Muscle, functional and cognitive adaptations after flywheel resistance training in stroke patients: a pilot randomized controlled trial

Abstract

BackgroundResistance exercise (RE) improves neuromuscular function and physical performance after stroke. Yet, the effects of RE emphasizing eccentric (ECC; lengthening) actions on muscle hypertrophy and cognitive function in stroke patients are currently unknown. Thus, this study explored the effects of ECC-overload RE training on skeletal muscle size and function, and cognitive performance in individuals with stroke.MethodsThirty-two individuals with chronic stroke (≥6 months post-stroke) were randomly assigned into a training group (TG; n = 16) performing ECC-overload flywheel RE of the more-affected lower limb (12 weeks, 2 times/week; 4 sets of 7 maximal closed-chain knee extensions; <2 min of contractile activity per session) or a control group (CG; n = 16), maintaining daily routines. Before and after the intervention, quadriceps femoris volume, maximal force and power for each leg were assessed, and functional and dual task performance, and cognitive functions were measured.ResultsQuadriceps femoris volume of the more-affected leg increased by 9.4 % in TG. Muscle power of the more-affected, trained (48.2 %), and the less-affected, untrained limb (28.1 %) increased after training. TG showed enhanced balance (8.9 %), gait performance (10.6 %), dual-task performance, executive functions (working memory, verbal fluency tasks), attention, and speed of information processing. CG showed no changes.ConclusionECC-overload flywheel resistance exercise comprising 4 min of contractile activity per week offers a powerful aid to regain muscle mass and function, and functional performance in individuals with stroke. While the current intervention improved cognitive functions, the cause-effect relationship, if any, with the concomitant neuromuscular adaptations remains to be explored.Trial registrationClinical Trials NCT02120846

Strength training protocols in hemiparetic individuals post stroke: a systematic review

“…Among the studies analyzed in this review, the type of exercise used by ~ 92% of the studies was isotonic. Only two studies [22,23] aimed at measuring differences between eccentric and concentric contractions. The skeletal muscle system produces less strength in concentric contraction when compared to eccentric contraction in poststroke patients submitted to ST, and in this context, the eccentric exercise has been shown to be more effective in neural adaptations [23].…”

Determining the cut-off value for knee extensor strength for identifying independence in gait in chronic stroke survivors

“…Resistance training is effective for increasing the knee extensor strength on the paretic and non-paretic sides in chronic stroke survivors (15). When a chronic stroke survivor is not independent in gait, we recommend measuring the knee extensor strength on the paretic and non-paretic sides and estimating the combined knee extensor strength.…”

Effect of two types of muscle contraction training on muscle thickness, strength, and delayed onset of muscle soreness in persons with chronic stroke

“…Nevertheless, there has been recent increases in cases where ECT has been used for the rehabilitation of chronic stroke patients. In the study by Fernandez-Gonzalo et al [13], 32 subjects with chronic stroke participated in eccentric overload flywheel resistance training for 12 weeks with results showing significantly improved balance and gait performance in the training group. In the study by Park et al [14], 30 chronic stroke participants undertook ECT at different velocities for 8 weeks with results showing improved muscle activation and static balance (limits of stability) at low velocities.…”

“…However, these studies focused only on functional performance abilities such as balance and gait after muscle contraction training, and there are few studies focusing on muscle characteristics [13,14]. Even if the characteristics of muscle had been analyzed, they were analyzed only by elec-trical signals from the skin surface, such as surface electromyography [14].…”