Clinician Article

Walking training with cueing of cadence improves walking speed and stride length after stroke more than walking training alone: a systematic review.

  • Nascimento LR
  • de Oliveira CQ
  • Ada L
  • Michaelsen SM
  • Teixeira-Salmela LF
J Physiother. 2015 Jan;61(1):10-5. doi: 10.1016/j.jphys.2014.11.015. Epub 2014 Dec 17. (Review)
PMID: 25529836
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  • Physical Medicine and Rehabilitation
    Relevance - 6/7
    Newsworthiness - 6/7
  • Neurology
    Relevance - 5/7
    Newsworthiness - 5/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 5/7
    Newsworthiness - 3/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 5/7
    Newsworthiness - 3/7


QUESTION: After stroke, is walking training with cueing of cadence superior to walking training alone in improving walking speed, stride length, cadence and symmetry?

DESIGN: Systematic review with meta-analysis of randomised or controlled trials.

PARTICIPANTS: Adults who have had a stroke.

INTERVENTION: Walking training with cueing of cadence.

OUTCOME MEASURES: Four walking outcomes were of interest: walking speed, stride length, cadence and symmetry.

RESULTS: This review included seven trials involving 211 participants. Because one trial caused substantial statistical heterogeneity, meta-analyses were conducted with and without this trial. Walking training with cueing of cadence improved walking speed by 0.23 m/s (95% CI 0.18 to 0.27, I(2)=0%), stride length by 0.21 m (95% CI 0.14 to 0.28, I(2)=18%), cadence by 19 steps/minute (95% CI 14 to 23, I(2)=40%), and symmetry by 15% (95% CI 3 to 26, random effects) more than walking training alone.

CONCLUSIONS: This review provides evidence that walking training with cueing of cadence improves walking speed and stride length more than walking training alone. It may also produce benefits in terms of cadence and symmetry of walking. The evidence appears strong enough to recommend the addition of 30 minutes of cueing of cadence to walking training, four times a week for 4 weeks, in order to improve walking in moderately disabled individuals with stroke.


Clinical Comments

Family Medicine (FM)/General Practice (GP)

Humans are creatures of habit and regularity. This meta-analysis supports the hypothesis that cuing with cadence can improve walking and stride length in post-stroke patients. It's not surprising given what we know about the human brain, but nice to know a low tech intervention can make a big difference in stroke rehab.

General Internal Medicine-Primary Care(US)

As a primary care internist, I do not find this article useful. I can see that it would useful for neurology or PMR.


This is a well-conducted, well-reported systematic review investigating the effects of cueing using a metronome or other rhythmic stimulus on walking speed and other characteristics. It definitely helps, and our physio gyms should all now resound to martial music (or dance music) and patients should be encouraged to use iPods and earphones to walk faster (it would also reduce cognitive-motor interference!). A few more large scale studies involving patients with other conditions would be good; there is no reason to think that this is unique to stroke.

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