- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03614585
Exercise Intensity Matters in Stroke Rehabilitation
Exercise Intensity Matters: An Opportunity to Promote Neurorecovery and Cardiovascular Health in Stroke
Study Overview
Status
Conditions
Detailed Description
Background: Stroke is a major health issue in Canada, with 405,000 Canadians currently living with stroke. Exercise is an important component of stroke rehabilitation that can result in improved function and health. Traditionally, exercise rehabilitation programs for stroke employ moderate-intensity continuous training (MICT) protocols that are typically sustained for 20-30 minutes. The continuous nature of this form of training however, even at moderate intensities, is challenging for many individuals with stroke to sustain due to neuromotor impairments and poor exercise capacity. High-intensity exercise, when delivered in short interval bursts (i.e. high-intensity interval training, HIIT), may be a feasible alternative that allows higher intensities to be achieved during exercise. This is important because intensity of training is the critical factor in promoting changes in neuroplasticity and cardiovascular health, the two most important aspects of recovery and secondary prevention after stroke. Interventions implemented earlier following stroke are generally viewed to yield greater benefits, but high intensity exercise may also promote neuroplasticity and optimize cardiovascular health in later stages of recovery. Furthermore, determining if HIIT is viewed to be motivating and enjoyable for individuals post-stroke can provide insight into the sustainability of this intervention.
Objective: To compare the effects of 12 weeks of HIIT and MICT on neuroplasticity, cardiovascular health and psychosocial predictors of physical activity in individuals with chronic stroke.
Design: Participants will be recruited from two research sites and randomly allocated into HIIT or MICT. Participants will be assessed before and after the training period, and at an 8-week follow-up.
Outcomes: 1) The investigators will assess: Neuroplasticity: by measuring markers of corticospinal excitability at rest and in response to a non-invasive brain stimulation protocol applied over the primary motor cortex (M1); 2) Cardiovascular health: by measuring cardiorespiratory fitness, resting blood pressure, arterial stiffness, and waist-hip ratio; 3) Psychosocial predictors of physical activity: by measuring exercise motivation and enjoyment.
Methods: Neuroplasticity: motor evoked potentials amplitude, intracortical facilitation and short-intracortical inhibition on the lesioned and unlesioned upper limb M1 area at rest and in response to continuous theta-burst will be measured with transcranial magnetic stimulation; Cardiovascular health: cardiorespiratory fitness will be measured with a graded exercise test, resting blood pressure with an automated blood pressure monitor and arterial stiffness using applanation tonometry. Exercise motivation and enjoyment will be assessed with the Physical Activity Enjoyment Scale and the Behavioral Regulation Exercise Questionnaire-3, respectively.
Expected results: Both HIIT and MICT will result in improvements in outcomes of neuroplasticity and cardiovascular health. However, improvements with HIIT will be greater and will last longer. Participants will rate HIIT as enjoyable as MICT, and motivation for exercise will increase similarly after both interventions.
Impact: HIIT is a promising, time-efficient, and potentially more effective alternative to traditional MICT protocols that could offer an opportunity for greater improvement in motor recovery and cardiovascular health in people living with stroke.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Marc Roig, PhD
- Phone Number: 00841 514-398-4400
- Email: marc.roigpull@mcgill.ca
Study Contact Backup
- Name: Ada Tang, PhD
- Phone Number: 27818 905-525-9140
- Email: atang@mcmaster.ca
Study Locations
-
-
Ontario
-
Hamilton, Ontario, Canada, L8L 2X2
- Recruiting
- Ontario Central South Stroke Network
-
Contact:
- Ada Tang, PhD
- Phone Number: 27818 905-525-9140
- Email: atang@mcmaster.ca
-
Contact:
- Jennifer Crozier, MSc
- Email: croziej@mcmaster.ca
-
-
Quebec
-
Laval, Quebec, Canada, H7V 1R2
- Recruiting
- Jewish Rehabiliation Hospital
-
Contact:
- Marc Roig, PhD
- Phone Number: 4677 450-688-9550
- Email: marc.roigpull@mcgill.ca
-
Contact:
- Jean-Francois Nepveu, MSc
- Phone Number: 4217 450-688-9550
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- 6-60 months following first-ever, single stroke confirmed by MRI/CT
- Living in the community and able to independently walk at least 10 meters (assistive devices permitted, as this is representative of many people who regain some walking ability following stroke but commonly with some adaptation)
- Montreal Cognitive Assessment score >20 (individuals with this score are capable to follow exercise instructions)
Exclusion Criteria:
- Significant disability as determined by modified Rankin scale score <2
- Stroke of non-cardiogenic origin or tumor
- Actively engaged in stroke rehabilitation services or a structured exercise program besides the one provided in the study
- Class C or D American Heart Association Risk Criteria
- Other neurological or musculoskeletal co-morbidities that preclude exercise participation
- Pain which is worsened with exercise
- Cognitive, communication, or behavioral issues that would limit safe exercise participation
- Contraindications to transcranial magnetic stimulation.
