AExaCTT - Aerobic Exercise and Consecutive Task-specific Training for the upper limb after stroke: Protocol for a randomised controlled pilot study

Abstract

Motor function may be enhanced if aerobic exercise is paired with motor training. One potential mechanism is that aerobic exercise increases levels of brain-derived neurotrophic factor (BDNF), which is important in neuroplasticity and involved in motor learning and motor memory consolidation. This study will examine the feasibility of a parallel-group assessor-blinded randomised controlled trial investigating whether task-specific training preceded by aerobic exercise improves upper limb function more than task-specific training alone, and determine the effect size of changes in primary outcome measures. People with upper limb motor dysfunction after stroke will be allocated to either task-specific training or aerobic exercise and consecutive task-specific training. Both groups will perform 60 hours of task-specific training over 10 weeks, comprised of 3 × 1 hour sessions per week with a therapist and 3 × 1 hours of home-based self-practice per week. The combined intervention group will also perform 30 minutes of aerobic exercise (70-85%HR_max) immediately prior to the 1 hour of task-specific training with the therapist. Recruitment, adherence, retention, participant acceptability, and adverse events will be recorded. Clinical outcome measures will be performed pre-randomisation at baseline, at completion of the training program, and at 1 and 6 months follow-up. Primary clinical outcome measures will be the Action Research Arm Test (ARAT) and the Wolf Motor Function Test (WMFT). If aerobic exercise prior to task-specific training is acceptable, and a future phase 3 randomised controlled trial seems feasible, it should be pursued to determine the efficacy of this combined intervention for people after stroke.

Keywords: 6MWT, Six Minute Walk Test; ARAT, Action Research Arm Test; Aerobic exercise; BDNF, brain-derived neurotrophic factor; CERT, Consensus on Exercise Reporting Template; CM, centimetre; CONSORT, Consolidated Standards of Reporting Trials; ECG, electrocardiography; ELISA, enzyme-linked immunosorbent assay; FAS, Fatigue Assessment Scale; GP, general practitioner; HRmax, age-predicted maximal heart rate maximum; HRpeak, peak heart rate; IPAQ, International Physical Activity Questionnaire; MAL, Motor Activity Log; MRI, magnetic resonance imaging; MS, Microsoft; Motor function; NAA, N-acetyl Aspartate; PD, Peak Deceleration; PV, Peak Velocity; REDCap, Research Electronic Data Capture; RPE, rating of perceived exertion; RPM, revolutions per minute; SIS, Stroke Impact Scale; Stroke; Task-specific training; VO2, oxygen uptake; VO2peak, peak oxygen uptake; WMFT, Wolf Motor Function Test; m/s, millimetres per second; mL.kg−1.min−1, millilitres per kilogram per minute; reps, repetitions; s, seconds.

Fig. 1

Study design.