Exercise the Mind and Brain. A Multimodal Intervention in Stroke
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      The main objective of MindFit Project is to develop an evidence-based multimodal
      investigation of combined non-pharmacological strategies in chronic stroke patients and
      clarify the neuroplasticity mechanisms underlying the benefits of physical exercise and
      mindfulness strategies combined with cognitive training on post-stroke recovery. The
      investigators have adopted a multidisciplinary and multimodal approach to provide a more
      integrative perspective using cognitive, social-psychological, biochemical, and neuroimaging
      measurements.
    

Detailed description: 
      The MindFit Project is a multicentric, prospective, parallel, single-blinded, randomized
      controlled trial with a sample of 141 participants at 3 to 60 months after stroke.
      Participants are randomly allocated to one of three arms (through a simple randomizing
      procedure with a 1:1:1 ratio created with a random sequence generator software).

      The first group (n=47) receives computer-based cognitive training (CCT) combined with a
      multicomponent physical exercise program. The second group (n=47) receives CCT combined with
      mindfulness-based stress reduction therapy. Finally, the third group (n=47), as an active
      control group, receives only CCT. All interventions last 12 weeks.

      Within two weeks before the start of the interventions, and again at 3 months after
      completing the interventions, medical, cognitive, and physical assessments, neuroimaging, and
      biological samples collection are performed.

      The objectives of this project are:

        1. To examine the effects of multimodal interventions in a population of chronic stroke
           patients on various domains: cognition, emotion, physical health, and quality of life.

        2. To examine specific plasticity effects of each of the three interventions regarding
           structural and functional magnetic resonance imaging (MRI) and how these changes may
           contribute to cognitive and emotional benefits.

        3. To study the molecular mechanisms by which the different types of interventions
           influence cognitive, emotional and brain benefits.

        4. To study interventions-induced microbiome changes and to explain how these changes may
           induce inflammatory and immune responses that may contribute to cognitive, emotional and
           brain benefits.

        5. To determine the demographic, clinical and genetic factors that may modulate cognitive,
           emotional and brain changes: baseline cognitive status; baseline cerebral status
           (atrophy, total intracranial volume); sex; age, educational level, intelligence.
    

Intervention name(s): Multicomponent Physical Activity Program; Mindfulness-Based Stress Reduction Program; Computerized Cognitive Training
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): The proposed physical exercise intervention follows the American College of Sports Medicine (ACSM, 2017) and the American Stroke Association (Billinger et al., 2014) recommendations for stroke patients. The five weekly 45-minute sessions are divided into (1) three sessions guided and supervised telematically by a physical exercise specialist and a physiotherapist; (2) and two autonomous exercise sessions. The supervised sessions include exercises to work aerobic capacity, muscle strength and endurance, flexibility, agility, and balance. The intensity of these exercises is prescribed individually according to each participant's initial level and are gradually increased as the program progresses. Participants are encouraged to walk at a similar intensity on autonomous physical exercise days as performed in the guided sessions (moderate intensity), based on the Borg scale of perceived exertion (Borg, 1982).; This intervention follows an adaptation of the scheme and instructions of the official Mindfulness-Based Stress Reduction (MBSR) program designed by Jon Kabat-Zinn. It includes body scanning, sitting meditation, and gentle hatha yoga techniques. An accredited mindfulness instructor leads the 12-week online program, which comprises a presentation session, followed by eight intervention sessions (once a week, lasting 2.5 hours) and an intensive practice session interspersed between sessions six and seven. Apart from the supervised session, the therapist asks participants to carry out some independent practice daily.; An accredited neuropsychologist programs and supervises the computerized cognitive training through the Guttmann Neuropersonal Trainer (GNPT®) platform. The 12-week program consists of five sessions a week (45 minutes each) that include personalized activities planned to stimulate executive functioning, attention, processing speed, and memory.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: 141 participants at 3 to 60 months after stroke are randomly allocated to one of three arms: The first group (n=47) receives computer-based cognitive training (CCT) combined with a multicomponent physical exercise program. The second group (n=47) receives CCT combined with mindfulness-based stress reduction therapy. Finally, the third group (n=47), as an active control group, receives only CCT.
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Neuroplasticity; stroke; neuroprotection; physical exercise; cognitive training; mindfulness; neuroimaging; intervention; randomization; blind