Promoting Recovery Optimization with WALKing Exercise after Stroke (PROWALKS)

项目总结/摘要 这项研究的总体目标是制定干预措施，改善儿童的整体健康和质量。 中风后的生活。作为一个群体，中风幸存者比大多数人更缺乏体力活动。 久坐的老年人。缺乏身体活动对中风患者有严重的后果，包括 增加中风复发、发展其他疾病和死亡的风险。目前的康复措施 对改善中风后的实际行走活动几乎没有帮助，这表明仅仅改善行走能力是 不足以改善中风后的日常体力活动。相反，我们假设， 快速步行干预，提高步行能力，与步骤活动监测程序，促进 将临床的收益转化为“现实世界”，将在真实的世界中产生更大的改善 步行活动比单独进行任何一种干预。来自我们实验室的数据为这一假设提供了支持; 然而，它表明，结合两种干预措施的更大功效取决于参与者的初始 步行活动。因此，我们并不期望一种干预措施对所有参与者来说都上级其他干预措施， 而是组合干预对于具有低水平基线行走活动的那些人将是上级的， 速度和耐力。本提案的具体目标是测试是否以及为谁快速结合 步行训练与步活动监测程序（FAST+SAM）是上级改善现实世界 步行活动与单独的快速步行训练（FAST）或步行活动监测和反馈相比 慢性中风患者的单独治疗（SAM）。使用随机对照实验设计，225 慢性（> 6个月）中风幸存者，将完成12周的快速步行训练（FAST），一步活动 在一个实施例中，患者可以使用快速步行训练+步行活动监测程序（SAM）或快速步行训练+步行活动监测程序（FAST+SAM）。 初级（每天步数）、次级（自选和最快步行速度、步行耐力、氧气 消耗）和探索性（血管事件、血脂、血糖、血压）结局 在开始治疗前、末次治疗后以及第6个月和第12个月时，由设盲评价者进行评估 随访将根据基线特征评价特定干预结局的适度， 确定干预措施对谁有效。在完成这项研究后，我们不仅 了解干预措施的有效性以及干预措施对哪些人有效， 必要的信息，以设计一项研究，调查二级预防的好处，改善身体 中风后的活动因此，这项研究是发展二级预防的重要一步 中风患者指南。

Project Summary/Abstract The overarching goal of this research is to develop interventions that improve the overall health and quality of life of individuals post-stroke. As a group, stroke survivors are more physically inactive than even the most sedentary older adults. Lack of physical activity has serious consequences in persons with stroke, including an increased risk of recurrent stroke, developing other diseases and mortality. Current rehabilitation interventions do little to improve real-world walking activity after stroke, suggesting that simply improving walking capacity is not sufficient for improving daily physical activity after stroke. Rather, we hypothesize that the combination of a fast walking intervention that improves walking capacity, with a step activity monitoring program that facilitates translation of gains from the clinic to the “real-world”, would generate greater improvements in real world walking activity than with either intervention alone. Data from our lab provides support for this hypothesis; however, it suggests that the greater efficacy of combining the 2 interventions depends on a participant's initial walking activity. Thus, we do not expect that one intervention will be superior to the others for all participants, but rather that the combined intervention will be superior for those with low levels of baseline walking activity, speed and endurance. The specific objective of this proposal is to test whether and for whom combining fast walking training with a step activity monitoring program (FAST+SAM) is superior in improving real-world walking activity compared to fast walking training alone (FAST) or a step activity monitoring and feedback program alone (SAM) in those with chronic stroke. Using a randomized controlled experimental design, 225 chronic (> 6 months) stroke survivors, will complete 12 weeks of fast walking training (FAST), a step activity monitoring program (SAM) or a fast walking training + step activity monitoring program (FAST+SAM).The primary (steps per day), secondary (self-selected and fastest walking speed, walking endurance, oxygen consumption) and exploratory (vascular events, blood lipids, glucose, blood pressure) outcomes will be assessed by blinded evaluators prior to initiating treatment, after the last treatment and at a 6 and 12 month follow-up. Moderation of specific intervention outcomes by baseline characteristics will be evaluated to determine for whom the interventions are effective. Following completion of this study, we will not only understand the efficacy of the interventions and the individuals for which they are effective, we will have the necessary information to design a study investigating the secondary prevention benefits of improved physical activity post-stroke. This study is, therefore, an important step in the development of secondary prevention guidelines for persons with stroke.