Forced Aerobic Exercise Enhances Motor Recovery After Stroke: A Case Report

Abstract

OBJECTIVE. Previously, we demonstrated that forced aerobic exercise (FE) increases the pattern of neural activation in Parkinson's disease. We sought to evaluate whether FE, when coupled with repetitive task practice, could promote motor recovery poststroke. METHOD.A 46-yr-old man with ischemic stroke exhibited chronic residual upper-extremity deficits, scoring 35/66 on the Fugl-Meyer Assessment (FMA) at baseline. He completed 24 training sessions comprising 45 min of FE on a motorized stationary bicycle followed by 45 min of upper-extremity repetitive task practice. RESULTS.From baseline to end of treatment, the FMA score improved by 20 points, perceived level of recovery on the Stroke Impact Scale increased by 20 percentage points, and cardiovascular function measured by peak oxygen uptake improved 30%. These improvements persisted 4 wk after the intervention ceased.

Movement-Based Priming: Clinical Applications and Neural Mechanisms

“…Chronic stroke survivors have difficulty reaching their aerobic target due to motor deficits and declines in cardiorespiratory systems secondary to lack of activity (Billinger, 2010). One case study has examined the feasibility of combining aerobic exercise and repetitive upper limb task practice in an individual with stroke (Linder et al, 2015). The aerobic exercise was completed using a forced-rate exercise paradigm.…”

“…It is important to note that priming is typically performed prior to training (Linder, Rosenfeldt, Rasanow, & Alberts, 2015; Nowak et al, 2008; C. M. Stinear, Petoe, Anwar, Barber, & Byblow, 2014; Takeuchi et al, 2005).…”

Forced Aerobic Exercise Preceding Task Practice Improves Motor Recovery Poststroke

“…Tasks were based on each participant's UE functional abilities and stated motor recovery goals and modeled after Birkenmeier, Prager, and Lang (2010). A typical RTP session consisted of three to four different tasks administered during a 45-min session and has been described in detail in Linder, Rosenfeldt, Rasanow, and Alberts (2015).…”

“…Critical to ensuring the safety of participants completing any aerobic exercise intervention is the cardiovascular screen (Linder et al, 2015). The primary cardiovascular reasons for exclusion prior to CPX testing were active or uncontrolled cardiac arrhythmia, congestive heart failure, and severely low ejection fraction.…”

Does assisted cycling improve function in those with Parkinson’s disease?

“…18 Assisted cycling has been shown to improve motor function in those following strokes. [19][20][21] Yet, there is limited research relating to the efficacy of assisted cycling for those with PD. However, Alberts et al 8 describe an occasion where an individual with PD was led on a tandem bicycle ride across Iowa and subsequently exhibited a substantial improvement in handwriting.…”