Power Exercise for Stroke

(POWER-P Trial)

Recruiting at 1 trial location

Overseen By Ada Tang, PT PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: McMaster University

Disqualifiers: Cardiovascular disease, Stroke rehab, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 32

60 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to explore whether a power training program can improve recovery for individuals who have experienced a stroke. The focus is to test if exercises performed at higher speeds can boost muscle power, which is crucial for everyday activities like walking and balancing. Participants will either join a power training program or follow standard strength training to compare results. Individuals at least six months post-stroke who can walk at least 10 meters may be suitable for this study. The findings could help design future rehabilitation programs for stroke recovery. As an unphased trial, this study offers a unique opportunity to contribute to innovative rehabilitation strategies for stroke recovery.

Do I need to stop my current medications for the trial?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that this power exercise program is safe for stroke recovery?

Research has shown that a 10-week program called Power Exercise for Stroke Recovery (POWER) is promising in terms of safety. In a small study with 15 participants, the program proved safe and may aid stroke recovery. Participants in earlier power training studies experienced significant muscle strength improvements, with a 54% increase in their weaker limbs and a 57% increase in their stronger limbs. This suggests that power training can be well-tolerated by individuals recovering from a stroke, making it a potentially safe option for enhancing strength and movement. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Power Exercise for Stroke Recovery (POWER) because it focuses on enhancing power, not just strength. Unlike standard stroke rehabilitation exercises, which usually emphasize building strength gradually, POWER introduces a faster-paced, three-phase regimen. This includes a familiarization week, followed by a strength-building phase, and then a unique power phase with rapid repetitions. This innovative approach might help stroke survivors regain movement and coordination more effectively and quickly.

What evidence suggests that this trial's treatments could be effective for stroke recovery?

Research has shown that intense exercise can greatly improve physical abilities after a stroke. It helps individuals walk longer distances and enhances balance, both crucial for daily activities. In this trial, participants will join one of two exercise programs. The Power Exercise for Stroke Recovery (POWER) program, one of the study arms, focuses on building strength and muscle power through progressively challenging exercises. A recent small study of the POWER program showed promising results for stroke recovery, suggesting that this method is safe and might aid recovery. More research is needed to confirm these results in larger groups. ^{6 7 8 9 10}

Are You a Good Fit for This Trial?

The POWER Pilot Trial is for individuals who are at least 6 months post-stroke. It's designed to help those struggling with muscle weakness, a common issue after stroke that affects daily activities like walking and balance.

Inclusion Criteria

My stroke has left me with slight to moderate disability.

Without significant cognitive impairment that would preclude safe exercise, screened via Montreal Cognitive Assessment-Blind score <18

It has been over 6 months since my stroke.

Exclusion Criteria

I don't have heart conditions that make exercise unsafe.

I am currently participating in or have plans for stroke rehabilitation.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Familiarization

Participants build familiarity with the upper and lower body exercises

1 week

3 visits (in-person)

Strength Training

Participants engage in strength training with 2-3 sets of 5-8 repetitions

4 weeks

12 visits (in-person)

Power Training

Participants perform power training with 2-3 sets of 15-20 repetitions at a fast tempo

5 weeks

15 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

8 weeks

2 visits (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Power Exercise for Stroke Recovery (POWER)

Trial Overview

This trial tests a power training program (POWER) against standard lower-intensity strength training recommended for stroke recovery. Participants will be randomly assigned to one of the two groups to compare effectiveness in improving walking, strength, and balance.

How Is the Trial Designed?

Group I: Power Exercise for Stroke Recovery (POWER) Experimental Treatment 1 Intervention

POWER involves 3 progressive phases: 1) Familiarization (1 week), 2) Strength (4 weeks, 2-3 sets, 5-8 repetitions), and 3) Power (5 weeks, 2-3 sets, 15-20 repetitions, fast tempo).

Group II: Strength Training Engaging Guidelines to Enhance Total Health (STRENGTH) Active Control 1 Intervention

STRENGTH is based on current resistance exercise training (RET) clinical practice guidelines for stroke with no focus on power.

Who Is Running the Clinical Trial?

