Effects of Dual Task-Oriented Circuit Training on Walking Recovery in Sub-acute Stroke (DTOCT-Stroke)

The Effect of Dual Task-Oriented Circuit Training on Neuroplasticity and Walking Adaptability in Subacute Stroke Patients: A Pilot and Feasibility Study

This pilot study aims to assess the feasibility, safety, and initial efficacy of an integrated Dual Task-Oriented Circuit Training (DTOCT) program for individuals in the subacute phase of stroke recovery. Although numerous patients recover the capacity to walk in a regulated hospital environment, they frequently encounter difficulties with "community ambulation," the capability to traverse real-world settings while multitasking (e.g., walking while conversing or circumventing barriers). This study will examine if the integration of high-intensity circuit training with cognitive difficulties can promote neuroplasticity and enhance the patient's capacity to safely traverse intricate daily settings.

Study Overview

• Status: Not yet recruiting
• Conditions: Stroke, Cerebrovascular
• Intervention / Treatment: Behavioral: Dual task oriented circuit training; Behavioral: Dual task training; Behavioral: Task Oriented Circuit Training

Detailed Description

Cognitive-Motor Interference (CMI) makes it challenging for stroke survivors to reintegrate into their communities. Walking is an automatic subcortical process in a healthy brain. After a stroke, however, the brain often has to "consciously" control walking, which takes away mental resources from other tasks. This "functional gap" is why almost 80% of survivors can walk house-hold, but only 30% can safely get around in the community. This study examines the "Golden Window" of recovery (2 weeks to 5 months post-stroke), a timeframe characterized by optimal physiological conditions for neuroplasticity. The DTOCT protocol functions as a synergistic intervention: the circuit training induces cardiovascular intensity to stimulate systemic Brain-Derived Neurotrophic Factor (BDNF) release, while concurrent cognitive tasks (e.g., memory recall or the Stroop test) focus on localized neurotrophic support within the prefrontal cortex and hippocampus. This three-arm pilot study (DTOCT vs. pure task-oriented training vs. pure dual-tasking) will give us important information about how easy it is to recruit participants, how well they stick to the plan, and how big the initial effects are. These results will constitute an essential basis for an upcoming comprehensive Randomized Controlled Trial (RCT) designed to enhance the standard of neurorehabilitation in Indonesia.

• Study Type: Interventional
• Enrollment (Estimated): 36
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Farida Arisanti, MD, PMR; Phone Number: +62-85351111946; Email: farida.arisanti@unpad.ac.id
• Study Contact Backup: Name: Vitriana Biben, Prof., MD, PMR; Phone Number: +628156262733; Email: vitriana@unpad.ac.id

Study Locations

• Indonesia
  • West Java
    • Bandung, West Java, Indonesia, 40131
      • RS Dustira Bandung
      • Contact: Bernadeta Cahyo Setianingrum Poernomo, MD, PMR; Phone Number: +6281214544779; Email: nuningbernadeta@ymail.com

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria

1. Diagnosed with a first-ever subacute stroke (defined as 2 weeks to 5 months post-onset) with anterior circulation involvement.
2. Diagnosis confirmed via neuroimaging (CT or MRI).
3. Men and women aged 40 to 65 years.
4. Motor recovery in the lower limbs corresponding to Brunnstrom stages 4 to
5. Functional Ambulation Category (FAC) score of at least grade 3.
6. Ability to walk independently, with or without walking aids.
7. Montreal Cognitive Assessment Indonesian version (MoCA-INA) score of ≥20, demonstrating the capacity to collaborate and follow multi-step instructions.
8. Medically stable with controlled comorbidities.