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: High-intensity interval training
Intensity will be determined using a combination of heart rate reserve (HRR, calculated as HRR= [max HR - resting HR] x [% training] + [resting HR]) and ratings of perceived exertion (RPE).
The protocol will involve 10 60-second intervals of high intensity interspersed with 9 60-second low-intensity intervals.
The initial high intensity intervals will start at 80% of the HRR (RPE=14-17) and progress by 10% every 4 weeks.
Low intensity intervals will be performed at 30% of HRR (RPE=9-11).
Three-minute warm-up and 2-minute cool-down periods will be performed at 30% of HRR.
Total HIIT time including warm-up and cool-down is 24 minutes.
|
Cardiovascular exercise
|
Experimental: Moderate-intensity continuous training
Intensity will be determined using a combination of heart rate reserve (HRR, calculated as HRR= [max HR - resting HR] x [% training] + [resting HR]) and ratings of perceived exertion (RPE).
The MICT protocol will be increased using a progression schedule previously used (initial intensity at 40% HRR (RPE=9-11), and progressed by 10% HRR every 4 weeks up to 60% HRR (RPE=13-14) will be maintained until the end of the intervention).
A 3-minute warm-up and 2-minute cool-down will be performed at 30% HRR (RPE=9-11).
The total duration of MICT, including warm-up and cool-down, will be 35 minutes.
|
Cardiovascular exercise
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Cortico-spinal excitability
Time Frame: 12 weeks
|
Single pulse of transcranial magnetic stimulation protocol.
|
12 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Cardiorespiratory fitness
Time Frame: 12 weeks
|
Maximum rate of oxygen consumption measured during maximum physical effort.
|
12 weeks
|
Intra-cortical inhibition
Time Frame: 12 weeks
|
Paired-pulse of transcranial magnetic stimulation protocol.
|
12 weeks
|
Intra-cortical facilitation
Time Frame: 12 weeks
|
Paired-pulse of transcranial magnetic stimulation protocol.
|
12 weeks
|
Systolic resting blood pressure
Time Frame: 12 weeks
|
Supine resting blood pressure.
|
12 weeks
|
Diastolic resting blood pressure
Time Frame: 12 weeks
|
Supine resting blood pressure.
|
12 weeks
|
Arterial stiffness
Time Frame: 12 weeks
|
Central pulse wave velocity.
|
12 weeks
|
Waist-hip ratio
Time Frame: 12 weeks
|
Ratio of waist circumference measured at the level of the umbilicus, and hip circumference taken at the level of the greater trochanters.
|
12 weeks
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Enjoyment
Time Frame: 12 weeks
|
The Physical Activity Enjoyment Scale.
Each item is scored 1-7 (1=does not make me happy, 7=makes me happy), yielding a total between 8 and 56.
|
12 weeks
|
Motivation
Time Frame: 12 weeks
|
The Behavioral Regulation Exercise Questionnaire-3.
24 items using a 5-point Likert scale (0=Not true for me, 4=Very true for me).
|
12 weeks
|
Gait speed
Time Frame: 12 weeks
|
self- and fast-paced 6-meter gait speed.
|
12 weeks
|
Walking capacity
Time Frame: 12 weeks
|
6-Minute Walk Test.
|
12 weeks
|
Motor learning
Time Frame: 12 weeks
|
A motor task that requires modulating hand-grasping force.
The goal is to apply force, move the cursor, and reach targets displayed on the screen as accurately as possible.
|
12 weeks
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Ada Tang, PhD, McMaster University
- Principal Investigator: Marc Roig, PhD, McGill University
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
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
- 388320
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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