INTERVENTIONS TO IMPROVE PHYSICAL ACTIVITY AFTER STROKE

描述(申请人提供)：在美国，中风是导致残疾的主要原因。这种残疾是缺乏运动和中风幸存者作为一个非常不活跃的群体的结果和风险因素。大多数研究发现，平均而言，慢性中风幸存者比最久坐不动的成年人更不活跃。缺乏体力活动会对中风患者造成严重后果，包括增加二次中风的风险、发展其他疾病(如糖尿病)和死亡率。考虑到中风后第一年不活动的情况会变得更糟，不运动的潜在后果甚至更令人担忧。因此，如果不进行治疗，缺乏运动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，但很少有人关注慢性中风幸存者的康复干预是否会影响他们的活动。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了改善，参与者的体力活动仍然远远低于推荐的水平。因此，当务之急是开发干预措施，以改善慢性中风患者的真实身体活动。在其他人群中，步态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。这项建议的主要目的是测试在快速跑步机训练中增加台阶活动监测计划是否可以改善慢性中风幸存者的步行活动，而不是仅仅通过快速跑步机训练来改善。次级目标将测试这种干预是否也会影响步行的速度、耐力和步行的能量成本，这些都已知与中风后的步行活动有关，是衡量功能的重要指标。采用随机对照实验设计，40名慢性(6个月)中风幸存者将接受单独12周的快速跑步机训练，或12周的快速跑步机训练结合 步态活动监控程序。在开始治疗前(基线)、最后一次治疗后立即(基线后12周)和最后一次治疗后3个月(基线后6个月)，将由盲法评估者评估初级(体力活动)和次级(步行速度、耐力、能量消耗)结果。这种新的干预措施结合了快速跑步机训练和分级活动监测计划对体力活动的预期积极效果，将为扩大康复干预措施的必要性提供强有力的支持，包括促进慢性中风幸存者真实世界体力活动增加的功能。

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.