Heart Rate Intensity and Gait Speed for Persons with Stroke with Severe Balance Impairment

BackgroundCurrent practice guidelines recommend 70-85% age-predicted heart rate (HR) max attainment and high walking dosages for ambulatory persons with chronic stroke. The evidence to support target heart rate attainment and walking dosage on gait speed for persons post stroke with severe balance impairments has been limited during inpatient rehabilitation.ObjectivesTo examine the relationship between 70% HR max attainment, walking distance (≥304.8 meters), and minimum detectable changes (MDC) in gait speed for persons post stroke who have severe balance impairment on admission to inpatient rehabilitation.MethodsRetrospective observational cohort study examining 70% HR max heart rate attainment during locomotor training for 244 persons post stroke with severe balance impairment (BERG Balance Scale ≤ 6/56) during inpatient rehabilitation and its association with the minimum detectable change (MDC) for the 10-meter walk test (10 MWT).Results164/244 persons post stroke achieved 70% HR max and this was significantly associated with MDC in gait speed (odds ratio 2.64, CI: 1.41-5.08). Preserved sitting balance (BERG Balance Scale 4-6/56) on admission was positively associated with meaningful gait speed changes (odds ratio 1.36, CI: 1.15-1.64). Walking distance was not positively associated with gait speed.ConclusionTwo-thirds of persons post stroke with severe balance impairment on admission to inpatient rehabilitation were able to achieve target heart rate. When this heart rate is achieved, meaningful changes in gait speed are likely to occur. Additionally, persons post stroke with preserved sitting balance are more likely to achieve meaningful improvements in gait speed.