Background: Decreased physical activity levels are an increasing concern, specifically for the aging population. Older adults (>65 years) are able to achieve health benefits from participating in a regular exercise program based on studies done in younger community-dwelling older adults. However, there is less research investigating the efficacy of exercise for improving physical function among the older adult population in assisted living settings. Barriers among the research that has been done so far include generalizability, specificity and varying exercise prescription details. The present study investigated the novel idea of using a treadmill with a harness system, to engage older adults in aerobic exercise. It is unknown if it is feasible to recruit and retain older adults in assisted living settings for such a treadmill study and if older adults would be able to achieve intensities associated with health benefits. Objectives: To determine the feasibility of recruitment and retention of older adults in an assisted living facility for a pilot treadmill walking study. Secondary objectives include: to identify determinants of participation and compliance with the treadmill study and to determine if the older adult population in assisted living settings are able to achieve exercise intensities aligned with established guidelines that are associated with health benefits. Design and Setting: Pilot, multi-visit feasibility study in an Assisted Living Facility in the Kitchener-Waterloo Region with care needs ranging from Retirement Home to Palliative Care Population: Older adults (>65y) living in an assistive living facility who could follow two-step commands and were able to walk two metres independently (with or without the use of an aid). Methods: The feasibility of recruitment and retention was determined by recording: the number of older adults who consented to participate in treadmill walking for three weeks; the number of older adults (and/or their legal representatives) who declined treadmill participation and reasons as to why; and the number of participants who completed the six treadmill sessions. Healthrelated and demographic characteristics were collected to characterize the population while age, number of co-morbidities, number of medications, cognition, fear of falling and walking ability were evaluated as potential determinants of participation. A detailed attendance log was used to assess compliance with the study. To determine if participants could achieve the recommended exercise intensity associated with health benefits, exercise intensity (40 %HRR) and duration (twenty minutes) achieved after the final treadmill session were reported. Results: Thirty percent of the residents on the eligibility list were recruited and consented to participate in the treadmill study. Average compliance was 94.4%±10.8%; one treadmill participant dropped out due to declining health. There are no significant differences between treadmill participants and those who chose not to walk on the treadmill. Treadmill participants were able to achieve the recommended intensity (40%HRR) and achieved an average intensity of 50.3% ± 30.2% and a frequency of three sessions in one week. Average total duration was approximately five minutes shy (14:53min ± 6:43min) of the recommendation of twenty minutes. Conclusion: The current study provides preliminary evidence that it is feasible to recruit and retain older adults in assisted living facilities to participate in a three week treadmill walking study, however it may be difficult to recruit a large number of individuals for a larger study. Treadmill participants were able to achieve ACSM’s recommended intensity and frequency for aerobic or endurance exercise. Secondly, the older adult population living in assisted settings may be able to achieve the recommended exercise prescription targets for cardiovascular training, specifically intensity and frequency; however they may need more than three weeks of progression or multiple sessions per day to obtain the recommended duration.

Background: Decreased physical activity levels are an increasing concern, specifically for the aging population. Older adults (>65 years) are able to achieve health benefits from participating in a regular exercise program based on studies done in younger community-dwelling older adults. However, there is less research investigating the efficacy of exercise for improving physical function among the older adult population in assisted living settings. Barriers among the research that has been done so far include generalizability, specificity and varying exercise prescription details. The present study investigated the novel idea of using a treadmill with a harness system, to engage older adults in aerobic exercise. It is unknown if it is feasible to recruit and retain older adults in assisted living settings for such a treadmill study and if older adults would be able to achieve intensities associated with health benefits. Objectives: To determine the feasibility of recruitment and retention of older adults in an assisted living facility for a pilot treadmill walking study. Secondary objectives include: to identify determinants of participation and compliance with the treadmill study and to determine if the older adult population in assisted living settings are able to achieve exercise intensities aligned with established guidelines that are associated with health benefits. Design and Setting: Pilot, multi-visit feasibility study in an Assisted Living Facility in the Kitchener-Waterloo Region with care needs ranging from Retirement Home to Palliative Care Population: Older adults (>65y) living in an assistive living facility who could follow two-step commands and were able to walk two metres independently (with or without the use of an aid). Methods: The feasibility of recruitment and retention was determined by recording: the number of older adults who consented to participate in treadmill walking for three weeks; the number of older adults (and/or their legal representatives) who declined treadmill participation