Exercise the Mind and Brain. A Multimodal Intervention in Stroke

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.

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.

Eligibility Criteria:
Inclusion Criteria:

* Individuals aged 18-80 years old
* Ischemic or hemorrhagic stroke
* Stroke diagnoses between 3-60 months ago
* To have consent from a physician to engage in an exercise intervention
* Fluency in Catalan or Spanish (I.e., able to understand and speak)
* Accept to take part in the study and sign the informed consent according to the Declaration of Helsinki.

Exclusion Criteria:

* Cognitive impairment (MMSE \> 23)
* Severe aphasia (item 9 of the NIHSS scale ≥ 2)
* Severe sensory problems
* Other neurological conditions apart from stroke
* Severe pre-stroke psychiatric disorders (e.g., bipolar disorder, schizophrenia)
* History of alcohol or other toxic abuse

Exclusion criteria only for MRI examination:

* Claustrophobia
* Medical device (e.g., pacemaker implants, stents)
* Other metal objects in the body