- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00891514
Trial of Aerobic Exercise Training in Stroke Survivors
Aging, Inflammation and Exercise in Chronic Stroke
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Many stroke survivors are sedentary and are at risk for the development of diabetes. We will study the interactions of adipose tissue and the paretic and non-paretic muscle inflammation, insulin signaling and action in hemiparetic stroke patients and the ability to employ exercise training to reverse these abnormalities in this ethnically diverse population. Participants aged 40-75 years with chronic stroke will be randomized to treadmill training versus stretch control group using a one-two-one blocked randomization on race (black vs. white), sex (male vs. female), and glucose tolerance status (normal vs. impaired and type 2 diabetes).
Stroke occurs in over 780,000 persons each year in the U.S., the vast majority reported in persons older than 55 years of age. Following stroke, patients remain at continued high risk for recurrent stroke. Inflammatory processes lead to cardiovascular events/stroke and contribute to disease risk progression by impacting insulin resistance and the development of type 2 diabetes. Interventions that reduce inflammation and improve insulin sensitivity have important clinical implications, especially in the stroke population.
Task-oriented treadmill training is utilized to improve cardiovascular fitness and functional mobility in hemiparetic stroke patients. Additionally, preliminary data indicates that progressive treadmill training in this population improves glucose tolerance.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Maryland
-
Baltimore, Maryland, United States, 20705
- University of Maryland, VAMC
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Ischemic or hemorrhagic stroke greater than or equal to 6 months prior with stable residual hemiparetic gait deficits
- Already completed all conventional inpatient and outpatient physical therapy
- Adequate language and neurocognitive function to safely participate in exercise testing and training
- Men or women ages 40-75 years
- Body mass index between 20 to 50 kg/m2
- Non-smoker, or history of no smoking for more than 5 years
- Under the care of a primary care medical provider
Exclusion Criteria:
- Already performing aerobic exercise 3 times a week
- Increased alcohol consumption defined as greater than 2 oz. liquor or 8 oz. of wine or 24 oz. of beer per day
Cardiac history of:
- unstable angina
- recent (less than 3 months prior to study entry) myocardial infarction, congestive heart failure
- hemodynamically significant valvular dysfunction
Medical History:
- recent hospitalization (less than 3 months prior to study entry) for severe medical disease
- peripheral arterial disease with vascular claudication
- orthopedic or chronic pain condition restricting exercise
- pulmonary or renal failure
- active cancer
- untreated poorly controlled hypertension measured on at least 2 occasions (greater than 160/100)
- type I diabetes mellitus, insulin therapy, untreated and/or poorly controlled diabetes with fasting blood glucose of greater than 160
- smoking within the last 5 years
- allergy to lidocaine
- medications: heparin, warfarin, lovenox, beta-blockers, oral steroids
Neurological history of:
- dementia with Mini-Mental Status Score less than 23 (less than 17 if education level at or below 8th grade), and diagnostic confirmation by neurologist or psychiatrist
- severe receptive or global aphasia which confounds testing and training, operationally defined as unable to follow 2 point commands
- hemiparetic gait from a prior stroke preceding the index stroke defining eligibility (more than one stroke)
- neurologic disorder restricting exercise, such as Parkinsons Syndrome or myopathy
- untreated major depression
Adipose tissue and muscle biopsy exclusion criteria:
- anti-coagulation therapy with heparin, warfarin, or lovenox (anti-platelet therapy is permitted)
- bleeding disorder
- allergy to lidocaine
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Aerobic Exercise
Treadmill training
|
Treadmill training- begins at 15 minutes total duration at 40-50% maximal heart rate reserve 3 times per week, increasing to 60-70% maximal heart rate reserve for 45-60 minutes for 6 months
|
Active Comparator: Stretch Control
Stretching exercises
|
Stretching, balance exercises, and components of conventional physical therapy-- begins at 15 minutes and progresses to 45 minutes for 6 months
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
VO2peak
Time Frame: Baseline and 6 months
|
maximal oxygen consumption during a treadmill test
|
Baseline and 6 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Whole body insulin sensitivity
Time Frame: Baseline and 6 months
|
glucose utilization during a glucose clamp
|
Baseline and 6 months
|
Cytokines
Time Frame: Baseline and 6 months
|
circulating TNF alpha levels
|
Baseline and 6 months
|
Body fat
Time Frame: Baseline and 6 months
|
whole body percent fat
|
Baseline and 6 months
|
Muscle mass
Time Frame: Baseline and 6 months
|
whole body lean mass
|
Baseline and 6 months
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Alice S. Ryan, PhD, University of Maryland, VA Research Service
- Principal Investigator: Charlene Hafer-Macko, MD, University of Maryland, VA Research Service, Department of Neurology
Publications and helpful links
General Publications
- Ivey FM, Ryan AS, Hafer-Macko CE, Goldberg AP, Macko RF. Treadmill aerobic training improves glucose tolerance and indices of insulin sensitivity in disabled stroke survivors: a preliminary report. Stroke. 2007 Oct;38(10):2752-8. doi: 10.1161/STROKEAHA.107.490391. Epub 2007 Aug 16.
- Ryan AS, Novitskaya M, Treuth AL. Predictive Equations Overestimate Resting Metabolic Rate in Survivors of Chronic Stroke. Arch Phys Med Rehabil. 2022 Jul;103(7):1352-1359. doi: 10.1016/j.apmr.2022.01.155. Epub 2022 Feb 19.
- Ryan AS, Dobrovolny CL, Smith GV, Silver KH, Macko RF. Hemiparetic muscle atrophy and increased intramuscular fat in stroke patients. Arch Phys Med Rehabil. 2002 Dec;83(12):1703-7. doi: 10.1053/apmr.2002.36399.
- Hafer-Macko CE, Yu S, Ryan AS, Ivey FM, Macko RF. Elevated tumor necrosis factor-alpha in skeletal muscle after stroke. Stroke. 2005 Sep;36(9):2021-3. doi: 10.1161/01.STR.0000177878.33559.fe. Epub 2005 Aug 18.
- Serra MC, Balraj E, DiSanzo BL, Ivey FM, Hafer-Macko CE, Treuth MS, Ryan AS. Validating accelerometry as a measure of physical activity and energy expenditure in chronic stroke. Top Stroke Rehabil. 2017 Jan;24(1):18-23. doi: 10.1080/10749357.2016.1183866. Epub 2016 Jun 20.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- AG0118
- R01AG030075 (U.S. NIH Grant/Contract)
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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