Exercise and Brain Stimulation for Post-stroke Depression

Treating Depression and Enhancing Locomotor Recovery Post-stroke

This project will assess the effects of aerobic exercise training (AET), repetitive transcranial magnetic stimulation (rTMS) or their combination on depressive severity as well as locomotor function in persons with post-stroke depression (PSD). Both AET and rTMS are established stand-alone treatments for non-stroke related depression, though neither has been adequately studied post-stroke. Furthermore, substantive research indicates that AET improves post-stroke locomotor function, thus offering a novel approach for treating PSD as well as an established vehicle to study the effects of PSD on response to rehabilitation.

The purpose of this project is to determine the impact of AET, rTMS and their combination (AET+rTMS) treatments on post-stroke depressive symptoms and locomotor function so as to guide the development of a future clinical trial. A total of 40 depressed post-stroke subjects will be randomly assigned to one of four groups 1) AET; 2) rTMS; 3) combined AET and rTMS (AET+rTMS) or 4) control (sham rTMS) group (n=10 per condition; equally distributed with mild and moderate MDD). Further, an additional 10 non-depressed post-stroke subjects will complete 8 weeks of AET so as to allow us to determine the effects of PSD on response to training (Aim 2). Training (AET, rTMS and AET+rTMS) will take place over an 8-week period, three times per week on non-consecutive days. Measures of depression (HRSD17) as well as self-selected walking speed (SSWS) will be performed prior to the initial treatment session of each week as well as 8 weeks following cessation of treatment. Additional measures of locomotor function (walking endurance and amount of daily community stepping) will be assessed prior to training (pre), following 4 weeks of training (mid), upon completion of 8 weeks of training (post) as well as 8 weeks following cessation of training (follow-up), allowing determination of the efficacy (and persistence) of training on these outcomes.

Study Overview

• Status: Completed
• Conditions: Stroke
• Intervention / Treatment: Behavioral: Aerobic exercise; Other: Repetitive transcranial magnetic stimulation

• Study Type: Interventional
• Enrollment (Actual): 23
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • South Carolina
    • Charleston, South Carolina, United States, 29425
      • Medical University of South Carolina

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 50 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• 1) age 50-70
• 2) stroke within the past 6 to 60 months,
• 3) major depressive disorder (PHQ-9 > 10) and diagnosed using the Structured Clinical Interview for Depression (SCID) according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV),
• 4) residual paresis in the lower extremity (Fugl-Meyer LE motor score <34),
• 5) ability to walk without assistance and without an AFO on the treadmill ≥ 30 seconds at speeds ranging from 0.2-0.8 m/s,
• 6) no antidepressant medications or clinically able to discontinue medications,
• 7) HRSD question #9 regarding suicide <2,
• 8) provision of informed consent. In addition, all subjects who meet criteria for the training portion must complete an exercise tolerance test and be cleared for participation by the study cardiologist.

Exclusion Criteria:

1. Unable to ambulate at least 150 feet prior to stroke, or experienced intermittent claudication while walking;
2. history of congestive heart failure, unstable cardiac arrhythmias, hypertrophic cardiomyopathy, severe aortic stenosis, angina or dyspnea at rest or during ADL's;
3. History of oxygen dependence;
4. Preexisting neurological disorders, dementia or previous stroke;
5. History of major head trauma;
6. Legal blindness or severe visual impairment;
7. history of psychosis or other Axis I disorder that is primary;
8. Life expectancy <1 yr.;
9. Severe arthritis or other problems that limit passive range of motion;
10. History of DVT or pulmonary embolism within 6 months;
11. Uncontrolled diabetes with recent weight loss, diabetic coma, or frequent insulin reactions;
12. Severe hypertension with systolic >200 mmHg and diastolic >110 mmHg at rest;
13. attempt of suicide in the last 2 years or at suicidal risk assessed by SCID interview;
14. Previous or current enrollment in a clinical trial to enhance motor recovery; 15) currently exercising ≥ 2 times per week (≥20 minutes);

16) Presence of non-MR compatible implants, pregnancy or severe claustrophobia.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: Double

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Aerobic Exercise; Treadmill aerobic exercise	Behavioral: Aerobic exercise; treadmill aerobic exercise; 3 sessions per week, 40 minutes per session
Experimental: rTMS; repetitive transcranial magnetic stimulation	Other: Repetitive transcranial magnetic stimulation; Repeated non-invasive brain stimulation to the left dorsolateral prefrontal cortex.; Other Names: rTMS
Experimental: AET+rTMS; Combined aerobic exercise and rTMS	Behavioral: Aerobic exercise; treadmill aerobic exercise; 3 sessions per week, 40 minutes per session; Other: Repetitive transcranial magnetic stimulation; Repeated non-invasive brain stimulation to the left dorsolateral prefrontal cortex.; Other Names: rTMS
Sham Comparator: Sham; Sham rTMS	Other: Repetitive transcranial magnetic stimulation; Repeated non-invasive brain stimulation to the left dorsolateral prefrontal cortex.; Other Names: rTMS

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from baseline in Hamilton Rating Scale for Depression	Rating of depressive symptom severity	weekly throughout the 8 week intervention as well as at the 8 week follow-up visit

Secondary Outcome Measures

Outcome Measure	Time Frame
Change from baseline in Self-selected walking speed	weekly throughout the 8 week intervention as well as at the 8 week follow-up visit

Collaborators and Investigators

• Sponsor: Medical University of South Carolina
• Investigators: Principal Investigator: Chris M Gregory, PhD, Medical University of South Carolina

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2016
• Primary Completion (Actual): December 31, 2019
• Study Completion (Actual): December 31, 2019

Study Registration Dates

• First Submitted: February 8, 2017
• First Submitted That Met QC Criteria: February 14, 2017
• First Posted (Actual): February 17, 2017

Study Record Updates

• Last Update Posted (Actual): March 5, 2020
• Last Update Submitted That Met QC Criteria: March 3, 2020
• Last Verified: May 1, 2019

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Stroke
• Other Study ID Numbers: COBRE: EXD

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No