Physical therapy clinical trial to further study vigorous exercise and walking improvements in chronic stroke patients

It was 3 o’clock in the morning when Larry Christian awoke to sudden pain in his left hand and arm. He didn’t think much of it and managed to fall back asleep. The next day, he got up, and his wife noticed he was bouncing off the walls. 

“I couldn’t keep my balance at all. My wife said, ‘There’s something wrong with you,’ and obviously there was,” he said.

An MRI determined the 67-year-old from Wilmington suffered a hemorrhagic stroke. He was referred to the University of Delaware’s Physical Therapy Clinic for rehabilitation. 

“Initially, I had a lot of balance problems that we worked pretty intensely to correct,” Christian said. 

He enrolled in a clinical trial at UD, led by co-investigator Darcy Reisman, professor and chair of the Department of Physical Therapy, that sought to explore whether high-intensity interval training (HIIT) aids in improved gait post-stroke. UD was one of three sites selected for the clinical trial led by primary investigator and associate professor Pierce Boyne of the University of Cincinnati. Sandra Billinger, professor and vice chair of stroke translation research at the University of Kansas Medical Center, is also a co-investigator and represents the third site involved in the clinical trial. 

Now, seven years later, Christian is walking better. 

“Participating in this study got me to a point where I could walk better and even take a walk outside,” Christian said. “I’ve been pretty healthy all my life, and while I can’t play volleyball anymore, walking again made me feel great.”

Christian is among the lucky ones. Among 7 million stroke survivors in the U.S., fewer than 10% have adequate walking speed and endurance to complete normal daily activities like grocery shopping. 

Reisman said the results of the multi-million-dollar, five-year clinical trial showed HIIT helped more people than just Christian. The results, published in JAMA Neurology, show that chronic stroke survivors who engaged in high-intensity exercise with bursts of maximum-speed walking alternated with recovery periods saw a significant difference in their walking capacity over 12 weeks. The improvements were so dramatic Boyne and Reisman have secured a clinical trial grant renewal for more than $3.4 million from the National Institutes of Health (NIH) to triple the size of their study to 165 participants. 

“We need a larger sample because the more people you sample, the more closely the results represent the population,” Reisman said.