None listed
Conditions
Brief summary
There is a link between two major causes of death, disability, and reduced quality of life in our society: stroke and neurodegenerative dementia. We now understand patients who suffer stroke are more likely to experience a long-term decline in thinking ability and a reduction in brain volume. Exercise is a simple, yet effective, method of improving cardiovascular health. We will examine if exercise after stroke can modify risk factors that may lead to post-stroke brain atrophy and cognitive decline. The aim of this project is to determine whether home-based aerobic exercise has a positive impact on preserving brain volume and function, as well as general physical and psychological well-being. We hypothesise that participants who undertake prescribed aerobic exercise (i.e., exercise that increases heart rate and breathing) after a stroke will have preserved brain volume and neurocognitive performance, higher mood levels, and better end-organ disease well-being (i.e., less recurrent strokes, improved blood pressure, reduced cardiovascular disease) compared to participants who do not undertake aerobic exercise. Results from this study will provide unique information on the relationship between stroke, physical activity, brain health, and dementia. Our findings will establish whether post-stroke aerobic physical activity can prevent, or at least minimise, the impact of brain atrophy, cognitive impairment, and end organ disease state. A prescribed and tailored exercise programme could offer a simple and economically viable solution to patient care.
Interventions
Participants are randomly allocated into one of two fitness training intervention groups using a computer-generated schedule. At 2-month post-stroke, participants undertake their respective fitness training programs. The fitness training program occurs 3 times per week for a duration of 8 weeks. Each fitness training session involves 1 hour of activities. The two exposure groups are:
* Balance-Stretching Group: Warm up (5 mins), Balance activities (25 mins), Stretching activities (25 mins), Cool
Participants are randomly allocated into one of two fitness training intervention groups using a computer-generated schedule. At 2-month post-stroke, participants undertake their respective fitness training programs. The fitness training program occurs 3 times per week for a duration of 8 weeks. Each fitness training session involves 1 hour of activities. The two exposure groups are: * Balance-Stretching Group: Warm up (5 mins), Balance activities (25 mins), Stretching activities (25 mins), Cool down (5 mins). * Strength Training-Aerobic Exercise Group: Warm up (5 mins), Strength activities (10 mins), Aerobic activities (i.e., activities that will raise heart-rate and breathing = 30 mins), Cool down (5 mins). The trial commenced on 26/05/2016 with exercise sessions being delivered face-to-face by an Exercise Physiologist or Physiotherapist (EP) at a time and location convenient for participants. 34 participants were recruited. Due to restrictions and health guidance enacted during the global pandemic, on 27/10/20 the sessions were pivoted to be delivered live, one-on-one by an EP via the video-conferencing platform Zoom from within the participants’ own homes. The EP closely monitors participants to ensure they are safe to exercise. For safety purposes, and to support intervention fidelity, participants are trained in conducting their own safe-to-exercise measures. Heart Rate and Rate of Perceived Exertion are self-monitored by the participant and reported back to the EP in real time for recording during each exercise session. The individual activities undertaken in each of the fitness training programmes will vary depending on each participant’s fitness level and will be progressed over the 8 weeks to match any improvements made. The programmes have been established in accordance with an international framework for prescribing safe and efficacious exercise interventions to chronic stroke populations. Participants will be aware of their group allocation based on the fitness training programme they are administered. Investigators who are blind to participant group will conduct the pre- and post-fitness training intervention assessments. To gauge activity levels outside of the intervention during the fitness training programs, all participants will be assessed via the Physical Activity Scale for the Elderly questionnaire at the start of each week of the intervention. As reflected in the changes to the study title, the study now includes two independent components of the intervention delivery: face-to-face and telehealth. These components will be analysed and reported independently, with a potential pooling of the results through meta-analysis if appropriate.
Sponsors
Monash University
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
- Ischaemic stroke (first or recurrent stroke); - Able to attend 3 study sessions over 10 months; - Motivation and willingness to participate in the study protocol; - No prior neurological or psychiatric disease, including dementia; - Can give informed consent and participate in cognitive testing.
Exclusion criteria
- No significant medical comorbidities (e.g., severe cardiac disease) and/or musculoskeletal injuries precluding participation in exercise intervention, or making survival for 1 year poststroke unlikely; - Regular exclusion criteria for MRI (e.g., implanted metal, severe claustrophobia); - Pre-existing dementia, or mRS >3.
Outcome results
None listed