Effects of Combined Resistance and Aerobic Training vs Aerobic Training on Cognition and Mobility Following Stroke (TRI-RAvA)
Cerebrovascular Accident
About this trial
This is an interventional treatment trial for Cerebrovascular Accident focused on measuring exercise therapy, rehabilitation
Eligibility Criteria
Inclusion Criteria:
- Clinical diagnosis of stroke (ischemic or hemorrhagic)
- Ability to walk at least 100 m independently with or without an assistive
- device with no severe limitations due to pain
- Living in the community at least 3 months post stroke (no upper limit)
- Stroke-related motor impairment score of 3-6 on the Chedoke-McMaster Stroke
- Assessment scale of the leg and/or foot
- Ability to provide informed consent
Exclusion Criteria:
- Unstable angina or orthostatic blood pressure decrease of > 20 mmHg
- Resting hypertension (SBP > 160 mm Hg or DBP > 100 mm Hg)
- Diabetes related or other eye/vision complications (severe proliferative retinopathy)
- Cardiovascular morbidities which would limit exercise tolerance (e.g. heart failure, hypertrophic cardiomyopathy, horizontal or downsloping ST-segment depression > 2 mm, symptomatic aortic stenosis, complex arrhythmias)
- Musculoskeletal impairments which would preclude safe participation in exercise
- Cognitive and/or behavioral issues that would significantly limit participation in exercise testing and training, prior unrelated neurological disorders or psychiatric illness
- Severe communicative aphasia or comprehensive aphasia (as noted in clinical reports)
- Patients with anxiety disorder, claustrophobia, or pacemaker implantation will be excluded from brain imaging and perfusion measures
- Exposure to a similar or identical neuropsychological battery within <6 months
- Currently smoking
Sites / Locations
- Toronto Rehabilitation Institute
Arms of the Study
Arm 1
Arm 2
Active Comparator
Experimental
Aerobic Training
Combined Resistance and Aerobic Training
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.
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