By incorporating 30 minutes of progressive walking exercises into the regular stroke rehabilitation regimen (which consists of 30 to 60 minutes of physical therapy five days a week), stroke patients experienced a notable enhancement in quality of life and mobility by the time they were discharged from the hospital compared to a control group.
A newly developed walking exercise program with gradually increasing intensity, alongside standard physical therapy, has been found to significantly improve life quality and mobility in stroke survivors. These findings will be presented in a preliminary study at the American Stroke Association’s International Stroke Conference 2025, taking place in Los Angeles from February 5-7, 2025. The conference is a premier global gathering for researchers and clinicians focused on stroke and brain health.
Restoring the ability to walk is a critical component of recovery after a stroke. The 2016 Guidelines for Adult Stroke Rehabilitation and Recovery by the American Stroke Association suggests that stroke survivors, who can participate in three hours of therapy five days a week and are medically stable, receive treatment in an inpatient rehabilitation facility.
“Although guidelines encourage structured and progressive exercise following a stroke, the implementation of these programs that offer adequate intensity for rehabilitation is still behind,” noted coauthor of the study, Janice Eng, Ph.D., a specialist in stroke rehabilitation and a professor at the University of British Columbia in Canada. “Structured and increasingly challenging exercises, supported by wearable devices that provide feedback on intensity, can assist individuals in maintaining safe intensity levels, which are essential for neuroplasticity — the brain’s capacity to heal and adapt. The initial months after a stroke are when the brain is most capable of change. Our study reveals positive outcomes during the early rehabilitation phase.”
The research took place at 12 stroke rehab units in Canada, involving 306 participants who entered rehabilitation roughly one month after experiencing either an ischemic (due to a clot) or a hemorrhagic (due to bleeding) stroke. Initially, they were asked to walk for six minutes, with the average distance covered being 152 meters (498 feet — approximately the length of two typical city blocks).
Following this, the researchers carried out a blinded trial, randomly assigning participants to receive standard care or a new exercise protocol. The goal of the new protocol was to ensure participants engaged in at least 30 minutes of daily weight-bearing and walking activities that increased in intensity over time, based on their initial capabilities. Participants used activity-tracking watches to monitor their heart rates and step counts, providing an assessment of exercise intensity. The target was for participants to reach 2,000 steps while maintaining a moderate heart rate for 30 minutes during their physical therapy sessions five times a week.
Initially, all clinical sites began in the control phase, with 162 participants receiving only usual care while 144 engaged in the progressive walking intervention. Physical and cognitive abilities, along with quality of life, were evaluated at the beginning of the study and at discharge, around four weeks later. Adjustments were made in the analysis for factors such as age, gender, and baseline six-minute walk test results.
The analysis revealed:
- The participants in the progressive walking group improved their six-minute walk test scores by approximately 43.6 meters (143 feet) more than those in the usual care group.
- Participants in the progressive walking group showed significant gains in quality of life, balance, mobility, and walking speed.
“A significant advancement in this study was that all front-line therapists at the 12 sites were trained. These therapists conducted safety screenings and verified participants’ eligibility for the protocol. Our goal was to evaluate the impact of integrating this protocol into standard care, allowing all therapists and participants to follow it,” Eng said, highlighting the success of this real-world trial.
“Changing established practices can be challenging. The researchers have demonstrated that improvements can be achieved within inpatient rehabilitation during a critical recovery period when the brain is most adaptable. This protocol not only boosted endurance but also contributed to reduced disability post-stroke, yielding very encouraging results for stroke recovery,” commented Preeti Raghavan, M.D., chair of the American Stroke Association’s Rehab and Recovery committee and associate professor at Johns Hopkins School of Medicine’s Department of Physical Medicine and Rehabilitation. Raghavan was not involved in this study.
One study limitation was that participants needed to be able to take at least five steps, though assistance from one individual was permissible. Some individuals were excluded from the trial if they were unable to walk, even with help.
Details about the study, its background, and design include:
- The study consisted of 306 participants (with an average age of 68; comprising 188 men and 118 women) who were on average 29 days post-stroke.
- A novel study design known as a Step Wedge trial, a randomized, blinded study conducted across 12 stroke units in Canada, took place between 2020 and 2022.
- Physical therapists employed the progressively higher-intensity walking protocol during the initial four weeks of participants’ rehabilitation stay, during which they had, on average, been hospitalized for one month following their stroke. The effectiveness of the intervention was evaluated through a six-minute walk test conducted at the trial’s outset and four weeks later.
- All therapists at each stroke unit implemented this protocol as part of an enhanced standard of care, with the responsibility for onboarding new therapists and maintaining the protocol’s implementation resting with the unit.
