Duration of Lokomat Training Effects
The effects of Lokomat (robotic-assisted locomotor) training typically begin to diminish within 3 weeks after training cessation, with most benefits potentially lost after 6 months if regular physical activity is not maintained. 1
Evidence on Duration of Effects
The available evidence suggests that the duration of Lokomat training effects follows a pattern similar to other exercise interventions:
In chronic heart failure patients, training effects from a 3-week residential program were lost after only 3 weeks of activity restriction, suggesting that continued activity is necessary to maintain benefits 1
A study examining exercise training in heart failure patients found that when trained patients decreased their habitual physical activity (similar to non-exercising controls), there was no sustained benefit 6 months after termination of training 1
For stroke patients, treadmill training with partial body weight support (similar to Lokomat) shows improvements in walking capacity, but these improvements require ongoing training to maintain 1
Factors Affecting Duration of Effects
The persistence of Lokomat training effects depends on several key factors:
Initial functional capacity: Patients with higher initial walking capacity tend to show more significant improvements in speed and functional mobility than those with lower initial capacity 2
Muscle strength: Maximum voluntary ankle torque (both plantar- and dorsi-flexion) can predict whether a patient will benefit from Lokomat training and potentially maintain those benefits 2
Continued physical activity: Without ongoing physical activity, the benefits of Lokomat training diminish significantly over time 1
Response Patterns to Lokomat Training
Research shows two distinct response patterns to Lokomat training:
High responders: Patients with initially higher walking capacity show significant improvements in speed (0.033 m/s/week) and functional mobility (-0.41 s/week in timed tests) 2
Low responders: Patients with initially low walking capacity may show minimal or no significant improvement 2, 3
Clinical Implications
For optimal maintenance of Lokomat training effects:
Regular follow-up: Schedule periodic assessments to monitor for decline in function after training cessation
Home exercise program: Implement a structured home program immediately following completion of Lokomat training
Continued activity: Encourage patients to remain physically active indefinitely to maintain gains 1
Periodic "booster" sessions: Consider scheduling periodic Lokomat sessions to refresh training effects if decline is observed
Pitfalls and Caveats
Assuming all patients will respond similarly to Lokomat training can lead to inappropriate treatment planning; response is non-uniform across patients 2, 4
Failing to assess baseline muscle strength (particularly at the ankle) may result in providing Lokomat training to patients unlikely to benefit 2
Discontinuing all physical activity after Lokomat training will likely result in rapid loss of gained benefits 1
Overestimating the duration of effects may lead to inadequate follow-up and monitoring
In summary, while Lokomat training can provide significant benefits for appropriate patients, these effects begin to diminish relatively quickly (within weeks) without continued physical activity and may be largely lost by 6 months post-training.