and reasons as to why; and the number of participants who completed the six treadmill sessions. Healthrelated and demographic characteristics were collected to characterize the population while age, number of co-morbidities, number of medications, cognition, fear of falling and walking ability were evaluated as potential determinants of participation. A detailed attendance log was used to assess compliance with the study. To determine if participants could achieve the recommended exercise intensity associated with health benefits, exercise intensity (40 %HRR) and duration (twenty minutes) achieved after the final treadmill session were reported. Results: Thirty percent of the residents on the eligibility list were recruited and consented to participate in the treadmill study. Average compliance was 94.4%±10.8%; one treadmill participant dropped out due to declining health. There are no significant differences between treadmill participants and those who chose not to walk on the treadmill. Treadmill participants were able to achieve the recommended intensity (40%HRR) and achieved an average intensity of 50.3% ± 30.2% and a frequency of three sessions in one week. Average total duration was approximately five minutes shy (14:53min ± 6:43min) of the recommendation of twenty minutes. Conclusion: The current study provides preliminary evidence that it is feasible to recruit and retain older adults in assisted living facilities to participate in a three week treadmill walking study, however it may be difficult to recruit a large number of individuals for a larger study. Treadmill participants were able to achieve ACSM’s recommended intensity and frequency for aerobic or endurance exercise. Secondly, the older adult population living in assisted settings may be able to achieve the recommended exercise prescription targets for cardiovascular training, specifically intensity and frequency; however they may need more than three weeks of progression or multiple sessions per day to obtain the recommended duration.

Background: Decreased physical activity levels are an increasing concern, specifically for the aging population. Older adults (>65 years) are able to achieve health benefits from participating in a regular exercise program based on studies done in younger community-dwelling older adults. However, there is less research investigating the efficacy of exercise for improving physical function among the older adult population in assisted living settings. Barriers among the research that has been done so far include generalizability, specificity and varying exercise prescription details. The present study investigated the novel idea of using a treadmill with a harness system, to engage older adults in aerobic exercise. It is unknown if it is feasible to recruit and retain older adults in assisted living settings for such a treadmill study and if older adults would be able to achieve intensities associated with health benefits. Objectives: To determine the feasibility of recruitment and retention of older adults in an assisted living facility for a pilot treadmill walking study. Secondary objectives include: to identify determinants of participation and compliance with the treadmill study and to determine if the older adult population in assisted living settings are able to achieve exercise intensities aligned with established guidelines that are associated with health benefits. Design and Setting: Pilot, multi-visit feasibility study in an Assisted Living Facility in the Kitchener-Waterloo Region with care needs ranging from Retirement Home to Palliative Care Population: Older adults (>65y) living in an assistive living facility who could follow two-step commands and were able to walk two metres independently (with or without the use of an aid). Methods: The feasibility of recruitment and retention was determined by recording: the number of older adults who consented to participate in treadmill walking for three weeks; the number of older adults (and/or their legal representatives) who declined treadmill participation and reasons as to why; and the number of participants who completed the six treadmill sessions. Healthrelated and demographic characteristics were collected to characterize the population while age, number of co-morbidities, number of medications, cognition, fear of falling and walking ability were evaluated as potential determinants of participation. A detailed attendance log was used to assess compliance with the study. To determine if participants could achieve the recommended exercise intensity associated with health benefits, exercise intensity (40 %HRR) and duration (twenty minutes) achieved after the final treadmill session were reported. Results: Thirty percent of the residents on the eligibility list were recruited and consented to participate in the treadmill study. Average compliance was 94.4%±10.8%; one treadmill participant dropped out due to declining health. There are no significant differences between treadmill participants and those who chose not to walk on the treadmill. Treadmill participants were able to achieve the recommended intensity (40%HRR) and achieved an average intensity of 50.3% ± 30.2% and a frequency of three sessions in one week. Average total duration was approximately five minutes shy (14:53min ± 6:43min) of the recommendation of twenty minutes. Conclusion: The current study provides preliminary evidence that it is feasible to recruit and retain older adults in assisted living facilities to participate in a three week treadmill walking study, however it may be difficult to recruit a large number of individuals for a larger study. Treadmill participants were able to achieve ACSM’s recommended intensity and frequency for aerobic or endurance exercise. Secondly, the older adult population living in assisted settings may be able to achieve the recommended exercise prescription targets for cardiovascular training, specifically intensity and frequency; however they may need more than three weeks of progression or multiple sessions per day to obtain the recommended duration.

