Sequenced hybrid electromechanically assisted and conventional gait training for concurrent optimization of weight management, blood pressure regulation, and functional mobility in chronic stroke survivors: A multicenter randomized controlled trial

Background Chronic stroke survivors often face ongoing mobility limitations alongside cardiometabolic comorbidities such as obesity and hypertension, which increases the risks of recurrent events leading to a lowered quality of life. Electromechanically assisted gait training (EAGT) offers high-intensity, repetitive practice, while conventional gait training (CGT) supports real-world functional transfer. The best sequence of these treatments to effectively address weight loss, blood pressure (BP) management, and gait improvement among chronic stroke survivors remains unknown. Objective To evaluate a sequenced hybrid protocol (initial EAGT followed by CGT) against EAGT alone or CGT alone in promoting concurrent improvements in body weight, BP, and gait parameters among chronic stroke survivors with overweight or obesity hypertension. Methods This multicenter randomized controlled trial recruited 140 participants (aged 45–78 years; over 6 months post-stroke; BMI of 25 kg/m² or higher; hypertension), stratified by stroke severity. The groups included; Hybrid (n = 48), EAGT-only (n = 46), and CGT-only (n = 46). The interventions lasted 12 weeks, consisting of 30 sessions. Outcomes were assessed at baseline, 6 weeks, 12 weeks, and at a 3-month follow-up. Results Hybrid sequencing resulted in greater weight loss (-4.3 ± 1.9 kg) and systolic BP reduction (-13.1 ± 5.8 mmHg) compared to EAGT-only (-2.9 ± 1.6 kg; -8.4 ± 5.1 mmHg) and CGT-only (-2.2 ± 1.5 kg; -7.5 ± 5.3 mmHg; p < 0.001). Gait speed and endurance improvements were similar across groups, with hybrid showing the best retention at follow-up. Conclusion Phased hybrid EAGT-CGT enhances cardiometabolic health and mobility, offering an innovative multifaceted rehabilitation approach.