Abstract
Objective
To investigate the effect of aerobic exercise vs control (stretching/balance) on inflammatory
and oxidative stress biomarkers in stroke survivors and whether these changes are
associated with improvements in physical and metabolic health.
Design
Randomized controlled trial.
Setting
The general communities of Baltimore, Maryland, and Atlanta, Georgia.
Participants
Two hundred forty-six older (>50 years), chronic (>6 months) survivors of stroke (N=246)
with hemiparetic gait were recruited, with 51 completing pre-intervention testing
and 39 completing postintervention testing. Participants were required to have completed
all conventional physical therapy and be capable of walking 3 minutes on a treadmill
(N=246).
Intervention
Participants completed 6 months of 2 times/wk stretching or balance (ST; n=19) or
3 times/wk aerobic treadmill rehabilitation (TM; n=20;).
Main Outcome Measure(s)
Peak oxygen uptake rate (V̇o2peak), 6-minute walking distance (6MWD), fasting plasma glucose, insulin, oxidative
stress, and inflammatory biomarkers were assessed pre- and postintervention. Homeostatic
Model Assessment of Insulin Resistance (HOMA-IR) was calculated.
Results
Physical function and metabolic health parameters tended to improve after TM but not
ST (ST vs TM: V̇o2peak: −9% vs 24%, P<.01; 6MWD: 1% vs 15%, P=.05; insulin: −1% vs −31%, P=.05; HOMA-IR: −3% vs −29%, P=.06). Plasma concentrations of nitrotyrosine, protein carbonyls, and oxidized low-density
lipoprotein (oxLDL) tended to decrease from pre-intervention concentrations in response
to TM compared to ST (ST vs TM: nitrotyrosine: 2% vs −28%, P=.01; protein carbonyls: −4% vs −34%, P=.08; oxLDL: −3% vs −32%, P<.01). Changes in circulating concentrations of C-reactive protein, protein carbonyls,
and oxLDL were negatively associated with changes in V̇o2peak and 6MWD (r's=−0.40 to −0.76) and positively associated with fasting plasma insulin
and HOMA-IR (r's=0.52-0.81, Ps<.01).
Conclusions
Six months of TM tends to be associated with increased functional capacity and reduced
oxidative stress in chronic stroke survivors. Our findings identify potentially modifiable
systemic markers of inflammation and oxidative stress important to stroke rehabilitation
and provide potential targets for novel therapeutics in future studies.
Keywords
List of abbreviations:
6MWD (6-minute walk distance), BBS (Berg Balance Scale), BMI (body mass index), CVD (cardiovascular disease), DGI (Dynamic Gait Index), FSS (Fatigue Severity Scale), HNE (hydroxynonenal adducts), HOMA-IR (Homeostatic Model Assessment of Insulin Resistance), HRR (heart rate reserve), hs-CRP (high-sensitivity C-reactive protein), IL-6 (intereukin-6), MDA (nitrotyrosine, protein carbonyls, malondialdehyde adducts), oxLDL (oxidized low-density lipoprotein), RD (registered dietitian), ST (6 months of stretching/balance), T2DM (type 2 diabetes mellitus), TM (6 months of aerobic treadmill rehabilitation), TUG (Timed Up and Go test), VA (Veterans Affairs), V̇o2 (volume of oxygen)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 11, 2022
Accepted:
June 24,
2022
Received in revised form:
June 17,
2022
Received:
December 20,
2021
Footnotes
Research reported in this publication was supported by the U.S. Department of Veterans Affairs (Career Development Award IK2 RX-000944 (PI: M. Serra); a Senior Research Career Scientist Award (PI: A. Ryan); the Baltimore, Atlanta, and San Antonio GRECCs; as well as the University of Maryland Claude D. Pepper Older Americans Independence Center (P30 AG028747).
Clinical Trial Registration: NCT02043574.
Disclosures: none.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine.
