Forced-rate aerobic cycling enhances motor recovery in persons with chronic stroke: A randomized clinical trial

BackgroundThe potential for intensive aerobic exercise to enhance neuroplasticity post-stroke has been theorized but not systematically investigated. Our aim was to determine the effects of forced-rate aerobic exercise paired with an abbreviated session of upper extremity (UE) repetitive task practice (FE+RTP) compared to time-matched UE repetitive task practice (RTP only) on the recovery of motor function in individuals with chronic stroke. MethodsA single center randomized clinical trial was conducted from April 2019 to December 2022. Sixty individuals [&ge;]6 months following single stroke with residual UE hemiparesis aged 18-85 were recruited. Participants were randomized 1:1 to one of two time-matched groups: FE+RTP (N=30) or RTP only (N=30). Both groups completed 90-minute sessions, 3x/week for 8 weeks. The FE+RTP group underwent 45-minutes of forced-rate aerobic exercise (FE) followed by 45-min of UE RTP. The RTP only group completed 2 sequential 45-minute sessions of UE RTP. The primary UE outcomes were the Fugl-Meyer Assessment (FMA) and the Action Research Arm Test (ARAT). The Six-minute Walk Test (6MWT) assessed walking capacity. ResultsSixty individuals 60.5 ({+/-}10.6) years of age and 26.0 [13.0, 69.0] months post-stroke were enrolled, and 56 completed the study. The RTP only group completed more RTP in terms of repetitions (411.8{+/-}44.4 versus 222.8{+/-}28.4, P<0.001) and time (72.7{+/-}6.7 versus 37.8{+/-}2.4 minutes, P<0.001) compared to FE+RTP. Both groups improved on the FMA (FE+RTP, 36.2{+/-}10.1 to 44.0{+/-}11.8 and RTP only, 34.4{+/-}11.0 to 41.2{+/-}13.4, P<0.001) and ARAT (FE+RTP, 32.5{+/-}16.6 to 37.7{+/-}17.9 and RTP only, 32.8{+/-}18.6 to 36.4{+/-}18.5, P<0.001). A group main effect was not observed. The FE+RTP group demonstrated greater improvements on the 6MWT (274.9{+/-}122.0 to 327.1{+/-}141.2 meters) compared to the RTP only group (285.5{+/-}160.3 to 316.9{+/-}170.0, P=0.004). ConclusionsWhile both interventions elicited comparable improvements in UE motor recovery, the summative value of FE+RTP in improving UE and lower extremity function was demonstrated. Trial RegistrationClinicalTrials.gov: NCT03819764