Forced, Not Voluntary, Aerobic Exercise Enhances Motor Recovery in Persons With Chronic Stroke.
Susan M Linder, Anson B Rosenfeldt, Sara Davidson and 5 others
PMID 31313626WHAT IT FOUND
In 40 adults with chronic stroke, forced aerobic cycling plus upper limb task practice improved Fugl-Meyer scores by 11 points, versus 6 with voluntary cycling plus task practice and 9 with education plus task practice.
The forced group improved most.
Key findings
01The primary Fugl-Meyer outcome had a significant group-by-time interaction favoring forced exercise plus task practice; mean improvements were 11, 6, and 9 points for forced, voluntary, and education groups.
02Forced cycling produced a higher cadence, 74 RPM versus 59 RPM, while aerobic intensity was 60% heart rate reserve in the forced group and 59% in the voluntary group.
03On the secondary Wolf Motor Function Test, there was no treatment-by-time interaction, but the forced group improved total, gross, and fine performance time and grip strength.
STILL TO COME
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What it does not show
The analysis combined data from two smaller randomized trials, not one large trial. The forced exercise group was younger and started with higher Fugl-Meyer scores, which could have affected the result. Repetitive task practice dosages were not identical across groups. The voluntary exercise group exercised at 59% heart rate reserve, just below the 60% target. Only 44% of forced exercise participants and 50% of voluntary exercise participants reached 60% heart rate reserve or greater.
Declared interests
The supplied metadata lists research support from NIH extramural and non-U.S. government sources. The supplied text does not include an author conflicts declaration.
The easy way to misread this
Do not read this as evidence that forced aerobic exercise alone improves upper limb function. All three groups received repetitive task practice, and all three groups improved on the Fugl-Meyer. The forced group's advantage was in comparison with voluntary exercise plus task practice and education plus task practice.