Straeten Frederike A, van Zyl Stephanie, Maus Bastian, Bauer Jochen, Raum Heiner, Gross Catharina C, Bruchmann Sabine, Landmeyer Nils C, Faber Cornelius, Minnerup Jens, Schmidt-Pogoda Antje
Department of Neurology, University Hospital Münster, University of Münster, Albert-Schweitzer-Campus 1, Building A1, 48147, Münster, Germany.
Translational Research Imaging Center, University of Münster, Münster, Germany.
Neurol Res Pract. 2023 May 11;5(1):18. doi: 10.1186/s42466-023-00244-w.
Motor impairments are the objectively most striking sequelae after stroke, but non-motor consequences represent a high burden for stroke survivors as well. Depression is reported in one third of patients, the fatigue prevalence ranges from 23 to 75% due to heterogenous definitions and assessments. Cognitive impairment is found in one third of stroke patients 3-12 months after stroke and the risk for dementia is doubled by the event. Aerobic exercise has been shown to reduce depressive symptoms, counteract fatigue, and improve cognitive functions in non-stroke patients. Furthermore, exercise is known to strengthen the immune system. It is unknown, though, if aerobic exercise can counteract poststroke depression, fatigue, poststroke dementia and poststroke immunosuppression. Therefore, we aim to analyse the effect of aerobic exercise on functional recovery, cognition, emotional well-being, and the immune system. Reorganization of topological networks of the brain shall be visualized by diffusion MRI fibre tracking.
Adults with mild to moderate stroke impairment (initial NIHSS or NIHSS determined at the moment of maximal deterioration 1-18) are recruited within two weeks of stroke onset. Study participants must be able to walk independently without risk of falling. All patients are equipped with wearable devices (smartwatches) measuring the heart rate and daily step count. The optimal heart rate zone is determined by lactate ergometry at baseline. Patients are randomized to the control or the intervention group, the latter performing a heart rate-controlled walking training on own initiative 5 times a week for 45 min. All patients receive medical care and stroke rehabilitation to the usual standard of care. The following assessments are conducted at baseline and after 90 days: Fugl Meyer-assessment for the upper and lower extremity, 6 min-walk test, neuropsychological assessment (cognition: MoCA, SDMT; fatigue and depression: FSMC, HADS-D, participation: WHODAS 2.0 12-items), blood testing (i.e. immune profiling to obtain insights into phenotype and functional features of distinct immune-cell subsets) and cranial magnetic resonance imaging (MRI) with grid-sampled diffusion weighted imaging, white matter fibre tracking and MR spectroscopy.
This study investigates the effect of smartwatch-controlled aerobic exercise on functional recovery, cognition, emotional well-being, the immune system, and neuronal network reorganization in stroke patients. Trial registration ClinicalTrials.gov NCT Number: NCT05690165. First posted19 January 2023. Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05690165.
运动障碍是中风后客观上最显著的后遗症，但非运动性后果对中风幸存者来说也是一个沉重负担。据报道，三分之一的患者会出现抑郁，由于定义和评估的异质性，疲劳患病率在23%至75%之间。三分之一的中风患者在中风后3至12个月会出现认知障碍，中风使患痴呆症的风险加倍。有氧运动已被证明可以减轻非中风患者的抑郁症状、对抗疲劳并改善认知功能。此外，运动还能增强免疫系统。然而，有氧运动是否能对抗中风后抑郁、疲劳、中风后痴呆和中风后免疫抑制尚不清楚。因此，我们旨在分析有氧运动对功能恢复、认知、情绪健康和免疫系统的影响。脑拓扑网络的重组将通过扩散MRI纤维追踪进行可视化。
在中风发作后两周内招募轻度至中度中风损伤（初始美国国立卫生研究院卒中量表[NIHSS]或在病情最严重时确定的NIHSS为1 - 18）的成年人。研究参与者必须能够独立行走且无跌倒风险。所有患者都配备可穿戴设备（智能手表）来测量心率和每日步数。最佳心率区间在基线时通过乳酸测力计测定。患者被随机分为对照组或干预组，干预组主动进行每周5次、每次45分钟的心率控制步行训练。所有患者均接受常规标准的医疗护理和中风康复治疗。在基线和90天后进行以下评估：上肢和下肢的Fugl Meyer评估、6分钟步行试验、神经心理学评估（认知：蒙特利尔认知评估量表[MoCA]、符号数字模式测验[SDMT]；疲劳和抑郁：疲劳严重程度量表[FSMC]、医院焦虑抑郁量表 - 抑郁分量表[HADS - D]、参与度：世界卫生组织残疾评定量表2.0简版[WHODAS 2.0 12项]）、血液检测（即免疫分析，以了解不同免疫细胞亚群的表型和功能特征）以及头颅磁共振成像（MRI），包括网格采样扩散加权成像、白质纤维追踪和磁共振波谱分析。
本研究调查了智能手表控制的有氧运动对中风患者功能恢复、认知、情绪健康、免疫系统和神经网络重组的影响。试验注册ClinicalTrials.gov标识符：NCT编号：NCT05690165。首次发布于2023年1月19日。回顾性注册，https://clinicaltrials.gov/ct2/show/NCT05690165。
