INTERVENTIONS TO IMPROVE PHYSICAL ACTIVITY AFTER STROKE

描述（由申请人提供）：中风是美国致残的主要原因。这种残疾是缺乏运动的结果，也是风险因素，中风幸存者作为一个群体，非常不运动。大多数研究发现，平均而言，慢性中风幸存者甚至比最久坐的成年人更不活跃。缺乏身体活动对中风患者有严重后果，包括增加第二次中风的风险、发展其他疾病（如糖尿病）和死亡。不运动的潜在后果更令人担忧，因为在中风后的第一年，不运动会变得更糟。因此，如果不及时治疗，缺乏身体活动可能是中风最严重和最昂贵的后遗症之一。尽管中风后不活动的严重后果，很少有人关注活动是否受到康复干预对慢性中风幸存者的影响。然而，有一种干预措施似乎有望改善慢性中风幸存者的活动，那就是快速跑步机训练。然而，即使在干预后观察到改善，参与者的身体活动仍然远低于建议水平。因此，开发干预措施以改善慢性中风患者的实际身体活动是当务之急。在其他人群中，步伐活动监测项目已被证明对增加日常步行活动非常有效；然而，它们的有效性从未在慢性中风幸存者中进行过测试。这项提议的主要目的是测试在快速跑步机训练中增加一个步数监测程序是否能改善慢性中风幸存者的步行活动，而不仅仅是单纯的快速跑步机训练。次要目的是测试这种干预是否也会影响步行速度、耐力和步行的能量消耗，所有这些都与中风后的步行活动有关，是功能的重要衡量指标。采用随机对照实验设计，40名慢性中风（6个月）幸存者将接受12周的快速跑步机训练或12周的快速跑步机训练联合a

DESCRIPTION (provided by applicant): Stroke is the leading cause of disability in the US. This disability is a consequence of, and a risk factor for, physical inactivity and stroke survivor, as a group, are extremely inactive. Most studies find that the average chronic stroke survivor is more inactive than even the most sedentary adults. Lack of physical activity has serious consequences in persons with stroke, including an increased risk of a second stroke, developing other diseases (i.e. diabetes) and mortality. The potential consequences of inactivity are even more alarming considering that inactivity gets worse over the first year after stroke. Therefore, left untreated, physical inactivity may be one of the most serious and costly sequela of stroke. Despite the severe consequences of inactivity after stroke, very little attention has been paid to whether activity is influenced by rehabilitation interventions for chronic stroke survivors. Nevertheless, one intervention that appears to hold promise for improving activity in chronic stroke survivors is fast treadmill training. However, even with the improvements observed after this intervention, the physical activity of the participants was still well below recommended levels. It is therefore imperative that interventions are developed to improve real-world physical activity in those with chronic stroke. In other populations, step activity monitorin programs have been shown to be extremely effective for increasing daily walking activity; however, their effectiveness has never been tested in chronic stroke survivors. The primary aim of this proposal is to test whether adding a step activity monitoring program to fast treadmill training can improve walking activity in chronic stroke survivors beyond improvements with fast treadmill training alone. The secondary aims will test whether this intervention also impacts walking speed, endurance and the energy cost of walking, all of which are known to be related to walking activity after stroke and are important measures of function. Using a randomized controlled experimental design, 40 chronic (> 6 months) stroke survivors, will receive either 12 weeks of fast treadmill training alone or 12 weeks of fast treadmill training in combination with a step activity monitoring program. The primary (physical activity) and secondary (walking speed, endurance, energy cost) outcomes will be assessed by blinded evaluators prior to initiating treatment (baseline), immediately after the last treatment (12 weeks post baseline) and 3 months after the last treatment (6 months post baseline). The expected positive effects of this novel intervention combining fast treadmill training and a step activity monitoring program on physical activity will provide strong support for the need to expand rehabilitation interventions t include features that facilitate an increase in the real-world physical activity of chronic stroke survivors.