Eccentric Versus Concentric Resistance Training to Enhance Neuromuscular Activation and Walking Speed Following Stroke

Background. Impaired voluntary neuromuscular activation of agonist muscles is a primary determinant of weakness and motor dysfunction following stroke. Objective. To determine whether eccentric resistance training (ECC) resistance training is superior to concentric resistance training (CON) resistance training to enhance neuromuscular activation, strength, and walking speed after stroke. Methods. A total of 34 adults poststroke participated in a staged intervention comprising (1) either CON-only or ECC-only resistance training of the paretic leg followed by (2) gait training. Changes in voluntary neuromuscular activation and power were assessed for both the trained paretic and untrained nonparetic legs. Self-selected and fast walking speeds were also assessed. Results. In response to resistance training, the ECC group experienced larger improvements in neuromuscular activation of paretic leg muscles, rectus femoris and vastus medialis (P < .005), and the largest gains in paretic leg power (+74% for ECC contractions, P < .0001). ECC also had greater cross-education of increased power to the untrained nonparetic leg (12%-14%, P = .006). Over the course of gait training, much of the gain in paretic leg activation in the ECC group was lost, such that the net change in agonist activation was comparable between the CON and ECC groups when the full intervention was completed. Nevertheless, improvement in walking speed postintervention was more prevalent in the ECC than CON group. Conclusion. ECC resistance training was more effective for improving bilateral neuromuscular activation, strength, and walking speed following stroke. Future research should assess whether a longer duration ECC training program can provide further benefit.