Treadmill Exercise Activates Subcortical Neural Networks and Improves Walking After Stroke

• DOI: 10.1161/strokeaha.108.527531
• Publication Date: 2008-08-29T01:50:13Z
• Authors: Andreas R. Luft; Richard F. Macko; Larry W. Forrester; Federico Villagra; Fred Ivey; John D. Sorkin; Jill Whitall; Sandy McCombe-Waller; Leslie Katzel; Andrew P. Goldberg; Daniel F. Hanley
• Keywords: Stroke; Treadmill; Aerobic Exercise; Gait training

Background and Purpose— Stroke often impairs gait thereby reducing mobility fitness promoting chronic disability. Gait is a complex sensorimotor function controlled by integrated cortical, subcortical, spinal networks. The mechanisms of recovery after stroke are not well understood. This study examines the hypothesis that progressive task-repetitive treadmill exercise (T-EX) improves in subjects with hemiparetic inducing adaptations brain (plasticity). Methods— A randomized trial determined effects 6-month T-EX (n=37) versus comparable duration stretching (CON, n=34) on walking, aerobic subset (n=15/17) activation measured functional MRI. Results— significantly improved treadmill-walking velocity 51% cardiovascular 18% (11% −3% for CON, respectively; P <0.05). but CON affected during paretic, nonparetic limb movement, showing 72% increased posterior cerebellar lobe midbrain ( <0.005). Exercise-mediated improvements walking correlated cerebellum midbrain. Conclusions— recruits cerebellum-midbrain circuits, likely reflecting neural network plasticity. recruitment associated better walking. These findings demonstrate effectiveness rehabilitation survivors long-term impairment provide evidence neuroplastic could lead to further refinements these paradigms improve outcomes.