Combining therapeutic approaches: rTMS and aerobic exercise in post-stroke depression: a case series.

This is a case series with only three participants, so it cannot show that rTMS or aerobic exercise caused the changes. All participants received both rTMS and aerobic exercise, so the contribution of either treatment alone cannot be separated. The study did not test whether combining rTMS and aerobic exercise was better than either treatment alone. Participants were selected for medical stability, walking ability, and absence of several conditions, so results may not apply to patients with more severe walking limits, cardiac or respiratory disease, dementia, or other excluded problems. The rTMS schedule was modified from the FDA-approved five-times-weekly protocol to three times weekly, although the weekly number of pulses times intensity was kept consistent. Lesion size and location were not explored, although they could affect response. Improvements could be due to social interaction with staff or increased community engagement rather than the treatments.

The article lists NIH extramural and non-U.S. government research support. No explicit author conflict-of-interest statement is provided.

Do not conclude that rTMS or aerobic exercise alone treated post-stroke depression. Only three people were studied, all received both treatments together, there was no control group, and the authors state no direct causality can be inferred.