Background: Decreased physical activity levels are an increasing concern, specifically for the aging population. Older adults (>65 years) are able to achieve health benefits from participating in a regular exercise program based on studies done in younger community-dwelling older adults. However, there is less research investigating the efficacy of exercise for improving physical function among the older adult population in assisted living settings. Barriers among the research that has been done so far include generalizability, specificity and varying exercise prescription details. The present study investigated the novel idea of using a treadmill with a harness system, to engage older adults in aerobic exercise. It is unknown if it is feasible to recruit and retain older adults in assisted living settings for such a treadmill study and if older adults would be able to achieve intensities associated with health benefits. Objectives: To determine the feasibility of recruitment and retention of older adults in an assisted living facility for a pilot treadmill walking study. Secondary objectives include: to identify determinants of participation and compliance with the treadmill study and to determine if the older adult population in assisted living settings are able to achieve exercise intensities aligned with established guidelines that are associated with health benefits. Design and Setting: Pilot, multi-visit feasibility study in an Assisted Living Facility in the Kitchener-Waterloo Region with care needs ranging from Retirement Home to Palliative Care Population: Older adults (>65y) living in an assistive living facility who could follow two-step commands and were able to walk two metres independently (with or without the use of an aid). Methods: The feasibility of recruitment and retention was determined by recording: the number of older adults who consented to participate in treadmill walking for three weeks; the number of older adults (and/or their legal representatives) who declined treadmill participation and reasons as to why; and the number of participants who completed the six treadmill sessions. Healthrelated and demographic characteristics were collected to characterize the population while age, number of co-morbidities, number of medications, cognition, fear of falling and walking ability were evaluated as potential determinants of participation. A detailed attendance log was used to assess compliance with the study. To determine if participants could achieve the recommended exercise intensity associated with health benefits, exercise intensity (40 %HRR) and duration (twenty minutes) achieved after the final treadmill session were reported. Results: Thirty percent of the residents on the eligibility list were recruited and consented to participate in the treadmill study. Average compliance was 94.4%±10.8%; one treadmill participant dropped out due to declining health. There are no significant differences between treadmill participants and those who chose not to walk on the treadmill. Treadmill participants were able to achieve the recommended intensity (40%HRR) and achieved an average intensity of 50.3% ± 30.2% and a frequency of three sessions in one week. Average total duration was approximately five minutes shy (14:53min ± 6:43min) of the recommendation of twenty minutes. Conclusion: The current study provides preliminary evidence that it is feasible to recruit and retain older adults in assisted living facilities to participate in a three week treadmill walking study, however it may be difficult to recruit a large number of individuals for a larger study. Treadmill participants were able to achieve ACSM’s recommended intensity and frequency for aerobic or endurance exercise. Secondly, the older adult population living in assisted settings may be able to achieve the recommended exercise prescription targets for cardiovascular training, specifically intensity and frequency; however they may need more than three weeks of progression or multiple sessions per day to obtain the recommended duration.

