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Background: Traditional models of rehabilitation following stroke include an emphasis on normalizing gait kinematics. Emerging evidence is leading to a movement to shift the focus of gait training following stroke to monitor dose of activity and the impact of high intensity, task-specific training to facilitate greater gains in locomotor function. Purpose: The purpose of this case report is to describe the implementation of high intensity gait training (HIGT) with a focus on variable stepping in the sub-acute rehabilitation setting and to identify the obstacles with achieving target heart rate zones in delivery of intensity-based interventions. Case Description: The patient was a 52-year-old male with right ischemic middle cerebral artery stroke due to right internal carotid artery dissection resulting in left-sided hemiparesis, sensory impairment, and left inattention. His recovery was complicated by a hemorrhagic conversion. The patient transferred to a subacute rehabilitation facility for continued focused therapies. Intervention: Gait training sessions included over ground (OG), treadmill (TM), and stair climbing training utilizing heart rate monitoring and rating of perceived exertion (RPE). Outcome Measures: The 6-Minute Walk Test (6MWT) and 10-Meter Walk Test (10MWT) were used as primary outcome measures and 5-Times Sit-Stand (5xSTS) was used as a secondary measure of function. Continuous heart rate monitoring and RPE Borg scale were used to monitor intensity during sessions. Discussion: This patient demonstrated lower than anticipated heart rate measurements during focused therapies. Barriers existed in collection of reliable RPE measures due to the right sided nature of his stroke and residual cognitive impairments. Despite this, his treatment sessions were successful in providing variable stepping activities and he demonstrated improvement in 6MWT following the 4-week treatment period.