Forced Aerobic Exercise Preceding Task Practice Improves Motor Recovery Poststroke

Abstract

Objective: To understand how two types of aerobic exercise affect upper-extremity motor recovery post-stroke. Our aims were to (1) evaluate the feasibility of having people who had a stroke complete an aerobic exercise intervention and (2) determine whether forced or voluntary exercise differentially facilitates upper-extremity recovery when paired with task practice.

Method: Seventeen participants with chronic stroke completed twenty-four 90-min sessions over 8 wk. Aerobic exercise was immediately followed by task practice. Participants were randomized to forced or voluntary aerobic exercise groups or to task practice only.

Results: Improvement on the Fugl-Meyer Assessment exceeded the minimal clinically important difference: 12.3, 4.8, and 4.4 for the forced exercise, voluntary exercise, and repetitive task practice-only groups, respectively. Only the forced exercise group exhibited a statistically significant improvement.

Conclusion: People with chronic stroke can safely complete intensive aerobic exercise. Forced aerobic exercise may be optimal in facilitating motor recovery associated with task practice.

Figure 1.

(A) Continuous HR during a session of FE exercise and RTP. (B) Exercise intensity measured as mean percentage of HRR for each FE and VE participant’s cycling sessions during the main 35-min exercise set. (C) Mean number of RTP repetitions per session for all participants in each group. The shaded area in 1A represents the target HR zone for this participant. The dashed line in 1B represents the AHA/ASA recommendations for minimum intensity measured by HRR during aerobic exercise after stroke. Note. ^*Participant was taking beta blockers. AHA/ASA = American Heart Association/American Stroke Association; Avg. = average; bpm = beats per min; FE = forced exercise; HR = heart rate; HRR = heart rate reserve; NS = not significant; RTP = repetitive task practice; VE = voluntary exercise.

Figure 2.

(A) Changes in upper-extremity FMA motor scores from baseline to EOT and from baseline to EOT + 4. (B) The relationship between average cadence (pedaling rate in revolutions per minute) during the intervention and change in FMA motor scores. The dashed line in 2A represents MCID on the FMA. All participants in the FE group (gray triangles, 2B) exhibited improvement greater than the MCID for the FMA, whereas the VE group (black circles) had 3 participants who did not achieve the MCID. Note. EOT = end of treatment; EOT + 4 = 4 wk after EOT; FE = forced exercise; FMA = Fugl-Meyer Assessment; MCID = minimal clinically important difference; NS = not significant; RTP = repetitive task practice only; VE = voluntary exercise. ^*p < .05.