None listed
Conditions
Brief summary
Despite optimal medical management, up to 60% of young stroke survivors experience impairments in cognition. These impairments adversely impact activities of daily living and quality of life. A number of treatment strategies have been proposed for therapeutically addressing cognitive impairments in stroke survivors. A promising, yet experimental, treatment strategy is environmental enrichment (EE), which involves careful modulation of the environmental setting to enhance physical, cognitive, sensory and social stimulation, as well as healthy eating and sleep routines. This approach has recently been shown to improve motor function in stroke survivors, however its effects on cognition are yet to be investigated. The purpose of this study is to evaluate, for the first time, the feasibility and therapeutic utility of a 12-week telehealth-delivered EE program, compared to lifestyle guidance, on cognition in young stroke survivors.
Interventions
The environmental enrichment (EE) program is informed by previous research in stroke and our work in neurodegenerative disorders and comprises 12-weeks of exercise training, cognitive training, green-blue light therapy, healthy eating and sleep guidance. Exercise training will be prescribed by an exercise physiologist and will be periodised and consist of 60 minutes of moderate to vigorous intensity aerobic (40-70% heart rate reserve [HRR]) and resistance (rate of perceived exertion (RPE) 10-16)
The environmental enrichment (EE) program is informed by previous research in stroke and our work in neurodegenerative disorders and comprises 12-weeks of exercise training, cognitive training, green-blue light therapy, healthy eating and sleep guidance. Exercise training will be prescribed by an exercise physiologist and will be periodised and consist of 60 minutes of moderate to vigorous intensity aerobic (40-70% heart rate reserve [HRR]) and resistance (rate of perceived exertion (RPE) 10-16) exercise three times per week. Exercise training will be programmed on HRR, repetition in reserve and rate of perceived exertion metrics. Aerobic training will consist of walking, cycling and swimming activities. Resistance training will consist of body weight and resistance tubing exercises and will target major muscle groups. Aerobic and resistance exercise will be counterbalanced during the intervention (30 minutes each). Computerised cognitive training will be undertaken remotely (at home) and independently three times per week for 30 minutes using an online software called NeuroNation and will target executive function, verbal learning and memory and complex attention domains, which are affected in young stroke survivors. Re-timer glasses will be used to deliver green-blue light therapy (500nm, 230 µW/cm2, 506 lux) for 30 minutes each morning at participants homes for the duration of the trial and will be supplemented by illustrative sleep health guidelines promoting greater sleep hygiene, including but not limited to, reduced screen time, relaxation techniques and food consumptions before bed (developed for an existing trial, see ACTRN12621000773831). Green-blue light therapy has been shown to positively impact fatigue, which contributes to cognitive impairments. Healthy eating guidance will be delivered as written and illustrative resources and will align with the MIND diet (e.g., focus on consuming green leafy vegetables, berries, nuts, olive oil, fish etc). The resources have been specifically designed for this study. Participants will be asked to read through the provided healthy eating resources. The extent to which participants re-read resources is at their discretion. Twelve 30-minute coaching sessions (one per week for the duration of the intervention) will be provided by a study researcher (exercise physiologist or occupational therapist) to participants via Microsoft Teams to facilitate adherence and compliance to the environmental enrichment program. Consistent with inpatient studies, participants will be provided with a variety of resources to enrich their environments, such as puzzles, games and books on healthy living. These resources will align with the interests of individuals.
Sponsors
Edith Cowan 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 65 Years
Healthy volunteers
No
Inclusion criteria
Inclusion criteria for this trial are as follows: 1) young stroke survivors aged 18-65 ; 2) radiologically confirmed diagnosis of ischaemic/haemorrhagic stroke and > 3 months post-stroke; 3) a modified Rankin score < 4 (Modified Rankin Assessment); 4) Tele-Montreal Cognitive Assessment score of 17 or more 5) clearance from a medical practitioner to participate 6) the ability to follow verbal and written instructions; and 7) the ability to provide informed consent.
Exclusion criteria
Exclusion criteria are as follows: 1) history of neurological conditions other than stroke; 2) an untreated mental illness; 3) active substance abuse; 4) severe aphasia preventing cognitive examinations; 5) cardiovascular conditions that contraindicate exercise (medical clearance requested);
Outcome results
None listed