Heart attack patients are usually urged to exercise to regain function, but "stroke patients are typically told to learn to live with their disabilities," said Andreas Luft, lead author of a randomized study that found that treadmill exercise improved mobility and cardiovascular health even years after a stroke. The improved mobility appears to result from a "rewiring" of the brain during exercise.
Researchers recruited 71 patients with stroke-induced hemiparetic gait disturbance lasting an average of four years; 27 could walk without an assistive device. Half participated in a six-month supervised program of treadmill walking that progressed to 40-minute sessions three times weekly, increasing in time and intensity every two weeks. A control group engaged in six months of supervised stretching exercises. All participants' treadmill walking speed and aerobic fitness were measured at baseline and at three and six months. Sixteen patients from each group also underwent functional magnetic resonance imaging (fMRI) at the beginning and end of the study period to assess exercise-induced changes in brain activation.
Walking speed increased by 51% in the treadmill group and by 11% in the control group. During a 10-meter walk, about the distance covered while doing household activities, the treadmill group's speed was twice that of the control group. Aerobic fitness increased by 18% in the treadmill group, but fell slightly in the control group. The fMRI revealed increased brain activity in the posterior lobe of the cerebellum and midbrain in the treadmill group, but no change in the posterior cerebellum and decreased activity in the midbrain in the control group. The results indicate that treadmill walking "activates networks in the cerebellum and midbrain and cortical areas that potentially mediate the improvements [horizontal ellipsis] elicited by treadmill training," the authors wrote.
Treadmill therapy should be part of stroke rehabilitation programs, Luft told AJN. "Nevertheless, more research is needed to investigate how walking leads to greater mobility and how treadmill benefits can be maintained once structured training has ended." He cautioned that because high-intensity treadmill walking was required to produce the benefits, patients should be supervised.
Carol Potera
NewsCAP
Nuts, seeds, corn, and popcorn are safe for men with diverticulitis, say Strate and colleagues in the August 27 issue of JAMA. Patients with diverticular disease have been told to avoid these foods because they were thought to damage the colon and cause inflammation or bleeding, but little evidence has supported this advice. Eighteen years of data collected from 47,228 men participating in the Health Professionals Follow-Up Study were evaluated for associations between new diverticular complications and consumption of particular foods. Men who ate nuts at least twice a week had a 20% lower risk of diverticulitis than men who ate them less than once a month. Men who ate the most popcorn had a 28% lower risk of diverticulitis than men who ate the least. Corn consumption had no effect on development of diverticulitis.