Study of Blood Flow Restriction and Cognitive-Motor Dual Task Training to Improve Strength, Gait, and Balance in People With Subacute Stroke

Effects of an Individualized Blood Flow Restriction Training Combined With a Cognitive-Motor Dual Task Intervention on Lower Limb Strength, Gait Ability, and Fall Stability in Subacute Stroke Patients: A Randomized Controlled Trial

This study aims to evaluate the effects of individualized blood flow restriction (BFR) training combined with cognitive-motor dual task intervention on lower limb muscle strength, gait ability, and fall stability in patients with subacute stroke. A total of 28 participants will be randomly assigned to either the experimental group (BFR + dual task training) or the control group (dual task only). The intervention will last for 5 weeks, with training sessions conducted three times per week, each lasting 40 minutes. The primary outcome is lower limb strength measured by the Five Times Sit-to-Stand Test. Secondary outcomes include gait ability (10-Meter Walk Test and Functional Gait Assessment) and fall stability (Timed Up and Go Test and Korean version of the Falls Efficacy Scale-International). This study seeks to verify whether combining low-pressure BFR training (40% of arterial occlusion pressure) with dual task training can be a clinically effective strategy for improving motor and cognitive function in individuals with subacute stroke.

Study Overview

• Status: Completed
• Conditions: Subacute Stroke
• Intervention / Treatment: Behavioral: Blood Flow Restriction + Dual Task Training; Behavioral: Dual Task Training Only

Detailed Description

Subacute stroke is defined as the period between 7 days and 6 months after stroke onset, a critical window during which neuroplasticity and functional recovery are highly active. During this phase, individualized and task-specific interventions can enhance motor recovery. Blood flow restriction (BFR) training is a promising low-load exercise modality that induces physiological effects similar to high-intensity training by restricting venous return using a proximal cuff. Studies suggest that BFR training at 40% of arterial occlusion pressure (AOP) can safely stimulate muscle hypertrophy and strength, particularly in populations with limited exercise capacity, such as stroke survivors.

Additionally, dual task training, which combines motor and cognitive tasks, has been shown to improve executive function and gait performance by increasing prefrontal cortex activity. While each approach has independent benefits, the combination of peripheral muscle activation through BFR and central stimulation via cognitive-motor dual tasks may provide synergistic effects on functional recovery.

This randomized controlled trial will compare an intervention group receiving BFR training (40% AOP) with concurrent dual task gait training to a control group performing the same cognitive-motor dual tasks without BFR. Both groups will train three times per week for 5 weeks. Outcome measures will assess changes in lower limb strength, gait ability, and fall stability before and after the intervention. The study also addresses safety and standardization concerns in BFR application by using pulse oximeter-based AOP measurement protocols.

By providing evidence on the efficacy and safety of combining BFR and dual-task training in subacute stroke rehabilitation, this study aims to contribute to the development of individualized, clinically applicable intervention strategies.

• Study Type: Interventional
• Enrollment (Actual): 28
• Phase: Not Applicable

Contacts and Locations

Study Locations

• South Korea
  • Seoul
    • Seoul, Seoul, South Korea, 01795
      • Sahmyook University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients diagnosed with subacute stroke within 1 to 6 months after onset
• Able to walk at least 10 meters, with or without assistive devices
• Modified Ashworth Scale score less than 1
• Korean Mini-Mental State Examination (K-MMSE) score of 24 or higher

Exclusion Criteria:

