PMID 42011378

Research
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The combined effect of task-oriented treadmill and high-intensity interval training on balance, gait parameters, and ADL in patients with chronic stroke: A randomized controlled trial with short-term follow-up

Kim K, Jung NJ, Kang MB

Question

Does task-oriented treadmill training combined with HIIT improve balance, spatiotemporal gait parameters, and activities of daily living more than HIIT treadmill training alone in patients with chronic stroke?

Summary

In a 4-week assessor-blinded randomized trial of 30 inpatient adults with chronic stroke, task-oriented treadmill HIIT using obstacle crossing was compared with high-intensity interval treadmill training alone. Both groups trained 30 minutes per session, 3 times per week, and both improved over time. The task-oriented HIIT group showed greater improvements for several gait and balance measures and showed a stronger 2-week transfer effect, although between-group differences were not significant for cadence and modified Barthel Index at post-test.

Methodology

  • Chronic stroke patients in an inpatient rehabilitation ward, able to walk at least 10 m, gait speed less than 0.8 m/s, and MMSE at least 24.
  • 30 participants.
  • Treadmill walking with obstacle-crossing tasks and body-weight support harness.
  • Work intervals: 2 minutes at 70%-80% HRR.
  • Recovery: 2 minutes active recovery at 30%-40% HRR.
  • Intensity: Target HRR calculated by Karvonen formula with real-time HR-guided treadmill speed titration.
  • 30 minutes including 5-minute warm-up, 20-minute main set, and 5-minute cool-down.
  • 3 sessions/week.
  • 4 weeks.
  • Parallel-group assessor-blinded randomized controlled trial with 1:1 allocation and 2-week follow-up.
  • Step length, Stride length, Cadence, and Double limb support and single limb support were tracked.

Outcomes

Gait parameters

Significant time x group interactions occurred for step length, stride length, cadence, double limb support, and single support; task-oriented HIIT showed greater post-test and follow-up advantages for most gait variables.

Time x group p<.05 for all gait parameters; partial eta2 examples: step length .601, stride length .797, cadence .536, double limb .589, single support .645.

Improved

Static balance

task-oriented HIIT improved COP 95% area, COP path length, and COP average velocity more than HIIT alone.

Time x group partial eta2: COP 95% area .804, COP path length .613, COP average velocity .153; p<.05.

Improved

Modified Barthel Index

MBI improved over time and showed a significant time x group interaction, but post-test between-group difference was not significant after correction; follow-up favored task-oriented HIIT.

Time x group partial eta2=.510, p<.05; post-test between-group p=.027 not significant under p<.025 correction; follow-up p=.016 significant.

Mixed

Completion and dropout

Thirty participants completed the study after 6 withdrawals from 36 selected/randomized participants.

task-oriented HIIT n=15 and HIIT n=15 completed; 3 withdrawals per group.

Mixed

Insights

  • For rehabilitation transfer, pairing HIIT with task-specific gait challenges may be more useful than intensity-focused treadmill intervals alone.
  • A 30-minute session using 5-minute warm-up, 20-minute 2:2 intervals, and 5-minute cool-down is a reproducible clinical structure.
  • Obstacle/task progression can be treated as a programming variable separate from intensity.
  • Translation to consumer HIIT is limited because the intervention required harnessed treadmill walking, therapist supervision, and clinical screening.

Limitations

  • Small sample size.
  • Sample size assumptions may have been optimistic.
  • Homogeneous selected sample with walking speed <0.8 m/s, FAC >=3, and MMSE-K >=24.
  • Short 4-week intervention.
  • Only 2-week follow-up.
  • No long-term sustainability data.
  • Participants and therapists could not be blinded.
  • Achieved HRR, RPE, attendance percentage, and adverse event counts were not reported.

Safety

  • No adverse event count was reported in the paper.
  • One task-oriented HIIT participant withdrew because of other medical problems.
  • Protocol required immediate stopping for shortness of breath, chest pain, muscle discomfort, or other distress.
  • Vital signs were to be monitored after distress, and training withheld until attending physician clearance.