High-Intensity Walking May Help Improve Early Stroke Recovery

• In a new study, stroke survivors in a progressive-intensity walking rehabilitation program showed greater mobility and improved quality of life compared to usual care.
• The program was carried out in twelve stroke rehabilitation centers across Canada.
• The research demonstrates that therapists could successfully implement the protocol in a real-world setting.

Stroke rehabilitation has come a long way. Today there is a better understanding of the critical time period following a stroke.

The greatest benefits of rehabilitation typically occur during the first three months following a stroke when the brain is most likely to self-repair, a concept known as neuroplasticity.

Researchers have looked for ways to improve outcomes during this window and turned to the intensity of exercise as a key variable. Exercise, specifically walking, is an important part of stroke rehabilitation, but the intensity of walking is often quite low.

Studies have consistently shown that higher-intensity exercise during the critical window for stroke rehabilitation yields better outcomes, but exercise protocols still vary widely from clinic to clinic.

In a new study, a stroke rehabilitation program utilizing progressive-intensity walking improved outcomes for stroke survivors. What’s more, the study demonstrated this program could be successfully implemented in real-world rehabilitation clinics.

“We’ve known for a long time that greater physical therapy intensity can improve walking in people after they’ve had a stroke, and this is actually most effective early after stroke in the first couple months,” said study co-author Janice Eng, PhD, a stroke rehabilitation specialist and a professor in the department of physical therapy at the University of British Columbia, Canada.

“But for many, many reasons in healthcare, it’s been very difficult to change practice. We were able to change the practice of 12 units in the real world,” Eng told Healthline.

A barrier to stroke rehabilitation over the years has been the difficulty of implementing treatment protocol outside of a controlled environment in real-world settings like clinics.

Eng and her team used a protocol known as Walk ‘n Watch, which combines progressively higher-intensity walking exercises and wearable activity trackers to measure heart rate and step count. This program was implemented at 12 clinics across seven provinces in Canada.

Between 2020 and 2022, 306 participants, with an average age of 68, were enrolled approximately one month after a stroke. 162 received usual care (the control group), and 144 received the Walk ‘n Watch protocol.

The goal of Walk ‘n Watch was to get participants to achieve 2,000 steps while exercising at a moderate intensity for 30 minutes during physical therapy sessions, five days a week.

The trial utilized a standard mobility measurement known as a six-minute walk test: the distance an individual can walk in six minutes. At baseline, the average distance participants could walk was 498 feet — about the distance of two city blocks.

Four weeks later, at discharge, patients who underwent the new protocol were able to walk 143 feet farther than those who received usual care on the six-minute walk test. They also reported significantly improved quality of life measures and improvements in balance, mobility, and gait speed.

“This showed that we could improve the walking outcomes after four weeks of inpatient therapy, and we also were able to show improved quality of life. And this lasted at least a year,” said Eng.

Paul George, MD, PhD, associate professor of neurology and neurological sciences at Stanford Medicine who wasn’t affiliated with the study, told Healthline that the research is promising.

“It starts to answer the question of what the optimal rehabilitation is for folks following a stroke and gives us some evidence, perhaps, how to do that better,” George said.

Stroke outcomes and rehabilitation have improved significantly over the past decades. However, disseminating current best practices and ensuring doctors and therapists are using up-to-date methods is still a significant roadblock.

“I think there’s a lot of good practice out there, but there’s not a ton of evidence saying this should be done or that should be done now,” said George.

Eng and her team demonstrated that stroke rehabilitation protocols can be successfully implemented in real-world settings. They did this by combining efforts to train frontline therapists, including workshops, videos, manuals, and hands-on practice.

Additionally, each site had a designated “protocol champion” to facilitate weekly meetings about the protocol.

“The innovative part about this trial was putting it into a real-world setting. We trained all the frontline physical therapists and some physical therapy assistants at the front end, and we tried to put in processes so that they could continue the protocol without us intervening,” said Eng.

“This is about getting these protocols into practice, so patients today can receive them,” she added.

Stroke rehabilitation using progressive intensity walking exercise showed improvements to walking and quality of life in stroke survivors after four weeks.

The protocol, known as Walk ‘n Watch, was successfully implemented at 12 real-world rehabilitation clinics across Canada.

Although improvements have been made to stroke rehabilitation over the years, transmitting those best practices to clinics is a significant barrier.

The study authors say the strength of the study is not just in its effects on stroke survivors but the fact that the program can be successfully implemented at clinics where it matters most.