The Utilization of Forced-Rate Cycling to Facilitate Motor Recovery Following Stroke: A Randomized Clinical Trial

Susan M. Linder, Andrea Bischof-Bockbrader, Sara Davidson,Yadi Li,Brittany Lapin, Tamanna Singh,John Lee,Francois Bethoux,Jay L. Alberts


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Background: The potential for aerobic exercise (AE) to enhance neuroplasticity post-stroke has been theorized but not systematically investigated. Our aim was to determine the effects of forced-rate AE (FE) paired with upper extremity (UE) repetitive task practice (FE + RTP) compared to time-matched UE RTP (RTP only) on motor recovery. Methods: A single center randomized clinical trial was conducted from April 2019 to December 2022. Sixty individuals >= 6 months post-stroke with UE hemiparesis were randomized to FE + RTP (N = 30) or RTP only (N = 30), completing 90-minute sessions, 3x/week for 8 weeks. The FE + RTP group underwent 45-minute of FE (5-minute warm-up, 35-minute main set, and 5-minute cool down) followed by 45-minute of UE RTP. The RTP only group completed 90-minute of RTP. Primary outcomes were the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT). The 6-minute Walk Test (6MWT, secondary outcome) assessed walking capacity. Results: Sixty individuals enrolled and 56 completed the study. The RTP only group completed more RTP in terms of repetitions (411.8 +/- 44.4 vs 222.8 +/- 28.4, P < .001) and time (72.7 +/- 6.7 vs 37.8 +/- 2.4 minutes, P < .001) versus FE + RTP. There was no significant difference between groups on the FMA (FE + RTP, 36.2 +/- 10.1-44.0 +/- 11.8 and RTP only, 34.4 +/- 11.0-41.2 +/- 13.4, P = .43) or ARAT (FE + RTP, 32.5 +/- 16.6-37.7 +/- 17.9 and RTP only, 32.8 +/- 18.6-36.4 +/- 18.5, P = .88). The FE + RTP group demonstrated greater improvements on the 6MWT (274.9 +/- 122.0-327.1 +/- 141.2 m) versus RTP only (285.5 +/- 160.3-316.9 +/- 170.0, P = .003). Conclusions: There was no significant difference between groups in the primary outcomes. The FE + RTP improved more on the 6MWT, a secondary outcome.
cycling,aerobic exercise,neuroplasticity
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