The majority of people with stroke regard walking in their community as very important (Lord et al 2004). Walking in the community is limited by slow walking speeds and poor walking capacity (Lord et al 2004; Patterson et al 2007). Slow walking speeds and poor walking capacity are identified sequela in people with stroke (Hill et al 1997). By the end of rehabilitation approximately 80% of people with stroke achieve independent walking (Dean & Mackay 1992; Hill et al 1997). However, less than 10 percent are able to easily walk in their community (Hill et al 1997). Optimal motor learning requires task-specific practice (Carr & Shepherd 2003). Treadmills offer the opportunity for repetitive practice of complete gait cycles (Shepherd & Carr 1999), potentially providing greater intensity and longer duration walking practice than usual physiotherapy rehabilitation. Recently there has been some suggestion that high-intensity interventions may improve walking in people with stroke (Moseley et al 2005). Low levels of cardiorespiratory fitness in people with stroke have been shown to impact on walking, in particular walking capacity (Kelly et al 2003). Treadmills, commonly used to retrain cardiorespiratory fitness in the healthy population, have been used to implement high-intensity interventions, improving cardiorespiratory fitness in people with chronic stroke (Macko et al 2005). Therefore it is possible that exercise aimed at improving cardiorespiratory fitness may improve walking in people with stroke. The aim of these four studies was to investigate in those following stroke if walking on a treadmill at high-intensity during inpatient rehabilitation could improve walking capacity without compromising pattern and quality. The first study determined, in an Australian setting, the duration and intensity of usual physiotherapy rehabilitation. Study 2 compared walking pattern immediately following overground and treadmill walking practice at the same intensity. Study 3 examined the effect of treadmill walking at intensities high enough to influence cardiorespiratory fitness on walking pattern and quality. The final study, investigated the feasibility of implementing a high-intensity treadmill intervention in addition to usual physiotherapy rehabilitation in people following stroke able to walk undergoing inpatient rehabilitation. Intensity in all studies was calculated using heart rate reserve or the Karvonen method. Heart rate is a valid, accurate and stable indicator of exercise intensity due to its relatively linear relationship with oxygen consumption (ACSM 2006). For those people taking beta-blocker medication, the heart rate-lowering effect of this type of medication was accommodated. A target intensity of 40% heart rate reserve was used; as this is the minimum required improve cardiorespiratory fitness (ACSM 2006). Walking pattern and quality were measured in Studies 2-4. Walking pattern was measured by linear kinematics using GAITRite (CIR Systems, Clifton, NJ, USA) and angular kinematics using a 2-dimensional webcam application. Walking quality was determined by observation of the webcam footage and scored using the Rivermead Visual Gait Assessment, Wisconsin Gait Scale and a vertical visual analogue scale by blinded assessor. The first study found that people with stroke spent an average of 21 (SD 11) minutes participating in standing and walking activities that are associated with reaching the target intensity during physiotherapy rehabilitation. Those who could walk spent longer in these activities (25 minutes, SD 12) compared to those would couldn’t walk (17 minutes, SD 9). However, the intensity of these activities was low; walkers reached a maximum of 30% heart rate reserve and non-walkers reached 35% heart rate reserve. Using the treadmill as a mode of task-specific physiotherapy rehabilitation, the second study in this thesis found that walking pattern was similar following 10 minutes of treadmill and overground walking practice at the same intensity. The third study found that during walking on the treadmill at intensities high enough to influence cardiorespiratory fitness (up to 60% heart rate reserve), many of the linear and angular kinematic parameters moved closer to a more normal pattern and walking quality was not compromised. The final study in this thesis, a randomised controlled trial, found that a 6-week high-intensity treadmill walking intervention was feasible in people with stroke able to walk who were undergoing rehabilitation. Participants attended 89% of the treadmill sessions, reaching an average duration of more than 20 minutes and an intensity of 40% heart rate reserve after two weeks. The intervention also appeared effective with significant improvements in walking speed and capacity following the treadmill walking intervention. Improvements in walking speed were maintained at 3 months. In summary, these studies found that usual physiotherapy in people with stroke was of low intensity. In addition, it was found that treadmill walking was safe and feasible as a means of increasing the intensity of physiotherapy rehabilitation, without compromising walking quality and pattern. Therefore, it may be possible to improve walking in people with stroke using high-intensity treadmill walking.