McMaster University

Lead Sponsor

Trials

936

Recruited

2,630,000+

Published Research Related to This Trial

This review provides evidence-based guidelines for safely implementing aerobic exercise in the early phases post-stroke, emphasizing the importance of pre-participation screening and monitoring for potential complications like blood pressure dysregulation and cerebral hypoperfusion.

Countermeasures such as avoiding prolonged standing and incorporating lower limb movements are recommended to prevent blood pooling and minimize risks during exercise, ensuring a safer rehabilitation process for stroke patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Aerobic Training and Mobilization Early Post-stroke: Cautions and Considerations. Marzolini, S., Robertson, AD., Oh, P., et al.[2020]

Stroke is a major cause of disability, and currently, only 5-10% of stroke patients receive hyperacute revascularization procedures, highlighting the need for timely interventions.

Early prescribed exercise after a stroke can have significant long-term benefits, but there is a lack of guidelines for clinicians on how to safely implement these activities, necessitating a better understanding of the evidence and physiological principles involved.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nonpharmacological Treatments for Hospitalized Patients with Stroke: A Nuanced Approach to Prescribing Early Activity. Bahouth, MN., Deluzio, S., Pruski, A., et al.[2023]

High-intensity functional electric stimulation (FES)-assisted exercise therapy (FES-ET) significantly improved motor function in stroke survivors, as measured by the Wolf Motor Function Test (WMFT), compared to low-intensity FES-ET, with a notable effect size of 0.95.

Despite the improvements in objective measures of motor function, self-assessments of motor activity (Motor Activity Log) and overall function (Fugl-Meyer Assessment) did not show significant differences, raising questions about the clinical relevance of the findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Upper-extremity functional electric stimulation-assisted exercises on a workstation in the subacute phase of stroke recovery. Kowalczewski, J., Gritsenko, V., Ashworth, N., et al.[2016]

Progressive strength and low-intensity aerobic exercise programs lasting 3 to 6 months can significantly improve motor function, strength, balance, and overall fitness in stroke survivors without worsening spasticity.

Increasing access to community-based physical activity programs is crucial for preventing deconditioning and enhancing the quality of life for individuals recovering from a stroke.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Adapted exercise important after stroke. Acute and long-term effects of different training programs]. Engardt, M., Grimby, G.[2017]

In a study of 200 patients with moderate to severe subacute stroke, those who underwent aerobic training experienced a higher rate of serious adverse events compared to those in the relaxation control group, with an incident rate ratio of 1.70.

The occurrence of serious adverse events in the aerobic training group was significantly influenced by pre-existing conditions such as diabetes mellitus and atrial fibrillation, indicating that these factors may increase risk and warrant further investigation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physical Fitness Training in Patients with Subacute Stroke (PHYS-STROKE): Safety analyses of a randomized clinical trial. Rackoll, T., Nave, AH., Ebinger, M., et al.[2022]

Progressive resistance training (PRT) is considered safe for individuals within the first 3 months after a stroke, as no significant increase in adverse events was reported in the studies reviewed.

However, the evidence suggests that PRT does not significantly improve muscle strength, upper limb function, or mobility during this early recovery period, indicating it may not be beneficial for this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

In the first 3 months after stroke is progressive resistance training safe and does it improve activity? A systematic review. Salter, K., Musovic, A., F Taylor, N.[2019]

The DOSE trial demonstrated that higher therapeutic intensity in physical therapy can significantly improve long-term walking outcomes after stroke, with participants achieving over double the steps and aerobic minutes compared to usual care.

A model developed from data of 25 individuals in inpatient rehabilitation provides specific targets for prescribing exercise based on walking impairment, predicting increases of 73 steps and 0.56 minutes of aerobic activity per session, which can help tailor rehabilitation programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Step Number and Aerobic Minute Exercise Prescription and Progression in Stroke: A Roadmap. Peters, S., Klassen, T., Schneeberg, A., et al.[2022]

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This program focuses on building strength and power in the muscles, which can help improve walking and overall mobility. The trial is aimed at adults aged 18 ...

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The results from POWER -Feasibility are promising, suggesting that POWER is safe and may improve stroke recovery. POWER -Feasibility was a small study (15 ...

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Power Exercise for Stroke · Info for Participants

The results from POWER-Feasibility are promising, suggesting that POWER is safe and may improve stroke recovery. POWER-Feasibility was a small study (15 ...