None listed
Conditions
Brief summary
The benefits of aerobic exercise for people with stroke are well established, and worldwide clinical practice guidelines recommend aerobic exercise training across all phases of stroke recovery. But aerobic exercise is not routinely prescribed by therapists, and when it is prescribed, it is often at sub-optimal levels that does little to improve the fitness of people with stroke. For many, it is their aerobic deconditioning that limits their walking ability and engagement in physical activity more so than their neuromotor impairment. This is a significant problem. Walking is not only fundamental for physical independence but is so important for health that it has been called the 6th vital sign. Aerobic exercise at sufficient intensity to challenge the neuromotor and cardiopulmonary systems can improve walking endurance and enhance cardiovascular health post-stroke. Most randomized controlled trials (RCTs) of aerobic exercise post-stroke have employed moderate intensity continuous training (MICT, i.e., 40-60% heart rate reserve [HRR]) to good effect. This is why MICT is recommended in national and international guidelines. There is, however, emerging evidence that more vigorous aerobic exercise training (i.e., >60% HRR) can improve walking and enhance stroke recovery, but sustaining such higher intensities of exercise can be difficult. High intensity interval training (HIIT), which involves short bursts of vigorous aerobic exercise (i.e., >60% HRR) alternated with active or passive recovery periods, may be a feasible approach to eliciting the benefits of vigorous aerobic exercise training in a manner acceptable to patients and providers. Since females are less likely to achieve independence after rehabilitation and are less likely to be discharged home, there could also be sex and gender differences when testing such an approach. In this pilot RCT to be administered at Epworth HealthCare, we will: 1) Examine data on safety, feasibility, and acceptability to plan for an international trial. 2) Evaluate the effects of 10 weeks of HIIT or MICT on walking speed, cardiorespiratory fitness and quality of life during the subacute phase of stroke recovery. 3) Evaluate sex differences on stroke outcomes.
Interventions
In this study, we will conduct a pilot RCT testing the feasibility, safety and acceptability of High Intensity Interval Training (HIIT) (Intervention) compared to Moderate Intensity Continuous Training (MICT) (Control) during stroke rehabilitation. An allied health clinician (i.e., Physiotherapist or Exercise Physiologist) will implement 10 weeks of individually tailored aerobic training three times per week as per national and international guidelines. Participants will be randomly assigned to
In this study, we will conduct a pilot RCT testing the feasibility, safety and acceptability of High Intensity Interval Training (HIIT) (Intervention) compared to Moderate Intensity Continuous Training (MICT) (Control) during stroke rehabilitation. An allied health clinician (i.e., Physiotherapist or Exercise Physiologist) will implement 10 weeks of individually tailored aerobic training three times per week as per national and international guidelines. Participants will be randomly assigned to either HIIT or MICT. For HIIT, the program will be delivered in small groups of 2-4 participants in a rehabilitation gym using recumbent steppers, treadmills or bicycle ergometers depending on individual capability. Specifically, if the person is able to walk 10m with less than minimal physical assistance, they will begin training using a treadmill. Otherwise, they will use the stepper or bicycle as appropriate and transition to treadmill as walking improves. For participants randomly assigned to HIIT, the aim is to train for 30 minutes (plus 5 minutes warm up and cool down). These levels are typically not within the capabilities of persons within the first month post-stroke, so we will employ the recommendations for aerobic training during sub-acute rehabilitation by Ploughman et al. (2016). The first week will involve 10-minute blocks of training interspersed with 1-2-minutes of rest at low intensity (20-40% heart rate reserve [HRR]). Depending on the participants response (oxygen saturation, heart rate, blood pressure and perceived level of exertion), training time and speed will be increased and rests reduced to obtain HIIT (>60% HRR) targets. All training and patient response data will be recorded.
Sponsors
Dr Liam Johnson
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients admitted to Epworth HealthCare Rehabilitation will be screened to determine their eligibility, namely they 1) have experienced an ischeamic or haemorrhagic stroke, 2) are less than one-month post-stroke, 3) are aged greater than or equal to 18 years, 4) are medically stable (as assessed by their treating Rehabilitation Physician), 5) are English speaking, 6) can provide informed consent to participate, and 7) are able to and agree to participate in either HIIT or MICT training in addition to their usual care.
Exclusion criteria
People with stroke will be excluded from participating in the study if they 1) are pregnant women, or 2) present with absolute contraindications to exercise as determined by American College of Sports Medicine exercise prescription guidelines
Outcome results
None listed