Treadmill Exercise Activates Subcortical Neural Networks and Improves Walking After Stroke

Authors:
  • RMRichard F. Macko
    Richard F. Macko
  • LFLarry W. Forrester
    Larry W. Forrester
  • FVFederico Villagra
    Federico Villagra
  • FIFred Ivey
    Fred Ivey
  • JSJohn D. Sorkin
    John D. Sorkin
  • JWJill Whitall
    Jill Whitall
  • SMSandy McCombe-Waller
    Sandy McCombe-Waller
  • LKLeslie Katzel
    Leslie Katzel
  • AGAndrew P. Goldberg
    Andrew P. Goldberg
  • DHDaniel F. Hanley
    Daniel F. Hanley
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Abstract
Background and Purpose— Stroke often impairs gait thereby reducing mobility and fitness and promoting chronic disability. Gait is a complex sensorimotor function controlled by integrated cortical, subcortical, and spinal networks. The mechanisms of gait recovery after stroke are not well understood. This study examines the hypothesis that progressive task-repetitive treadmill exercise (T-EX) improves fitness and gait function in subjects with chronic hemiparetic stroke by inducing adaptations in the brain (plasticity). Methods— A randomized controlled trial determined the effects of 6-month T-EX (n=37) versus comparable duration stretching (CON, n=34) on walking, aerobic fitness and in a subset (n=15/17) on brain activation measured by functional MRI. Results— T-EX significantly improved treadmill-walking velocity by 51% and cardiovascular fitness by 18% (11% and −3% for CON, respectively; P P Conclusions— T-EX improves walking, fitness and recruits cerebellum-midbrain circuits, likely reflecting neural network plasticity. This neural recruitment is associated with better walking. These findings demonstrate the effectiveness of T-EX rehabilitation in promoting gait recovery of stroke survivors with long-term mobility impairment and provide evidence of neuroplastic mechanisms that could lead to further refinements in these paradigms to improve functional outcomes.

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