Forced Aerobic Exercise for Stroke Rehabilitation
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      The purpose of the study is to determine if performing different types of aerobic exercise
      (cycling) before upper extremity exercises will help to improve outcomes after stroke.
    

Detailed description: 
      The goal of this study is to determine the potential for forced aerobic exercise to augment
      the recovery of motor function in individuals with stroke. Current approaches to stroke
      rehabilitation involve intensive, therapist-directed task practice that is both expensive and
      in some cases, ineffective in fostering functional neuromotor recovery. The identification of
      a safe, cost-effective approach, such as forced aerobic exercise, to augment the recovery of
      function achieved through task practice while simultaneously decreasing the cardiovascular
      risk factors prevalent in stroke survivors would be significant to rehabilitation and stroke
      communities.

      Animal studies along with preliminary human data indicate a specific type of aerobic exercise
      (AE), forced aerobic exercise (FE), may be ideal in facilitating motor recovery associated
      with repetitive task practice (RTP). The hypothesis is that that deficits in afferent input
      and motor cortical output following stroke prevents patients from achieving and maintaining
      an exercise intensity that is sufficient for facilitating motor recovery; therefore, FE is
      needed to augment their voluntary efforts and achieve greater gains in recovery. In previous
      research, a safe lower extremity FE intervention was initially applied to individuals with
      Parkinson's disease and subsequently to individuals with stroke. Preliminary results indicate
      that those completing an 8-week FE intervention paired with an abbreviated session of RTP
      exhibited significantly greater improvement in Fugl-Meyer scores at end of treatment despite
      completing 40% fewer RTP repetitions, compared to those receiving voluntary-rate aerobic
      exercise (VE) and RTP and time-matched RTP only. Improvements in cardiovascular fitness and
      lower extremity motor function were also evident in both groups that engaged in aerobic
      exercise (FE and VE). Positive results from a preliminary trial indicate safety, feasibility,
      and initial efficacy of combining two modes of aerobic exercise training with RTP provide
      rationale for a systematic and larger scale trial to determine the precise role of aerobic
      exercise, forced and voluntary, in facilitating motor recovery following stroke.

      For this study, 30 individuals with chronic stroke will be randomized into one of the
      following groups: FE = RTP, VE + RTP or patient education and RTP. All three groups will
      receive an identical dose of contact time over 8 weeks (3X per week). An intervention group
      receiving a 45-minute session of patient education paired with RTP will serve as the
      non-exercise control. Clinical and biomechanical outcomes measuring change in upper extremity
      motor function, lower extremity motor function, and cardiovascular fitness will provide the
      most complete picture, to date, on the potential neurologic effects of AE (forced and
      voluntary) on motor recovery and brain function in humans with stroke.
    

Intervention name(s): Forced Exercise & Upper Extremity Repetitive Task Practice; Voluntary Exercise & Upper Extremity Repetitive Task Practice; Stroke Education & Upper Extremity Repetitive Task Practice
Intervention type(s): Behavioral; Behavioral; Behavioral
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: stroke; aerobic exercise; forced exercise; repetitive task practice; arm function; upper extremity