• History of psychiatric disorders or cognitive impairment
• Presence of peripheral neuropathy
• Resting systolic blood pressure ≥160 mmHg or diastolic blood pressure ≥100 mmHg despite medication
• Diagnosis of heart failure or unstable angina
• History of bypass surgery within the past 3 months
• Serious musculoskeletal disorders affecting gait (e.g., amputation, fracture)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Experimental: BFR + Dual Task; Participants in this group will perform cognitive-motor dual task training while wearing blood flow restriction (BFR) cuffs set at 40% of their individualized arterial occlusion pressure (AOP). The training consists of three sessions per week for five weeks. Each session lasts 40 minutes and includes tasks such as forward walking, obstacle crossing, and seated-to-stand with concurrent verbal fluency or serial subtraction tasks.	Behavioral: Blood Flow Restriction + Dual Task Training; Participants will undergo lower limb resistance and gait training while wearing blood flow restriction cuffs at 40% of their individualized arterial occlusion pressure. Tasks include walking, sit-to-stand, and obstacle crossing combined with verbal fluency or serial subtraction. Training is performed 3 times per week for 5 weeks.; Other Names: BFR-DT; Individualized BFR
Active Comparator: Active Comparator: Dual Task Only; Participants in this group will perform the same cognitive-motor dual task training as the experimental group but without blood flow restriction. The training will also be conducted three times per week for five weeks, with each session lasting 40 minutes. Tasks include walking and obstacle navigation combined with verbal fluency or serial subtraction exercises.	Behavioral: Dual Task Training Only; Participants will perform the same cognitive-motor dual task training without blood flow restriction. Tasks include forward walking, obstacle crossing, and sit-to-stand exercises with concurrent cognitive tasks such as verbal fluency or serial subtraction. Training is performed 3 times per week for 5 weeks.; Other Names: DT; Dual Task Gait Training

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
5 Times Sit-to-Stand Test (5STS)	Lower limb strength will be assessed using the Five Times Sit-to-Stand Test. A shorter time indicates better performance.	Baseline and after 5 weeks of intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
10-Meter Walk Test (10MWT)	Walking speed (m/s) will be measured over a middle 10-meter segment of a 14-meter walking path. Higher values indicate better performance.	Baseline and after 5 weeks of intervention
Timed Up and Go Test (TUG)	Shorter completion time on the TUG indicates improved functional balance and mobility.	Baseline and after 5 weeks of intervention
Korean Version of Falls Efficacy Scale - International (KFES-I)	KFES-I assesses confidence in avoiding falls during daily activities. Lower scores indicate higher confidence.	Baseline and after 5 weeks of intervention
Functional Gait Assessment (FGA)	The FGA is a 10-item test that assesses postural stability during various walking tasks. Higher scores indicate better functional gait and balance.	Baseline and after 5 weeks of intervention

Collaborators and Investigators

• Sponsor: Sahmyook University
• Investigators: Principal Investigator: Seungwon Lee, PhD, Sahmyook University

Publications and helpful links

General Publications

• Liu YC, Yang YR, Tsai YA, Wang RY. Cognitive and motor dual task gait training improve dual task gait performance after stroke - A randomized controlled pilot trial. Sci Rep. 2017 Jun 22;7(1):4070. doi: 10.1038/s41598-017-04165-y.
• Ahmed I, Mustafaoglu R, Erhan B. The effects of low-intensity resistance training with blood flow restriction versus traditional resistance exercise on lower extremity muscle strength and motor functionin ischemic stroke survivors: a randomized controlled trial. Top Stroke Rehabil. 2024 May;31(4):418-429. doi: 10.1080/10749357.2023.2259170. Epub 2023 Sep 19.

Study record dates

Study Major Dates

• Study Start (Actual): September 8, 2025
• Primary Completion (Actual): October 17, 2025
• Study Completion (Actual): November 11, 2025

Study Registration Dates

• First Submitted: August 15, 2025
• First Submitted That Met QC Criteria: August 15, 2025
• First Posted (Actual): August 22, 2025

Study Record Updates

• Last Update Posted (Actual): December 12, 2025
• Last Update Submitted That Met QC Criteria: December 11, 2025
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Keywords: Balance; Gait; Muscle Strength; Subacute Stroke; BFR; Dual Task Training; Falls Efficacy
• Additional Relevant MeSH Terms: Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Stroke
• Other Study ID Numbers: SYU 2025-06-027-001

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