Feasibility of performing a multi-arm clinical trial examining the novel combination of repetitive transcranial magnetic stimulation and aerobic exercise for post-stroke depression.
Ryan E Ross, Catherine J VanDerwerker, Mark S George and 1 others
PMID 36606675WHAT IT FOUND
Combining brain stimulation and treadmill walking is feasible for post-stroke depression, with high adherence and mild side effects.
Preliminary data suggest both interventions reduce symptoms, but the study is too small to prove which treatment works or if the combination is superior to either alone.
Key findings
01Participants showed high adherence to both aerobic exercise and repetitive transcranial magnetic stimulation, with withdrawal rates low enough to support a larger trial.
02Half of the participants with depression responded to treatment, but the study did not determine if the combination was more effective than either intervention alone.
03Side effects were mild and transient, including headaches and discomfort at the stimulation site, with no serious adverse events reported.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study was underpowered and could not determine if the combination treatment was superior to rTMS or exercise alone. Participants receiving both treatments had roughly double the contact time with researchers compared to those receiving only one intervention, which may have influenced results. Allocation was quasi-randomized, not fully randomized, which increases the risk of bias. There was no sham rTMS control group, so it is impossible to know how much of the improvement was due to the placebo effect of receiving brain stimulation. Only participants who could walk independently or with an assistive device were included, excluding those with more severe motor impairments.
Declared interests
Neuronetics Inc. donated SenStars (inserts for the TMS device) but had no role in study design, implementation, analysis, or interpretation. The authors declared no other conflicts of interest.
The easy way to misread this
Do not conclude that combining rTMS and exercise is more effective than either alone. The study lacked a control group for the added time and attention received by the combination arm, and the sample size was too small to detect differences between the active treatments.