# Effects of task-oriented treadmill training applied high-intensity interval training on walking ability in patients with chronic stroke: A randomized controlled trial with short-term follow-up PMID: 40988269 Journal: Medicine Published: 2025-09-19 Authors: Kim KR, Kim YJ, Kim MK ## Question Does task-oriented treadmill training combined with high-intensity interval treadmill training improve walking ability more than high-intensity interval treadmill training alone in patients with chronic stroke? ## Summary This randomized controlled trial studied 34 inpatients with chronic stroke who could walk at least 10 meters but had slow walking speed. For 4 weeks, both groups completed supervised high-intensity interval treadmill training for 30 minutes, 3 times per week, and both also received NeuroDevelopment Treatment. The experimental group added task-oriented obstacle crossing on the treadmill, while the control group performed high-intensity interval treadmill training without the task-oriented obstacle component. Both groups improved over time, but the task-oriented HIIT treadmill group improved more on walking speed, walking endurance, and functional gait assessment; timed up and go improved within groups but not significantly more between groups. The protocol is clinically relevant but requires supervision, treadmill hardware, harness safety measures, and stroke-specific screening. ## Population - Thirty-four chronic stroke rehabilitation inpatients analyzed after randomization, able to walk at least 10 meters and with walking speed below 0.8 m/s. - Sample size: 34 - Age: Experimental group 58.41 +/- 9.29 years; control group 51.00 +/- 13.44 years. - Sex: Experimental group 10 male/7 female; control group 12 male/5 female. - Fitness level: Chronic stroke patients with slow walking speed; FAC about 3.35 to 3.53. - Health status: Chronic stroke 6 to 24 months post-onset; MMSE-K at least 24; excluded heart disease, circulatory problems, medical instability, pain limiting movement, visual impairment, and cognitive impairment. ## Methodology - Randomized controlled trial with pretest, post-test after 4 weeks, and 2-week follow-up. - 4-week intervention plus 2-week follow-up. - Inpatient rehabilitation hospital in Korea with physical therapist-supervised treadmill sessions. - Randomized and controlled study design. ## Protocol - Task-oriented treadmill HIIT. - Modality: Treadmill walking with obstacle-crossing tasks. - Work intervals: 2 minutes at target high intensity. - Recovery: 2 minutes active low-intensity treadmill walking. - Sets or repetitions: Repeated high/low intervals during a 20-minute main set. - Intensity: 70-80% exercise intensity using Karvonen target heart rate for high intervals; 30-40% for low-intensity periods. - Session duration: 30 minutes: 5-minute warm-up, 20-minute main exercise, 5-minute cool-down. - Frequency: 3 times per week. - Program length: 4 weeks. - Progression: Obstacle-crossing progressed by week from affected side/small obstacle to affected side/larger obstacle, non-affected side/random obstacle, then random side/random obstacle; speed adjusted to maintain heart-rate target. - High-intensity interval treadmill training. - Modality: Treadmill walking intervals without obstacle-crossing task component. - Work intervals: 2 minutes at target high intensity. - Recovery: 2 minutes active low-intensity treadmill walking. - Sets or repetitions: Repeated high/low intervals during a 20-minute main set. - Intensity: 70-80% exercise intensity using Karvonen target heart rate for high intervals; 30-40% for low-intensity periods. - Session duration: 30 minutes: 5-minute warm-up, 20-minute main exercise, 5-minute cool-down. - Frequency: 3 times per week. - Program length: 4 weeks. - Progression: Treadmill speed adjusted to maintain target heart rate; no obstacle-task progression. ## Outcomes ### TUG Status: improved Both groups improved over time, but between-group differences were not significant. Experimental group 14.76 +/- 2.75 s pre, 11.83 +/- 2.50 post, 10.99 +/- 2.53 follow-up; control 15.27 +/- 4.14, 13.14 +/- 3.51, 12.62 +/- 3.47. Time-by-group interaction P = .001; between-group P values .671, .219, .124. ### FGA Status: improved Experimental group improved more than control at post-test and follow-up. Experimental 23.65 +/- 2.71 pre, 26.41 +/- 1.73 post, 26.71 +/- 1.86 follow-up; control 22.88 +/- 3.22, 24.18 +/- 2.92, 24.24 +/- 3.03. Time-by-group interaction P < .001; between-group post P = .011 and follow-up P = .007. ### 10MWT Status: improved Experimental walking speed increased more than control and exceeded the cited 0.8 m/s community walking threshold after training. Experimental 0.72 +/- 0.06 m/s pre, 0.91 +/- 0.09 post, 0.87 +/- 0.08 follow-up; control 0.71 +/- 0.11, 0.80 +/- 0.11, 0.78 +/- 0.12. Time-by-group interaction P < .001; between-group post P = .002 and follow-up P = .011. ### 6MWT Status: improved Experimental walking endurance increased more than control. Experimental 276.71 +/- 25.86 m pre, 349.71 +/- 38.83 post, 352.94 +/- 40.39 follow-up; control 268.24 +/- 34.00, 317.94 +/- 39.17, 312.94 +/- 41.04. Time-by-group interaction P < .001; between-group post P = .024 and follow-up P = .007. ## Practical Insights - For clinical rehabilitation, HIIT can be implemented as prescribed heart-rate intervals rather than all-out work. - Task specificity matters: adding obstacle-crossing tasks to treadmill intervals improved gait measures more than treadmill intervals alone in this chronic stroke sample. - Clinical HIIT protocols need fall prevention, symptom stop rules, vital-sign monitoring pathways, and professional supervision. ## Limitations - Short intervention period. - Small sample size. - Actual community walking transfer was not closely evaluated. - Spatiotemporal gait variables were not measured. - Both groups also received NDT, so the isolated contribution of HIIT versus broader rehabilitation is limited. - Adverse-event outcomes were not explicitly reported. ## Safety And Adherence - Harness/suspension device, protective vest, safety bars, automatic treadmill stop, physical therapist supervision, and heart-rate monitoring were used. - Training was to be stopped immediately for breathing symptoms, chest pain, reported difficulty, pain elsewhere, or participant request. - Blood pressure, heart rate, respiration rate, and oxygen saturation were monitored when training stopped. - The article did not report actual adverse events or injuries. ## Original Sources - [PubMed](https://pubmed.ncbi.nlm.nih.gov/40988269/) (pubmed) - [DOI](https://doi.org/10.1097/MD.0000000000044444) (doi) - [PMC full text](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459590/) (full text) ## Agent Guidance Preserve the paper-level scope of this note. Do not generalize beyond the population, protocol, measured outcomes, and limitations above.