Forced Exercise Shows Improvement in Poststroke Lower Extremity Motor Function

March 18, 2021
Marco Meglio
Marco Meglio

Marco Meglio, Associate Editor for NeurologyLive, has been with the team since October 2019. Follow him on Twitter @marcomeglio1 or email him at

The findings suggest the externally altered proprioceptive feedback in forced exercises may be increasing cortical engagement.

Data from a prospective cohort study presented at the American Stroke Association’s (AHA) International Stroke Conference (ISC) 2021, March 17-19, revealed that lower extremity motor function is improved with high-rate forced exercise (FE) in poststroke patients.1

Senior author Jay Alberts, PhD, The Edward F. and Barbara A. Bell Family Endowed Chair, Cleveland Clinic Lerner Research Institute, and colleagues also concluded that these improvements may, in part, be due to externally altered proprioceptive feedback in FE enhancing cortical engagement.

Individuals with chronic hemiparesis underwent 24 sessions of an FE cycling intervention at a cadence of at least 80 revolutions per minute. At the end of the 8-week period, participants demonstrated improved gait velocity from 0.44 m/s to 0.58 m/sec, exceeding the minimally clinically important difference for chronic stroke survivors.

Each session was 45 minutes, and participants exercised at 60% to 80% of their heart rate reserve. Alberts and colleagues collected biomechanical gait analysis at baseline and post-intervention using motion capture.

In addition to improved gait velocity, patients increased cadence by 9.4 steps/min, as well as increased right and left stride length by 6.7 cm and 8.2 cm, respectively. Other improvements in spatiotemporal characteristics such as step width were decreased by 2.4 cm, as well as single limn stance time, which was decreased by 0.2 seconds.

READ MORE: Mobile Stroke Units Superior to Standard Management in 90-Day Stroke Outcomes

Electroencephalograms (EEGs) were collected during a sample session of FE, unassisted voluntary cycling at the FE heart rate, and fully assisted passive cycling at the FE cadence. During both FE and similar passive leg movements, EEG recordings showed greater alpha/beta band desynchronization than voluntary rate cycling.

This is not the first project Alberts has worked on evaluating cycling and its effects on neurological disorders. He and his colleague Stephen Rao, PhD, are in the process of leading a 5-year study that will assess the effect of high-intensity exercise using a Peloton bike in slowing disease progression in healthy older people at high genetic risk for developing Alzheimer disease (AD).2

If successful, the trial has the potential to provide a scalable, low-cost intervention capable of substantially reducing healthcare costs by modifying the trajectory of the disease. The effects that exercise has on cognition and potentially lowering the risk of AD has been previously observed, but not in this same capacity.

Treating poststroke disability can be a challenge for clinicians, in part due to the range in levels of disability and the inconsistencies that occur with the available treatment options. Expanded efforts towards exercise interventions or modalities have gained more traction over recent years. Mijail Serruya, MD, PhD assistant professor of neurology at Thomas Jefferson University, recently sat down with NeurologyLive to discuss the need to improve poststroke care, stressing that an increase in research opportunities may lend itself to an overall greater treatment of the disease.

For more coverage of ISC 2021, click here.

1. Linder S, Taylor D, Streicher M, Davidson S, Alberts J. The effects of forced exercise on gait and cortical activation post-stroke. Presented at International Stroke Conference 2021; March 17–19. Abstract LB P21
2. National Institutes of Health awards Cleveland Clinic $6.7 million grant to evaluate impact of high-intensity exercise in preventing Alzheimer disease. News release. Cleveland Clinic. January 28, 2021. Accessed March 17, 2021.