Participants were excluded if they had: an unstable cardiac status precluding them from participation in a treadmill training program (ie, permission not granted by their medical practitioner); or had severe
cognitive and/or language deficits (aphasia) precluding them from participation Cytoskeletal Signaling inhibitor in the training sessions (ie, unable to follow two-step commands). Participants were divided into two subgroups according to baseline comfortable walking speed (> 0.4 m/s and ≤ 0.4 m/s), measured during a 10-m walk test. This cut-off was decided prior to analysis.7 The experimental group received training based on a previous treadmill walking program.9 Thirty minutes of walking was carried out three times a week for 16 weeks. Given that participants could already walk, treadmill training was conducted without Selleckchem GPCR Compound Library any body-weight support. It was structured to increase step length, speed, workload, and automaticity. Overground walking was practised each session to reinforce the gains achieved during treadmill training. Overground walking initially comprised 20% of the intervention time and was progressively increased each week so that it comprised 50% of the 30-minute intervention time. Overground walking was defined as a whole-task practice involving propulsion forwards, backwards, sideways
or up and down stairs. Guidelines were used to outline the progression of treadmill
and overground walking training. Oxygenase The control group received no intervention. The primary outcome was walking, which was quantified by measuring the distance walked (in m) during a six-minute walk test. The instructions for the test were standardised according to Lipkin and colleagues.10 Participants were instructed to cover as much ground as possible in six minutes. They were told to walk as continuously as possible, but they could slow down or stop if necessary. No encouragement was given, but the investigator informed participants at the halfway point (three minutes) and when there was one minute remaining. Participants wore shoes and used aids if necessary. Walking was also quantified by measuring speed (in m/s) during a 10-m walk test. Participants were timed while walking independently at their comfortable and fast speeds over the middle 10-m of a 15-m track (to allow for acceleration and deceleration). Health status was measured using the EuroQol EQ-5D-3L, which is a standardised instrument providing a single value for health status. The EQ-5D-3L records self-rated health on a vertical, 100-mm visual analogue scale where the endpoints are labelled ‘best imaginable health state’ and ‘worst imaginable health state’. In the main AMBULATE Trial,6 all outcomes were analysed using an intention-to-treat analysis.