The majority of people with stroke regard walking in their community as very important (Lord et al 2004). Walking in the community is limited by slow walking speeds and poor walking capacity (Lord et al 2004; Patterson et al 2007). Slow walking speeds and poor walking capacity are identified sequela in people with stroke (Hill et al 1997). By the end of rehabilitation approximately 80% of people with stroke achieve independent walking (Dean & Mackay 1992; Hill et al 1997). However, less than 10 percent are able to easily walk in their community (Hill et al 1997). Optimal motor learning requires task-specific practice (Carr & Shepherd 2003). Treadmills offer the opportunity for repetitive practice of complete gait cycles (Shepherd & Carr 1999), potentially providing greater intensity and longer duration walking practice than usual physiotherapy rehabilitation. Recently there has been some suggestion that high-intensity interventions may improve walking in people with stroke (Moseley et al 2005). Low levels of cardiorespiratory fitness in people with stroke have been shown to impact on walking, in particular walking capacity (Kelly et al 2003). Treadmills, commonly used to retrain cardiorespiratory fitness in the healthy population, have been used to implement high-intensity interventions, improving cardiorespiratory fitness in people with chronic stroke (Macko et al 2005). Therefore it is possible that exercise aimed at improving cardiorespiratory fitness may improve walking in people with stroke. The aim of these four studies was to investigate in those following stroke if walking on a treadmill at high-intensity during inpatient rehabilitation could improve walking capacity without compromising pattern and quality. The first study determined, in an Australian setting, the duration and intensity of usual physiotherapy rehabilitation. Study 2 compared walking pattern immediately following overground and treadmill walking practice at the same intensity. Study 3 examined the effect of treadmill walking at intensities high enough to influence cardiorespiratory fitness on walking pattern and quality. The final study, investigated the feasibility of implementing a high-intensity treadmill intervention in addition to usual physiotherapy rehabilitation in people following stroke able to walk undergoing inpatient rehabilitation. Intensity in all studies was calculated using heart rate reserve or the Karvonen method. Heart rate is a valid, accurate and stable indicator of exercise intensity due to its relatively linear relationship with oxygen consumption (ACSM 2006). For those people taking beta-blocker medication, the heart rate-lowering effect of this type of medication was accommodated. A target intensity of 40% heart rate reserve was used; as this is the minimum required improve cardiorespiratory fitness (ACSM 2006). Walking pattern and quality were measured in Studies 2-4. Walking pattern was measured by linear kinematics using GAITRite (CIR Systems, Clifton, NJ, USA) and angular kinematics using a 2-dimensional webcam application. Walking quality was determined by observation of the webcam footage and scored using the Rivermead Visual Gait Assessment, Wisconsin Gait Scale and a vertical visual analogue scale by blinded assessor. The first study found that people with stroke spent an average of 21 (SD 11) minutes participating in standing and walking activities that are associated with reaching the target intensity during physiotherapy rehabilitation. Those who could walk spent longer in these activities (25 minutes, SD 12) compared to those would couldn’t walk (17 minutes, SD 9). However, the intensity of these activities was low; walkers reached a maximum of 30% heart rate reserve and non-walkers reached 35% heart rate reserve. Using the treadmill as a mode of task-specific physiotherapy rehabilitation, the second study in this thesis found that walking pattern was similar following 10 minutes of treadmill and overground walking practice at the same intensity. The third study found that during walking on the treadmill at intensities high enough to influence cardiorespiratory fitness (up to 60% heart rate reserve), many of the linear and angular kinematic parameters moved closer to a more normal pattern and walking quality was not compromised. The final study in this thesis, a randomised controlled trial, found that a 6-week high-intensity treadmill walking intervention was feasible in people with stroke able to walk who were undergoing rehabilitation. Participants attended 89% of the treadmill sessions, reaching an average duration of more than 20 minutes and an intensity of 40% heart rate reserve after two weeks. The intervention also appeared effective with significant improvements in walking speed and capacity following the treadmill walking intervention. Improvements in walking speed were maintained at 3 months. In summary, these studies found that usual physiotherapy in people with stroke was of low intensity. In addition, it was found that treadmill walking was safe and feasible as a means of increasing the intensity of physiotherapy rehabilitation, without compromising walking quality and pattern. Therefore, it may be possible to improve walking in people with stroke using high-intensity treadmill walking.

