While fitness may be its most popular use, treadmills are making headlines in stroke therapy treatment and other rehabilitation treatment protocols. From the fitness point of view, studies have shown that people get more out of a treadmill than other fitness equipment because it is natural to walk or run, and users are more apt to stick with it for longer each session and keep using the equipment itself. This article will take a look at a few recent studies using treadmills in the rehabilitation niche, as well as at some of the latest treadmill products on the market today.

TREADMILL EXERCISE FOR STROKE VICTIMS

According to recent research at Johns Hopkins University School of Medicine, Baltimore, people who walk on a treadmill can significantly improve their health and mobility-changes that reflect actual "rewiring" of their brains-even years after having a stroke.

The study's results, published in Stroke, the journal of the American Heart Association, suggest that patients' brains may retain the capacity to rewire through a treadmill exercise program months or years after conventional physical therapy has ended.¹

For this study, investigators combined efforts to recruit 71 patients who had a stroke at least 6 months earlier, with an average time lapse of nearly 4 years. At the study's onset, half of the subjects could walk without assistance, while the rest used a cane, a walker, or a wheelchair.

All of the subjects, separated into two random groups regardless of disability, were tested for mobility and aerobic capacity (also known as VO₂ peak), a measure of cardiac fitness. Thirty-two patients drawn equally from both groups underwent functional magnetic resonance imaging (fMRI) to assess brain activity linked to moving their legs in a walking motion.

One group then participated in an exercise program that principally involved walking on a treadmill three times per week for up to 40 minutes, assisted by a supporting sling and tether if needed. PTs assigned to each subject increased the intensity of the workouts over time by increasing the treadmills' speed and incline, though the workouts never taxed the patients beyond a moderate level of 60% VO₂ peak.

With the second group of patients, therapists assisted the patients in performing stretching exercises for the same period of time.

After 6 months, patients were again tested for walking speed and VO₂ peak, and the same group who had undergone fMRI was rescanned. Walking speed for the treadmill group increased 51%, compared to about 11% faster for those in the stretching group. Ground walking speed among the treadmill exercisers increased 19%, compared to about 8% for the stretchers. The treadmill exercisers also were significantly more fit at study completion, with VO₂ peak increasing by about 18%. VO₂ peak decreased slightly in the stretching group.

Hoping to find evidence that improved brain activity was responsible for the results, the investigators analyzed the brain scans and found markedly increased metabolic activity in brain stem areas associated with walking among all the treadmill exercisers. Brain scans of patients in the stretching group showed no such changes.

Those patients with the most improvement in walking showed the strongest change in brain activity, though the researchers don't yet know whether these brain changes were caused by more walking or whether participants walked better because brain activity in these key areas increased. This question will be the focus of a future study.

TREADMILL TRAINING FOR DOWN SYNDROME PATIENTS

PTs recently found that treadmills can help infants with Down syndrome learn how to walk months earlier than traditional therapies. The study was published in the October issue of Physical Therapy, the journal of the American Physical Therapy Association.²

Parents of 30 babies with Down syndrome were asked to help their children walk on the treadmills for 8 minutes per day, 5 days per week. They sat on a bench, which straddled the machine, and held their babies as the treadmill belt encouraged them to take steps.

The study found that the exercise helped the babies learn to walk up to 4 or 5 months earlier than traditional physical therapy alone. More intensive training helped the babies to walk even sooner. Getting them walking sooner can help improve their social skills, motor skills, perception, and spatial cognition, according to study author Dale Ulrich of the University of Michigan's Division of Kinesiology, Ann Arbor.

"The key is if we can get them to walk earlier and better, then they can explore their environment earlier. And when you start to explore, you learn about the world around you," Ulrich says. "Walking is a critical factor in development in every other domain."

ON THE MARKET

Treadmills are an essential piece of equipment in physical therapy practices. While not all facilities treat patients with neurological conditions, the use of treadmills for the average weekend warrior patient is widespread. Here are a few listings of the current treadmills on the market today used by PTs in various types of facilities.

Biodex Medical Systems (www.biodex.com)

Biodex Medical Systems, Shirley, NY, offers the RTM 400 and RTM 600 treadmills, which can be used for exercise with acute postoperative, neurologic, pediatric, cardiopulmonary, respiratory, orthopedic/ sports medicine, and older adult patients in need of strengthening and aerobic conditioning.

Both the RTM 400's and RTM 600's features include Speed Range-always starts at 0 mph with 0.1 mph speed increments (0 to 10 mph range); Reverse Belt Direction-from 0 to 3 mph, which promotes knee extension, ankle dorsiflexion, and eccentric hamstring control, and allows for up to a 15% decline; Exact-Track Belt, which eliminates belt shift and tracking problems, even for patients with uneven gait; and a low profile-a 7-inch step-up height that provides easy patient transfer and therapist interaction.

Landice (www.landice.com)

Landice, Randolph, NJ, rehabilitation and wellness treadmills offer versatile solutions for rehabilitative, medical, and sports conditioning therapy. The treadmills can be used from treating the most acute neurological or postoperative conditions, to training world-class athletes. User options include reversing belt direction for downhill, retro walking, a handheld remote stop-start switch, AccuTrack contact heart rate monitoring, an orthopedic tread belt, and an accessory/reading rack.

Life Fitness (www.lifefitness.com)

Life Fitness, Schiller Park, Ill, offers the new 95T treadmill, which is offered with three new consoles: the Engage™, Inspire™, and Achieve™, with entertainment and motivational features. The consoles feature various entertainment and motivational features such as LCD touch screens, iPod® integration, and USB connectivity to track and store workout data. The new 95T offers a large running surface of 22 inches by 60 inches, and a new Activity Zone that places the most used controls at the user's fingertips.

Med-Fit Systems Inc (www.medfitsystems.com)

Med-Fit Systems Inc, Fallbrook, Calif, offers the PS100 treadmill with key rehabilitation and senior use features such as 1/10 mph start speed; 6.25-inch step up height; a backlit LCD monitor; extended safety rails; an emergency stop lanyard; contact and telemetric heart rate measurement; and speed, incline, elapsed time, distance, pace, heart rate, time remaining, calories, and target heart rate measurement.

Woodway (www.woodway.com)

Woodway treadmills feature an internationally patented design that features a low-friction ball-bearing transportation system and a slat style running surface. According to the company, its patented rubberized slat design has been medically proven to absorb shock at the point of impact, allowing for natural gait patterns and proper biomechanics.

Treadmill options include The BariMill, an ideal machine for patients requiring walking support. The medical- grade, fully adjustable handrails are infinitely customizable in width and height to provide an optimal comfort level.

Michelle Park is a contributing writer for Physical Therapy Products. For more information, contact .

REFERENCES

1. Luft AR, Macko RF, Forrester LW, et al. Treadmill exercise activates subcortical neural networks and improves walking after stroke. A randomized controlled trial. Stroke. 2008:Aug 28. [ePub ahead of print]
2. Ulrich DA, Lloyd MC, Tiernan CW, Looper JE, Angulo-Barroso RM. Effects of intensity of treadmill training on developmental outcomes and stepping in infants with Down syndrome: a randomized trial. Phys Ther. 2008;88(1):114–22.