INTERVENTIONS TO IMPROVE PHYSICAL ACTIVITY AFTER STROKE

描述（由申请人提供）：中风是美国残疾的主要原因。这种残疾是缺乏身体活动的结果，也是缺乏身体活动的风险因素，而中风幸存者作为一个群体，是非常不活跃的。大多数研究发现，慢性中风幸存者的平均活动量甚至比久坐不动的成年人还要多。缺乏身体活动对中风患者有严重后果，包括增加二次中风的风险，发展其他疾病（即糖尿病）和死亡率。考虑到中风后第一年不活动会变得更糟，不活动的潜在后果甚至更令人担忧。因此，如果不及时治疗，身体活动不足可能是中风最严重和代价最高的后遗症之一。尽管中风后不活动的严重后果，很少有人注意到活动是否受到慢性中风幸存者康复干预的影响。然而，一种似乎有望改善慢性卒中幸存者活动的干预措施是快速跑步机训练。然而，即使在这种干预后观察到改善，参与者的身体活动仍然远低于建议的水平。因此，必须制定干预措施，以改善慢性卒中患者的实际身体活动。在其他人群中，步行活动监测计划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。本提案的主要目的是测试在快速跑步机训练中添加步活动监测程序是否可以改善慢性卒中幸存者的步行活动，而不仅仅是快速跑步机训练。次要目的将测试这种干预是否也影响步行速度，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，并且是功能的重要指标。采用随机对照实验设计，40名慢性（> 6个月）卒中幸存者将接受12周的单独快速跑步机训练或12周的快速跑步机训练联合 步进活动监测程序。在开始治疗前（基线）、末次治疗后即刻（基线后12周）和末次治疗后3个月（基线后6个月），将由设盲评价者评估主要（体力活动）和次要（步行速度、耐力、能量消耗）结局。这种新型干预结合快速跑步机训练和阶梯活动监测计划对身体活动的预期积极影响将为扩展康复干预的需求提供强有力的支持，包括促进慢性卒中幸存者增加真实世界身体活动的功能。 公共卫生相关性：中风是美国残疾的主要原因，这种残疾是身体活动不足的后果和风险因素。因此，中风幸存者作为一个群体，非常不活跃，这对他们有严重的后果，包括增加二次中风和发展其他疾病的风险。该提案研究了一种新的干预措施，将快速跑步机训练与台阶活动监测计划相结合，以改善中风后的不活动。

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. PUBLIC HEALTH RELEVANCE: Stroke is the leading cause of disability in the US and this disability is a consequence of, and a risk factor for, physical inactivity. As a result, stroke survivors, as a group, are extremely inactive and this has serious consequences for them, including an increased risk of a second stroke and developing other diseases. This proposal investigates a novel intervention that combines fast treadmill training with a step activity monitoring program to improve inactivity after stroke.