Forced, Not Voluntary, Aerobic Exercise Enhances Motor Recovery in Persons With Chronic Stroke

Abstract

Background. The recovery of motor function following stroke is largely dependent on motor learning–related neuroplasticity. It has been hypothesized that intensive aerobic exercise (AE) training as an antecedent to motor task practice may prime the central nervous system to optimize motor recovery poststroke. Objective. The objective of this study was to determine the differential effects of forced or voluntary AE combined with upper-extremity repetitive task practice (RTP) on the recovery of motor function in adults with stroke. Methods. A combined analysis of 2 preliminary randomized clinical trials was conducted in which participants (n = 40) were randomized into 1 of 3 groups: (1) forced exercise and RTP (FE+RTP), (2) voluntary exercise and RTP (VE+RTP), or (3) time-matched stroke-related education and RTP (Edu+RTP). Participants completed 24 training sessions over 8 weeks. Results. A significant interaction effect was found indicating that improvements in the Fugl-Meyer Assessment (FMA) were greatest for the FE+RTP group ( P = .001). All 3 groups improved significantly on the FMA by a mean of 11, 6, and 9 points for the FE+RTP, VE+RTP, and Edu+RTP groups, respectively. No evidence of a treatment-by-time interaction was observed for Wolf Motor Function Test outcomes; however, those in the FE+RTP group did exhibit significant improvement on the total, gross motor, and fine-motor performance times ( P ≤ .01 for all observations). Conclusions. Results indicate that FE administered prior to RTP enhanced motor skill acquisition greater than VE or stroke-related education. AE, FE in particular, should be considered as an effective antecedent to enhance motor recovery poststroke.

The Effect of Priming on Outcomes of Task-Oriented Training for the Upper Extremity in Chronic Stroke: A Systematic Review and Meta-analysis

“…After the selection process, 125 full-text articles were assessed for eligibility, and 36 articles fulfilled all the inclusion criteria (Figure 1). Of those 36 studies, 31 presented high methodological quality 4,21-50 and 5 studies presented fair quality. 51-55 All included studies had a score ≥6 on the PEDro scale (Table 1).…”

“…21-23,32,36,37,42,48,49,52-55 Five studies had a follow-up of less than 1 month. 33,41,46,47,51 Eight studies had follow-up periods of 1 month, 4,27-30,34,44,45 4 studies assessed their participants after 3 months, 24-26,35 4 studies performed 4 months of follow-up, 31,38,39,43 and Malcolm et al 40 and Wu et al 50 had a 6-month follow-up period.…”

“…Of the 22 outcome measures, 6 were classified as structure and body function, and 8 activity domains were classified according to the ICF model (Table 5). The most common assessment tools for the structure and body function domain were the UE-FMA, identified in 20 studies 4,21,25,27-30,35,36,38,39,42-45,47-50 (55.5%) of the total 36 included. Considering the activity domain, the WMFT was the most used tool, which was reported in 12 studies 21,25,28,29,34,35,38-40,45,46,55 (33%).…”

In Search of a Dose: The Functional and Molecular Effects of Exercise on Post-stroke Rehabilitation in Rats

“…However, neurological outcomes of post-stroke rehabilitation appear to differ according to the intensity of the exercise regimen that is used (Bell et al, 2015 ; Xing et al, 2018 ). Some previous studies have demonstrated that higher intensity exercise may yield better functional recovery and neuroplasticity (Linder et al, 2019 ; Luo et al, 2019 ; Andrews et al, 2020 ), while other studies have suggested that mild exercise results in superior neuroprotection and synaptic plasticity after stroke (Lee et al, 2009 ; Shih et al, 2013 ). These conflicting results underscore the principle that exercise intensity is an important determinant of post-stroke neurological outcomes.…”

Effect of Different Exercise Intensity Preconditioning on Global Ischemia-Induced Neuronal Death and Expression of Gadd45β and DNA-PKcs in Rats

“…However, the issue of exercise intensity is still controversial. As Shown by Linder et al, higher intensity exercise can promote functional recovery and neuroplasticity after stroke [13][14][15]. Other studies have shown that mild exercise can improve neuroprotection and synaptic plasticity after stroke [16].…”