Feasibility, safety and efficacy of an early aerobic rehabilitation program for patients after minor ischemic stroke: A pilot randomized controlled trial

Objective: To examine the feasibility, safety and effectiveness of an early aerobic rehabilitation program for patients after minor ischemic stroke. Design: Randomized control trial. Methods: Twenty-eight patients, 1-3 weeks post minor ischemic stroke (modified Rankin scale; mRS ≤ 2), were randomly assigned to intervention or control groups. Measures were taken at weeks 1 and 6. All participants were instructed in home practice to achieve strength and flexibility, and were asked to continue their normal community routine. Intervention group participants performed a supervised exercise training program twice a week for 6 weeks. Exercise capacity was evaluated by the 6-minute walk distance test (6MWD), and the modified Bruce treadmill test. Results: Eight subjects out of 14 participated in all 12 training sessions, one at less than 50% of the sessions, while five reached the highest stage of the program. No adverse events were noted during the intervention period. In the intention to treat analysis a significant improvement over time was seen for the functional parameters only. No interaction (group*time) was found. According to the per protocol analysis a significant interaction effect was found; only the intervention group participants showed a significant clinical change in the 6MWD test (412 ± 178 meters to 472 ± 196 meters, vs the control group 459 ± 116 meters to 484 ± 122 meters, p< 0.01). Conclusions: An early supervised aerobic training after minor ischemic stroke is feasible and well tolerated and, in a per-protocol analysis, was associated with improved walking endurance. Further studies with a larger sample size are needed to assess the effect of such a program on functional abilities, prevention of risk factors, and recurrent stroke.