor of neurorehabilitation at the University of Zurich in Switzerland.

Those patients with the most improvement in walking showed the strongest change in brain activity, though the researchers don't yet know whether these brain changes were caused by more walking or whether participants walked better because brain activity in these key areas increased. This question will be the focus of a future study.

Hanley says stroke patients are typically told to "learn to live with" their disabilities, unlike heart attack patients and others who are often prescribed lifestyle changes and exercise programs to help recover function. Most stroke rehabilitation programs focus on short-term improvement, ending just a few months after a patient has had a stroke. Consequently, over the following years, patients' functional improvement plateaus and their fitness often wanes—a factor that could increase the chance of a second stroke.

"Many stroke survivors believe there's nothing to be gained from further rehabilitation, but our results suggest that health and functional benefits from walking on a treadmill can occur even decades out from stroke," says Macko, professor of neurology at the University of Maryland School of Medicine, noting that one of the patients in the study had significant improvement 20 years after a stroke. "We believe exercise gives individuals a way to fight back against stroke disabilities."

Source: Johns Hopkins Medical Institutions

Explore further: Risks for blood clot in a vein may rise with increased TV viewing

Related Stories

Risks for blood clot in a vein may rise with increased TV viewing

November 13, 2017
Risk of blood clots increases with the amount of time spent watching television, even if people get the recommended amount of physical activity, according to preliminary research presented at the American Heart Association's ...

Study shows stroke patients can improve walking ability

May 27, 2011
(Medical Xpress) -- Stroke patients regain walking ability through at-home strength and balance exercise provided by a physical therapist just as well as when they participate in programs that practice the actual task of ...

Robot legs helping stroke patients

September 26, 2011
(Medical Xpress) -- When it comes to recovering from a stroke, one of the major goals or rehabilitation is learning how to walk again. Researchers in the Netherlands are working with a prototype device called the LOwer Extremity ...

Large rehabilitation study looks at getting stroke patients back on their feet

May 25, 2011
In the largest stroke rehabilitation study ever conducted in the United States, stroke patients who had physical therapy at home improved their ability to walk just as well as those who were treated in a training program ...

Alternating training improves motor learning

October 18, 2011
Learning from one's mistakes may be better than practicing to perfection, according to a study in the Oct. 19 issue of the Journal of Neuroscience. The study found that forcing people to switch from a normal walking pattern ...

Post-stroke patients reach terra firma with new exosuit technology

July 26, 2017
Upright walking on two legs is a defining trait in humans, enabling them to move very efficiently throughout their environment. This can all change in the blink of an eye when a stroke occurs. In about 80% of patients post-stroke, ...

Recommended for you

Pickled in 'cognac', Chopin's heart gives up its secrets

November 26, 2017
The heart of Frederic Chopin, among the world's most cherished musical virtuosos, may finally have given up the cause of his untimely death.

Sugar industry withheld evidence of sucrose's health effects nearly 50 years ago

November 21, 2017
A U.S. sugar industry trade group appears to have pulled the plug on a study that was producing animal evidence linking sucrose to disease nearly 50 years ago, researchers argue in a paper publishing on November 21 in the ...

Female researchers pay more attention to sex and gender in medicine

November 7, 2017
When women participate in a medical research paper, that research is more likely to take into account the differences between the way men and women react to diseases and treatments, according to a new study by Stanford researchers.

Drug therapy from lethal bacteria could reduce kidney transplant rejection

August 3, 2017
An experimental treatment derived from a potentially deadly microorganism may provide lifesaving help for kidney transplant patients, according to an international study led by investigators at Cedars-Sinai.

Exploring the potential of human echolocation

June 25, 2017
People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...

Team eradicates hepatitis C in 10 patients following lifesaving transplants from infected donors

April 30, 2017
Ten patients at Penn Medicine have been cured of the Hepatitis C virus (HCV) following lifesaving kidney transplants from deceased donors who were infected with the disease. The findings point to new strategies for increasing ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.