Effects of Combined Resistance and Aerobic Training vs Aerobic Training on Cognition and Mobility Following Stroke "TRI-RAvA"

Active, not recruiting

Phase N/A Results N/A

Trial Description

Both aerobic training (AT) and resistance/strength training (RT) have the potential to improve recovery after stroke. Research conducted in chronic disease and healthy populations suggest that AT and RT "combination therapy" may produce synergistic and superior effects along cognition and mobility domains, when compared to AT alone. However, the effects of a combined training approach (AT+RT) compared to AT alone has not been investigated in people post-stroke.

Detailed Description

Patients referred to Toronto Rehabilitation Institute's Risk Factor Modification and Exercise Program following Stroke (TRI-REPS) will be randomized to either AT+RT or AT alone. Mobility (6 minute walk test), and cognition (Vascular Cognitive Impairment Harmonization Standards) will be measured pre- post 6 months of exercise. Secondary measures will include body composition, and biochemical changes. This project will help to determine an exercise treatment strategy that will guide best practice guidelines aimed at promoting mobility and brain health in people post-stroke.

Conditions

Interventions

  • Exercise modality (aerobic exercise versus combined aerobic and resistance exercise) Behavioral
    Intervention Desc: The goal of AT will be to progress patients to 20-60 minutes of exercise either 5 or 3 times×wk-1 depending on the study arm the patient is randomized to. The intensity will be prescribed based on results of a cardiopulmonary exercise test. For the group randomized to AT+RT, the RT exercises will be task specific, incorporating muscle actions that are performed during daily activities. A weight load equivalent to 50-60% of 1 repetition maximum will be prescribed on the non-affected limb. On the hemiparetic limb ≥50% of 1 repetition maximum and/or a resistance rated as 13-14 on the Rating of Perceived Exertion scale on the last repetition of the set will be prescribed. Patients will gradually be progressed from 1-2 sets and then from 10-15 repetitions and then increase resistance by 1.6-5 kg or increase the exercise band level and then reduced repetitions to 10 and repeated this process.
    ARM 1: Kind: Experimental
    Label: Aerobic Training
    Description: All patients will attend a 90 minute exercise class 1 time wk-1 for 6 months at the rehab centre. The AT group will complete AT 5 d∙wk-1.
    ARM 2: Kind: Experimental
    Label: Combined Resistance and Aerobic Training
    Description: All patients will attend a 90 minute exercise class 1 time wk-1 for 6 months at the centre. The AT+RT group will complete AT 3 d∙wk-1 + RT 2 d∙wk-1.
  • Combined resistance and aerobic training Other
    Intervention Desc: For the group randomized to AT+RT, Patients will gradually be progressed from 1-2 sets and then from 10-15 repetitions and then increase resistance by 1.6-5 kg or increase the exercise band level and then reduced repetitions to 10 and repeated this process.
    ARM 1: Kind: Experimental
    Label: Aerobic Training
    Description: Walking, elliptical, stationary recumbent or upright cycling will be the modes of AT prescribed depending on individual ability and access to equipment when away from the Centre. Treadmill or overground walking will be considered for those who can sustain high enough speeds and durations to achieve aerobic benefit. Cycle ergometer exercise (upright or recumbent) will be prescribed to patients in addition to walking when stroke-related deficits preclude a sufficient walking speed. The AT group will complete AT 5 d∙wk-1.
    ARM 2: Kind: Experimental
    Label: Combined Resistance and Aerobic Training
    Description: The AT+RT group will complete AT 3 d∙wk-1 + RT 2 d∙wk-1.The RT exercises will be task specific, incorporating muscle actions that are performed during daily activities. Resistance will be provided by hand-held dumbbells, exercise bands (wrist/ankle attachments), or patients' body weight. A weight load equivalent to 50-60% of 1 repetition maximum will be prescribed on the non-affected limb. On the hemiparetic limb ≥50% of 1 repetition maximum and/or a resistance rated as 13-14 on the Rating of Perceived Exertion scale on the last repetition of the set will be prescribed

Trial Design

  • Allocation: Randomized
  • Masking: Single Blind (Outcomes Assessor)
  • Purpose: Treatment
  • Endpoint: Efficacy Study
  • Intervention: Parallel Assignment

Outcomes

Type Measure Time Frame Safety Issue
Primary Cognitive function 1 year No
Primary Functional Ambulation (mobility) 1 year No
Secondary Structural Brain Changes 1 year No
Secondary Body Composition 1 year No
Secondary Biochemical Changes (blood samples) 1 year No
Secondary Functional Mobility 1 year No

Sponsors