The majority of people with stroke regard walking in their community as very important (Lord et al 2004). Walking in the community is limited by slow walking speeds and poor walking capacity (Lord et al 2004; Patterson et al 2007). Slow walking speeds and poor walking capacity are identified sequela in people with stroke (Hill et al 1997). By the end of rehabilitation approximately 80% of people with stroke achieve independent walking (Dean & Mackay 1992; Hill et al 1997). However, less than 10 percent are able to easily walk in their community (Hill et al 1997). Optimal motor learning requires task-specific practice (Carr & Shepherd 2003). Treadmills offer the opportunity for repetitive practice of complete gait cycles (Shepherd & Carr 1999), potentially providing greater intensity and longer duration walking practice than usual physiotherapy rehabilitation. Recently there has been some suggestion that high-intensity interventions may improve walking in people with stroke (Moseley et al 2005). Low levels of cardiorespiratory fitness in people with stroke have been shown to impact on walking, in particular walking capacity (Kelly et al 2003). Treadmills, commonly used to retrain cardiorespiratory fitness in the healthy population, have been used to implement high-intensity interventions, improving cardiorespiratory fitness in people with chronic stroke (Macko et al 2005). Therefore it is possible that exercise aimed at improving cardiorespiratory fitness may improve walking in people with stroke. The aim of these four studies was to investigate in those following stroke if walking on a treadmill at high-intensity during inpatient rehabilitation could improve walking capacity without compromising pattern and quality. The first study determined, in an Australian setting, the duration and intensity of usual physiotherapy rehabilitation. Study 2 compared walking pattern immediately following overground and treadmill walking practice at the same intensity. Study 3 examined the effect of treadmill walking at intensities high enough to influence cardiorespiratory fitness on walking pattern and quality. The final study, investigated the feasibility of implementing a high-intensity treadmill intervention in addition to usual physiotherapy rehabilitation in people following stroke able to walk undergoing inpatient rehabilitation. Intensity in all studies was calculated using heart rate reserve or the Karvonen method. Heart rate is a valid, accurate and stable indicator of exercise intensity due to its relatively linear relationship with oxygen consumption (ACSM 2006). For those people taking beta-blocker medication, the heart rate-lowering effect of this type of medication was accommodated. A target intensity of 40% heart rate reserve was used; as this is the minimum required improve cardiorespiratory fitness (ACSM 2006). Walking pattern and quality were measured in Studies 2-4. Walking pattern was measured by linear kinematics using GAITRite (CIR Systems, Clifton, NJ, USA) and angular kinematics using a 2-dimensional webcam application. Walking quality was determined by observation of the webcam footage and scored using the Rivermead Visual Gait Assessment, Wisconsin Gait Scale and a vertical visual analogue scale by blinded assessor. The first study found that people with stroke spent an average of 21 (SD 11) minutes participating in standing and walking activities that are associated with reaching the target intensity during physiotherapy rehabilitation. Those who could walk spent longer in these activities (25 minutes, SD 12) compared to those would couldn’t walk (17 minutes, SD 9). However, the intensity of these activities was low; walkers reached a maximum of 30% heart rate reserve and non-walkers reached 35% heart rate reserve. Using the treadmill as a mode of task-specific physiotherapy rehabilitation, the second study in this thesis found that walking pattern was similar following 10 minutes of treadmill and overground walking practice at the same intensity. The third study found that during walking on the treadmill at intensities high enough to influence cardiorespiratory fitness (up to 60% heart rate reserve), many of the linear and angular kinematic parameters moved closer to a more normal pattern and walking quality was not compromised. The final study in this thesis, a randomised controlled trial, found that a 6-week high-intensity treadmill walking intervention was feasible in people with stroke able to walk who were undergoing rehabilitation. Participants attended 89% of the treadmill sessions, reaching an average duration of more than 20 minutes and an intensity of 40% heart rate reserve after two weeks. The intervention also appeared effective with significant improvements in walking speed and capacity following the treadmill walking intervention. Improvements in walking speed were maintained at 3 months. In summary, these studies found that usual physiotherapy in people with stroke was of low intensity. In addition, it was found that treadmill walking was safe and feasible as a means of increasing the intensity of physiotherapy rehabilitation, without compromising walking quality and pattern. Therefore, it may be possible to improve walking in people with stroke using high-intensity treadmill walking.

