OBJECTIVE: To evaluate the effectiveness of a treadmill and overground walking program in reducing the disability and handicap associated with poor walking performance after stroke. DESIGN: Randomised, placebo-controlled clinical trial with a 3-month follow-up. SETTING: General community. PARTICIPANTS: A volunteer sample of 29 ambulatory individuals (less 2 dropouts) who were living in the community after having suffered a stroke more than 6 months previously. INTERVENTIONS: The experimental group participated in a 30-minute treadmill and overground walking program, 3 times a week for 4 weeks. The control group received a placebo consisting of a low-intensity, home exercise program and regular telephone contact. MAIN OUTCOME MEASURES: Walking speed (over 10 m), walking capacity (distance over 6 min), and handicap (stroke-adapted 30-item version of the Sickness Impact Profile) measured by blinded assessors. RESULTS: The 4-week treadmill and overground walking program significantly increased walking speed (p = 0.02) and walking capacity (p < 0.001), but did not decrease handicap (p = 0.85) compared with the placebo program. These gains were largely maintained 3 months after the cessation of training (p < 0.05). CONCLUSIONS: The treadmill and overground walking program was effective in improving walking in persons residing in the community after stroke. This suggests that the routine provision of accessible, long-term, community-based walking programs would be beneficial in reducing disability after stroke.

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