Use of an Elliptical Machine for Improving Functional Walking Capacity in Individuals With Chronic Stroke: A Case Series

Background and Purpose: Decreased functional walking capacity is a common consequence of stroke. Identifying practical and cost-effective methods to improve walking in individuals with stroke is an important goal of rehabilitation professionals. Participants: Participants were 3 men with chronic (>6 month) stroke, who could walk on level surfaces either without an assistive device or with a single-point cane. Intervention: Participants trained 2 to 3 times per week for 8 weeks, using an elliptical machine. The training target was 20 minutes of uninterrupted training, while maintaining predetermined parameters of heart rate and perceived exertion. Outcomes: Outcome measures assessed before and after training included habitual and fast gait speed, 6-minute walk test (6MWT), Timed "Up & Go" test, and Berg Balance Scale. Following training there was no change in walking speed. There was no change in 6MWT performance for participants 1 and 2. While participant 3 showed a 25% improvement in 6MWT, this change did not meet the minimal detectable change for walking speed in individuals with stroke. All participants demonstrated improved Berg Balance Scale performance (9%-28%), with participant 1 exceeding the minimal detectable change in this measure. Timed Up & Go test performance improved by 5% to 15% in all participants. Discussion: Elliptical training appears to be a safe and feasible training alternative for ambulatory individuals with chronic stroke. Training 2 to 3 days per week resulted in no improvements in walking speed; however, participants did demonstrate variable improvements in endurance, balance, and functional mobility. It is possible that a higher training frequency and/or training speed are required to influence walking performance in individuals who are ambulatory. Equipment design, principles of exercise prescription, and participant characteristics should be considered when selecting elliptical training as an intervention.