injury. The comprehensive Copen-
hagen Stroke Study reported that
neurological recovery and functional
recovery reach a plateau within 6 to
20 weeks after the occurrence of the
lesion.
7
This report might imply that
once motor function has reached a
plateau, no further changes can oc-
cur unless there is a massive change
in the level of activity. This notion is
consistent with the fact that all par-
ticipants in the present study
showed the same amounts of im-
provements in physical parameters
irrespective of age or time since in-
jury. Consequently, it seems likely
that this kind of intervention will
have an effect on most people who
have had a stroke.
Because all participants were in the
chronic stage at the beginning of the
intervention and because there was a
substantial difference in the amounts
of physical training that they re-
ceived before the intervention,
(ranging from 0 to 7 hours per
week), the previous rehabilitative
training did not relate to aerobic ca-
pacity at the beginning of the inter-
vention or to improvements after the
intervention. These findings indicate
that an individual’s potential for im-
provement is not related to a prior
intervention. Most of the partici-
pants reported that training received
before the intervention did not in-
volve sweating or being out of
breath because it was less intense
than the intervention. Training inten-
sity seems to play a crucial role in an
individual reaching full potential for
functional recovery. Another impor-
tant aspect is the magnitude of the
total training volume over the course
of a training week. In addition, the
elements of the training protocol are
factors that determine outcome.
Time-Wise Progression of
Improvements
The time course for treadmill speed
improvements revealed a gradual de-
crease in the rate at which speed
increased during the intervention.
Therefore, speed was still increasing
during the final weeks of the inter-
vention, albeit to a lesser extent than
during the initial weeks. These find-
ings indicate that longer training pe-
riods of high-intensity BWSTT, PRST,
and AE may lead to further improve-
ments in physiological capacity. The
other intervention elements also
showed this tendency. Most of the
initial progression appeared to be at-
tributable to gradual adaptation to
the exercises and determination of
the appropriate level of intensity.
Later, when the rate of progression
decreased, further progression likely
was attributable to real physiological
changes.
The walking speed on the 6MWT
increased approximately linearly
throughout the intervention, indicat-
ing that if the duration of the inter-
vention had been longer, then there
might have been further
improvement.
Because there is good evidence in
the literature for speed-dependent
BWSTT, 2 of the 3 sessions in the
present study were speed depen-
dent. In one session, the goal was to
reach the highest speed possible; in
the other session, the goal was qual-
ity of movement rather than speed,
so the speed was to be slightly above
the most recent 6MWT speed. Dur-
ing the entire intervention, partici-
pants maintained a treadmill speed
that was substantially higher than
the 6MWT speed; therefore, the
6MWT speed could serve as a param-
eter for setting the treadmill speed in
BWSTT sessions.
It was possible to combine the inter-
ventions and sustain a high level of
intensity for a 12-week period with-
out any negative side effects. All par-
ticipants but 1 were motivated dur-
ing the entire intervention and were
able to endure the intensity.
A limitation of the present study was
the lack of a control group. How-
ever, as previously shown,
7
func-
tional and neurological performance
reaches a steady state within the first
6 months after injury. Because the
average time since injury was more
than 2 years in the present study, it is
highly unlikely that the observed
gains in ambulation and cardiovascu-
lar health could be ascribed to a nat-
ural course of recovery. However,
the results of the present study
should be tested in a future random-
ized controlled trial.
Conclusion
A high dose of intensive physical
training for participants with stroke
in the chronic stage (a combination
of BWSTT, PRST, and AE 5 times per
week for 1.5 hours per session for 12
weeks) increased walking speed on
the 6MWT by 62%, regardless of
chronicity, age, or level of function-
ing. Weekly testing of the walking
speed revealed an almost linear pro-
gression during the entire interven-
tion, indicating that an undetected
and dormant plateau of recovery af-
ter stroke was reached for this group
of participants. Further studies
should investigate the duration of in-
tervention needed to reach the full
potential of recovery of gait.
All authors provided concept/idea/research
design. Mr Jørgensen, Mr Bech-Pedersen, Mr
Zeeman, Dr Andersen, and Dr Scho
̈nberger
provided writing. Mr Jørgensen, Mr Bech-
Pedersen, Mr Zeeman, and Mrs Sørensen
provided data collection. Dr