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 along with cardiometabolic comorbidities such as obesity and hypertension, which increase the risks of recurrent events and lower 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 is still uncertain. 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