Exclusion Criteria

1. Expressive or receptive aphasia that impedes task comprehension
2. Unstable cardiovascular or medical conditions (e.g., severe hypertension, congestive heart failure) for which moderate exercise is contraindicated.
3. Moderate to severe depression, indicated by a Patient Health Questionnaire-9 (PHQ-9) score of ≥ 15.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Dual Task Oriented Circuit Training (DTOCT); Experimental: DTOCT Behavioral: Dual Task-Oriented Circuit Training. Participants engage in 5 circuit stations (e.g., obstacle walking, stair navigation) while performing secondary cognitive tasks (e.g., backward counting, object naming). 3 sessions/week for 4 weeks.	Behavioral: Dual task oriented circuit training; 1. Experimental Arm: Dual Task-Oriented Circuit Training (DTOCT) Intervention Name: Behavioral: Dual Task-Oriented Circuit Training (DTOCT) Description: Participants will undergo an integrated 60-minute rehabilitation session, 3 times per week for 4 weeks (total 12 sessions). Each session includes 25-50 minutes of active circuit training across five specialized stations: Dual-Task Walking: Straight walking (3-8m) while performing forward/backward number sequencing. Obstacle Walking: Stepping over cone or hurdle obstacles (5-14cm) while naming object categories from long-term memory. Stair Navigation: Ascending/descending stairs (10-17cm step height) while identifying colors and shapes. Walking with Navigation: Navigating an oval path (3-8m) while performing an incongruent Stroop color-word task. ADL Stimulation: Walking while carrying a cup of liquid or a shopping bag to train executive function and working memory. Training intensity and cognitive difficulty are progressed weekly; Other Names: DTOCT
Active Comparator: Dual Task Training (DTT); Behavioral: Pure Dual-Task Training. Participants practice walking under cognitive load (e.g., Stroop task) in a standard non-circuit format.	Behavioral: Dual task training; 3. Active Comparator Arm: Pure Dual-Task Training (DT) Intervention Name: Behavioral: Pure Dual-Task Training (DT) Description: Participants will perform standard, non-circuit walking at a self-selected comfortable speed while executing simultaneous cognitive demands. The protocol includes: Backward Counting: Continuous subtraction from a random 3-digit number. Stroop Task: Identifying font colors or semantic meanings of incongruent words. Memory Tasks: Sequential recall of shopping lists (3-5 items) and reverse word recall (2-4 words). Verbal Fluency: Generating word chains or category naming. Each session consists of two 15-minute sets of core dual-task training (30 minutes total activity) within a 60-minute therapist-supervised visit. Training is conducted 3 times per week for 4 weeks (total 12 sessions). Cognitive difficulty is adjusted weekly to maintain an optimal challenge.; Other Names: DTT
Active Comparator: Task Orinted Circuit Training (TOCT); Behavioral: Task-Oriented Circuit Training. Focuses on high-intensity motor repetition using circuit stations (e.g., sit-to-stand, stepping) without added cognitive load.	Behavioral: Task Oriented Circuit Training; 2. Active Comparator Arm: Task-Oriented Circuit Training (TOCT) Intervention Name: Behavioral: Task-Oriented Circuit Training (TOCT) Description: Participants will focus exclusively on functional motor relearning and cardiovascular endurance through 6 circuit-based stations: Standing and Reaching: Multidirectional reaching to targets while standing. Sit-to-Stand: Transitions using chairs of various heights to strengthen extensors. Anterior/Posterior Stepping: Stepping onto blocks of various heights. Lateral Stepping: Side-stepping for lateral stability. Forward Step-Up: Strengthening for stair climbing mechanics. Heel Raise: Improving gait push-off mechanics. Each station is performed for 2.5 to 5 minutes with 1-minute rest periods. Training is conducted 3 times per week for 4 weeks (total 12 sessions), with each session lasting 60 minutes including warm-up and cool-down. No explicit secondary cognitive tasks are added.; Other Names: TOCT

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Adherence Rate	Description: Percentage of attended sessions (out of 12) during the 4-week intervention period.	4 weeks
Retention Rate	Proportion of participants who complete the full 4-week protocol and follow-up assessments	4 weeks
Incidence of Adverse Events	Frequency of falls or medical adverse events documented during the training sessions.	4 weeks
Mean Exercise Heart Rate	Evaluation of cardiovascular demand and tolerability during the circuit training stations. Measured using a digital heart rate monitor. Unit of Measure: Beats per minute (bpm)	During each of the 12 training sessions (4 weeks)
Mean Systolic and Diastolic Blood Pressure	Monitoring of hemodynamic stability to ensure the high-intensity circuit training is safe for subacute stroke patients Unit of Measure: Millimeters of mercury (mmHg)	Pre-and post-each training session (4 weeks)
Mean Borg Rating of Perceived Exertion (RPE) Score	Assessment of subjective physical effort and tolerability. The scale ranges from 6 to 20 (or 0-10 depending on the version used), where higher scores indicate greater perceived exertion. Unit of Measure: Units on a scale	At the end of each circuit station during all 12 sessions (4 weeks)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from Baseline in 6-Minute Walk Test (6MWT)	Change in total distance walked in meters during the 6-Minute Walk Test from baseline to 4 weeks.	Baseline and 4 weeks
Change from Baseline in 10-Meter Walk Test (10MWT)	Change in gait speed measured in meters per second (m/s) in 10 meter walk test	Baseline and 4 weeks
Change from Baseline of Completion Time in Standardized Walking Obstacle Course (SWOC)	Mean time taken to complete the 12.2-meter curved course across three conditions (normal, tray, dark-glasses) and measured using a stopwatch. The total time in seconds taken to complete the 12.2-meter curved obstacle course under three conditions (normal, tray, and dark-glasses). A shorter time indicates better walking adaptability. Unit of Measure: Seconds	Baseline and 4 weeks
Change from Baseline in Standardized Walking Obstacle Course (SWOC) Step Count	Mean number of contacts between the foot and ground during course completion across three conditions Unit of measure : Number of steps	Baseline and 4 weeks
Change of number of errors in Standardized Walking Obstacle Course (SWOC)	Errors are operationally defined as the aggregate sum of "stumbles" (where the participant's leg or walking aid strikes an obstacle) and "step-offs" (where a whole foot is placed outside the 0.92-meter wide curved pathway) Number of errors (atau "Count of errors")	Baseline and 4 weeks (Post-intervention)
Change from Baseline in Serum BDNF Concentration	Concentration of Brain-Derived Neurotrophic Factor quantified via sandwich ELISA to measure neuroplasticity. Unit of measure : Picograms per milliliter (pg/mL)	Baseline and 4 weeks

Collaborators and Investigators

• Sponsor: Universitas Padjadjaran
• Investigators: Principal Investigator: Farida Arisanti, MD, PMR, Faculty of Medicine Universitas Padjadjaran

Study record dates

Study Major Dates

• Study Start (Estimated): June 1, 2026
• Primary Completion (Estimated): August 30, 2026
• Study Completion (Estimated): August 30, 2026

Study Registration Dates

• First Submitted: March 14, 2026
• First Submitted That Met QC Criteria: March 19, 2026
• First Posted (Actual): March 27, 2026

Study Record Updates

• Last Update Posted (Actual): May 28, 2026
• Last Update Submitted That Met QC Criteria: May 23, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Stroke
• Other Study ID Numbers: IKFR-202603.01

Drug and device information, study documents

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