Promoting Recovery Optimization with WALKing Exercise after Stroke (PROWALKS)

项目摘要/摘要 这项研究的总体目标是开发干预措施，以改善总体健康和质量 中风后个体的生活。作为一个群体，中风幸存者甚至比大多数中风患者更缺乏身体活动 久坐的老年人。缺乏体力活动会对中风患者造成严重后果，包括 增加中风复发、发展成其他疾病和死亡的风险。当前的康复干预措施 对改善中风后现实世界的步行活动几乎没有什么帮助，这表明简单地提高步行能力是 不足以改善中风后的日常体力活动。更确切地说，我们假设 快速步行干预，提高步行能力，步态活动监测计划，促进 将从诊所获得的成果转化为现实世界，将在现实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都要好。我们实验室的数据支持这一假设； 然而，它表明，将两种干预措施结合起来的更大效果取决于参与者最初的 步行活动。因此，我们不期望对所有参与者来说，一种干预措施会优于其他干预措施， 相反，联合干预对那些基线步行活动水平较低的人更好， 速度和耐力。这项提议的具体目标是测试FAST是否以及为谁而结合 步态活动监测计划(FAST+SAM)的步行训练在改善现实世界方面更具优势 步行活动与单独的快走训练(FAST)或一步活动监测和反馈的比较 慢性卒中患者仅接受SAM治疗。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周的快走训练(FAST)，这是一项阶梯式活动 监测程序(SAM)或快速步行训练+台阶活动监测程序(FAST+SAM)。 初级(每天的步数)，次级(自选和最快的步行速度，步行耐力，氧气 (消费)和探索性(血管事件、血脂、血糖、血压)结果将是 在开始治疗前、最后一次治疗后以及6个月和12个月时由盲人评估者进行评估 后续行动。将根据基线特征评估特定干预结果的适中程度 确定干预措施对谁有效。这项研究完成后，我们不单会 了解干预措施的有效性和对其有效的个人，我们将有 设计一项研究的必要信息，以调查改善的身体状况对二级预防的益处 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.