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Aerobic Exercise Improves Cognition and Motor Function Poststroke

Department of Neurology, Kansas University Medical Center, Kansas City, Kansas, Department of Physical Therapy and Rehabilitation Science, Kansas University Medical Center, Kansas City, Kansas, Landon Center on Aging, Kansas University Medical Center, Kansas City, Kansas, bquaney{at}kumc.edu

Lara A. Boyd, PT, PhD

Department of Physical Therapy, University of British Columbia, Vancouver, Canada

Joan M. McDowd, PhD

Landon Center on Aging, Kansas University Medical Center, Kansas City, Kansas

Laura H. Zahner, PT

Landon Center on Aging, Kansas University Medical Center, Kansas City, Kansas

Jianghua He, PhD

Department of Biostatistics Kansas University Medical Center, Kansas City, Kansas

Matthew S. Mayo, PhD

Department of Biostatistics, Kansas University Medical Center, Kansas City, Kansas

Richard F. Macko, MD

Department of Neurology, Medicine, Physical Therapy and Rehabilitation Science, Baltimore Veterans Affairs Medical Center, Geriatrics Research, Education and Clinical VA RR&D Maryland Exercise and Robotics Center of Excellence, Center and University of Maryland School of Medicine, Baltimore, Maryland

Background. Cognitive deficits impede stroke recovery. Aerobic exercise (AEX) improves cognitive executive function (EF) processes in healthy individuals, although the learning benefits after stroke are unknown. Objective. To understand AEX-induced improvements in EF, motor learning, and mobility poststroke. Methods. Following cardiorespiratory testing, 38 chronic stroke survivors were randomized to 2 different groups that exercised 3 times a week (45-minute sessions) for 8 weeks. The AEX group (n = 19; 9 women; 10 men; 64.10 ± 12.30 years) performed progressive resistive stationary bicycle training at 70% maximal heart rate, whereas the Stretching Exercise (SE) group (n = 19; 12 women; 7 men; 58.96 ± 14.68 years) performed stretches at home. Between-group comparisons were performed on the change in performance at "Post" and "Retention" (8 weeks later) for neuropsychological and motor function measures. Results. VO₂max significantly improved at Post with AEX (P = .04). AEX also improved motor learning in the less-affected hand, with large effect sizes (Cohen’s d calculation). Specifically, AEX significantly improved information processing speed on the serial reaction time task (SRTT; ie, "procedural motor learning") compared with the SE group at Post (P = .024), but not at Retention. Also, at Post (P = .038), AEX significantly improved predictive force accuracy for a precision grip task requiring attention and conditional motor learning of visual cues. Ambulation and sit-to-stand transfers were significantly faster in the AEX group at Post (P = .038), with balance control significantly improved at Retention (P = .041). EF measurements were not significantly different for the AEX group. Conclusion. AEX improved mobility and selected cognitive domains related to motor learning, which enhances sensorimotor control after stroke.

Key Words: Aerobic exercise • Rehabilitation • Cognition • Executive function • Motor learning • Stroke

This version was published on November 1, 2009

Neurorehabilitation and Neural Repair, Vol. 23, No. 9, 879-885 (2009)
DOI: 10.1177/1545968309338193


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