Influence of Cognition on Activity and Participation in People With Stroke (CAPS)

If a subject agrees to participate, the primary investigators will collect some basic information including age, height, and weight. Intake of some general questions regarding health and each subject will complete some tests that measure walking speed, cognition, and balance. During these tests participants will be asked to stand from a chair, walk up & down a staircase, walk over objects in a forward, backward, and sideways directions, walk around objects in forward and backward directions. After completing those tests, participants will be asked to repeat them while doing another task such as counting out loud, naming objects, or passing an object from one hand to another. At the end of the day, a step counter will be attached to each subject's ankle and you asked to wear it when awake for the next 7 days. Investigators expect that the evaluation will last 1 hour. After 7 days, subjects will return the step counter to the researchers and begin the exercise classes. The exercise classes will occur 2 days per week for 8 weeks. In the class participants will be asked to perform gentle exercises and use memory to improve brain functioning. Each class is expected to last 1 hour. At the conclusion of the exercise classes, investigators will again perform the gait, balance and cognitive tasks as we did before each started the class. Once a subject finishes all the exercise classes and testing, investigators will call one every week to see if you have had any falls at home. The calls will go on for 6 months.

After stroke, it has been noted that up to 70% of people have cognitive impairment , between 20-60% experience depression and most are significantly less active than healthy older adults. These deficits are particularly problematic as they affect quality of life, participation in community activities and lead to a cycle of declining function. In people post stroke, participation in exercise programs has been associated with improvements in cognitive function, but others have found no cognitive improvements. Other exercise programs have helped people with stroke with depression, decreased falls incidence, and improved walking activity, but other research shows a lack of carryover of exercise programs to participation in the community. Of note, some standard outcome measures used in this work are not sensitive to change and some disadvantage those with aphasia, while many have been almost exclusively paper and pencil tests. This research project will be using a battery of cognitive measures to capture change in participants. The investigators will assess the person's ability to change their cognitive status by using functional tests with and without a cognitive challenge and compare changes with those seen in computerized testing as that represents the gold standard. This unique program attempts to combine multiple aspects that easily fit together including music and a group setting for socialization. The use of music to improve cognition as has been shown in other research studies to improve participation in exercise program. By linking cognitive retraining, low intensity exercise, group activities and music, the researchers of this project can determine if a movement program with these attributes can benefit individuals as a program of wellness, once their rehabilitation plans have been completed. The researchers are specifically interested in the effect on balance, activity and incidence of falls in people with chronic stroke. Additionally, the researchers will investigate the differences that this structured program will make on older adults who will act as a comparison group. This will bring insight into some of the additional challenges that people with stroke encounter on a daily basis.

This subset of subject's have a fair history with this methodology and are being used as the comparator.

Individuals post stroke have recently participated in this ongoing investigation in a live format but these subjects are now entered into a telehealth arm.

This unique program attempts to combine multiple aspects that easily fit together including music and a group setting for socialization. The use of music to improve cognition as has been shown in other research studies to improve participation in exercise program. By linking cognitive retraining, low intensity exercise, group activities and music, the researchers of this project can determine if a movement program with these attributes can benefit individuals as a program of wellness once their rehabilitation plans have been completed. The researchers are specifically interested in the effect on balance, activity and incidence of falls in people with chronic stroke. Additionally, the researchers will investigate the differences that this structured program will make on older adults who will act as a comparison group. This will bring insight into some of the additional challenges that people with stroke encounter on a daily basis.

The primary purpose is to determine the impact of a low intensity seated exercise program (24 sessions 2x/wk for 12 weeks) with cognitive training on dual task cognitive/motor function in individuals post stroke compared to age matched older adults

dual task processing speed (time differential between isolated motor task and task with cognitive activity challenge included)

The secondary objectives are to determine the effects of the exercise program on walking activity (steps per day) for all enrolled subjects, while at home & in the community; as a result of the 24 training sessions

effects of a 3 day baseline walking average (prior to the 24 sessions at 2x/wk) compared to a 3 day walking average post training

Inclusion Criteria: Subjects who have sustained a stroke will be recruited to participate in this research study. Inclusion Criteria: Over 18 years of age with 1 or more strokes at least 3 months ago Able to follow directions and talk with the researchers Able to safely exercise in a group setting when sitting as determined by your primary healthcare provider Older adults in good health will be recruited to act as a comparison group Inclusion Criteria: Retired or semi-retired Be able to walk without assistance Able to safely exercise in a group setting when sitting as determined by your primary healthcare provider Exclusion Criteria: • Bone or joint problems that restrict your movement or walking Really high or low blood pressure or pulse Pain in your chest or difficulty breathing when you are sitting Any other neurological problems Lack of clearance provided to you by your primary health care provider

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