Impact of Individual Factors on Exercise Dose During a Walking Intervention in People With Stroke.

Abstract

Background and objective: There has been a substantial increase in the number of studies demonstrating improvements in walking capacity in people with chronic stroke following moderate-to-high intensity walking exercise interventions. Yet, there is significant variability in response to these interventions. This is likely due to the heterogeneity in this population and the variability in the exercise dose parameters actually attained within these walking interventions. Exercise prescription can be optimized by understanding how individual variables impact walking exercise dose. This study leveraged a large, clinical dataset to classify people with chronic stroke into homogeneous groups (called classes) and compare classes on the walking exercise dose achieved in a walking intervention.

Methods: One hundred sixty-nine people with chronic (>6-Months) stroke completed clinical evaluations and a 12-week high-intensity treadmill intervention. Baseline measures of walking capacity, physical health, and psychosocial factors were used in a latent variable mixture model to assess if latent, homogeneous classes existed within the dataset. Objective criteria determined the optimal number of classes, which were compared to the walking exercise dose attained across the intervention.

Results: Four homogeneous classes were distinguished by differences in baseline walking capacity, steps-per-day, comorbidity burden, and balance self-efficacy. Despite clear "clinical profiles" of people with chronic stroke, these classes did not differ on the walking exercise dose attained.

Discussion and conclusions: Prior literature and clinical intuition suggest individuals with lower baseline walking capacity, physical health, and self-efficacy are less likely to tolerate high-intensity exercise, however our results demonstrate this is not true for people with chronic stroke.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A524.