The majority of people with stroke regard walking in their community as very important (Lord et al 2004). Walking in the community is limited by slow walking speeds and poor walking capacity (Lord et al 2004; Patterson et al 2007). Slow walking speeds and poor walking capacity are identified sequela in people with stroke (Hill et al 1997). By the end of rehabilitation approximately 80% of people with stroke achieve independent walking (Dean & Mackay 1992; Hill et al 1997). However, less than 10 percent are able to easily walk in their community (Hill et al 1997). Optimal motor learning requires task-specific practice (Carr & Shepherd 2003). Treadmills offer the opportunity for repetitive practice of complete gait cycles (Shepherd & Carr 1999), potentially providing greater intensity and longer duration walking practice than usual physiotherapy rehabilitation. Recently there has been some suggestion that high-intensity interventions may improve walking in people with stroke (Moseley et al 2005). Low levels of cardiorespiratory fitness in people with stroke have been shown to impact on walking, in particular walking capacity (Kelly et al 2003). Treadmills, commonly used to retrain cardiorespiratory fitness in the healthy population, have been used to implement high-intensity interventions, improving cardiorespiratory fitness in people with chronic stroke (Macko et al 2005). Therefore it is possible that exercise aimed at improving cardiorespiratory fitness may improve walking in people with stroke. The aim of these four studies was to investigate in those following stroke if walking on a treadmill at high-intensity during inpatient rehabilitation could improve walking capacity without compromising pattern and quality. The first study determined, in an Australian setting, the duration and intensity of usual physiotherapy rehabilitation. Study 2 compared walking pattern immediately following overground and treadmill walking practice at the same intensity. Study 3 examined the effect of treadmill walking at intensities high enough to influence cardiorespiratory fitness on walking pattern and quality. The final study, investigated the feasibility of implementing a high-intensity treadmill intervention in addition to usual physiotherapy rehabilitation in people following stroke able to walk undergoing inpatient rehabilitation. Intensity in all studies was calculated using heart rate reserve or the Karvonen method. Heart rate is a valid, accurate and stable indicator of exercise intensity due to its relatively linear relationship with oxygen consumption (ACSM 2006). For those people taking beta-blocker medication, the heart rate-lowering effect of this type of medication was accommodated. A target intensity of 40% heart rate reserve was used; as this is the minimum required improve cardiorespiratory fitness (ACSM 2006). Walking pattern and quality were measured in Studies 2-4. Walking pattern was measured by linear kinematics using GAITRite (CIR Systems, Clifton, NJ, USA) and angular kinematics using a 2-dimensional webcam application. Walking quality was determined by observation of the webcam footage and scored using the Rivermead Visual Gait Assessment, Wisconsin Gait Scale and a vertical visual analogue scale by blinded assessor. The first study found that people with stroke spent an average of 21 (SD 11) minutes participating in standing and walking activities that are associated with reaching the target intensity during physiotherapy rehabilitation. Those who could walk spent longer in these activities (25 minutes, SD 12) compared to those would couldn’t walk (17 minutes, SD 9). However, the intensity of these activities was low; walkers reached a maximum of 30% heart rate reserve and non-walkers reached 35% heart rate reserve. Using the treadmill as a mode of task-specific physiotherapy rehabilitation, the second study in this thesis found that walking pattern was similar following 10 minutes of treadmill and overground walking practice at the same intensity. The third study found that during walking on the treadmill at intensities high enough to influence cardiorespiratory fitness (up to 60% heart rate reserve), many of the linear and angular kinematic parameters moved closer to a more normal pattern and walking quality was not compromised. The final study in this thesis, a randomised controlled trial, found that a 6-week high-intensity treadmill walking intervention was feasible in people with stroke able to walk who were undergoing rehabilitation. Participants attended 89% of the treadmill sessions, reaching an average duration of more than 20 minutes and an intensity of 40% heart rate reserve after two weeks. The intervention also appeared effective with significant improvements in walking speed and capacity following the treadmill walking intervention. Improvements in walking speed were maintained at 3 months. In summary, these studies found that usual physiotherapy in people with stroke was of low intensity. In addition, it was found that treadmill walking was safe and feasible as a means of increasing the intensity of physiotherapy rehabilitation, without compromising walking quality and pattern. Therefore, it may be possible to improve walking in people with stroke using high-intensity treadmill walking.

Thesis (M.Sc.). / Written for the Dept. of Kinesiology and Physical Education. Title from title page of PDF (viewed 2008/07/24). Includes bibliographical references.

Thesis (MS )--Montana State University--Bozeman, 2008. / Typescript. Chairperson, Graduate Committee: Daniel P. Heil. Includes bibliographical references (leaves 59-62).