Now Available for Public Comment: Notice of Proposed Rulemaking (NPRM) for FDAAA 801 and NIH Draft Reporting Policy for NIH-Funded Trials

Structural Neuroplasticity Associated With Aerobic Treadmill Training in Geriatric Chronic Stroke Survivors

This study is enrolling participants by invitation only.
Sponsor:
Collaborators:
Robert Bosch Medical Center
Max-Planck-Institute Tuebingen
Information provided by:
University Hospital Tuebingen
ClinicalTrials.gov Identifier:
NCT00614224
First received: January 31, 2008
Last updated: NA
Last verified: January 2008
History: No changes posted
  Purpose

Aerobic treadmill exercise has been shown to improve walking, cardiovascular fitness and thereby risk factor profiles in chronic stroke patients (Macko et al., Stroke 2005). The proposed project is a randomized controlled trial in geriatric stroke patients with chronic disabilities to investigate potential mechanisms of treadmill therapy. The hypothesis is tested that 3-months of aerobic treadmill exercise induces structural brain plasticity and reorganization. The outcome measures are walking ability, gait pattern, cardiovascular fitness and brain morphology. This study will elucidate fundamental mechanisms of brain adaptations linked to task-repetitive aerobic lower extremity exercise. These mechanisms will not only lead to a better understanding but may also help to identify predictors of treatment response.

40 patients aged over 60 years with lower extremity paresis after a first-ever clinical stroke longer than 6 months prior to study inclusion will be recruited from: 1) The Geriatric Rehabilitation Clinic at the Robert-Bosch Hospital in Stuttgart 2) the Dept of Neurology, University Hospital in Tübingen. Subjects will be randomized to 3 months progressive graded aerobic treadmill exercise training (TAEX; 3 times/week, duration 10-45 min) or an attention control group (CON). Because we expect that localization and size of stroke affect therapy outcomes, stratified randomization will be used to balance entry into groups.

We hypothesize that 3 months of treadmill gait training but not conventional care leads to improvements of cardiovascular fitness and gait and to brain reorganization (structural plasticity) in regions in which functional adaptations have been demonstrated using fMRI in previous studies. The specific aims are:

  • To assess reorganization by comparing cortical thickness, cortical density and fiber tract morphology before (time point 0), and after therapy (3 months) using T1-weighted 3D-MPRAGE images, voxel based morphometry and diffusion tensor imaging.
  • To correlate brain reorganization with improvements in walking velocity, and analysis of gait patterns (parameters, swing time, stance time, gait symmetry).
  • To correlate brain reorganization with location and size of the index stroke lesion and of diffuse white matter damage (subcortical vascular encephalopathy). Lesion and white matter damage will be evaluated based on T2-weighted FLAIR sequences.

Condition Intervention
Stroke
Hemiparesis
Behavioral: treadmill exercise training

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Structural Neuroplasticity Associated With Aerobic Treadmill Training in Geriatric Chronic Stroke Survivors

Resource links provided by NLM:


Further study details as provided by University Hospital Tuebingen:

Primary Outcome Measures:
  • aerobic capacity (peak VO2) [ Time Frame: Baseline (timepoint 0) and after training (3 months) ] [ Designated as safety issue: No ]
  • gait velocity [ Time Frame: Baseline (timepoint 0) and after training (3 months) ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • cortical thickness (MRI) [ Time Frame: Baseline (timepoint 0) and after training (3 months) ] [ Designated as safety issue: No ]
  • grey matter density (VBM-MRI) [ Time Frame: Baseline (timepoint 0) and after training (3 months) ] [ Designated as safety issue: No ]
  • cerebrovascular reserve capacity (ASL-MRI) [ Time Frame: Baseline (timepoint 0) and after training (3 months) ] [ Designated as safety issue: No ]

Estimated Enrollment: 40
Study Start Date: January 2008
Estimated Study Completion Date: July 2009
Estimated Primary Completion Date: July 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: A
Treadmill training group (TAEX)
Behavioral: treadmill exercise training
3 months (3 times/week) progressive graded aerobic treadmill training with a duration of 10-45 min per training session
No Intervention: B
Attention control group (CON)
Behavioral: treadmill exercise training
3 months (3 times/week) progressive graded aerobic treadmill training with a duration of 10-45 min per training session

  Eligibility

Ages Eligible for Study:   60 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • women and men aged > 60 years
  • first ever ischemic stroke at least prior 6 months
  • all conventional inpatient and outpatient physical therapy completed
  • residual hemiparetic gait disturbance adequate language and neurocognitive function to participate in exercise training and testing

Exclusion Criteria:

  • already performing > 20 minutes aerobic exercise 3 X/ week
  • Alcohol consumption >2 oz liquor, or 2x 4oz glasses of wine, or 2x 12 oz cans of beer per day.
  • Cardiac history of

    1. unstable angina
    2. recent (< 3 months) myocardial infarction
    3. congestive heart failure (NYHA category II)
    4. hemodynamically significant valvular dysfunction.
  • Medical History:

    1. recent hospitalization (<3 months) for severe medical disease
    2. symptomatic peripheral arterial occlusive disease
    3. orthopedic or chronic pain conditions restricting exercise
    4. pulmonary or renal failure
    5. active cancer
    6. poorly controlled hypertension (>160/100) or diabetes mellitis (fasting glucose>180 mg/dl, HbA1C >10%)
  • Neurological history of

    1. dementia
    2. receptive or global aphasia that confounds testing and training, operationally defined as unable to follow 2 point commands
    3. cognitive deficits (other than dementia and aphasia, as above)

    (e) non-stroke neuromuscular disorder restricting exercise (eg Parkinson's Syndrome) (f) untreated major depression

  • exclusion criteria for MRI scanning (metal implants (e.g. pacemaker), claustrophobia, etc.)
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

No Contacts or Locations Provided
  More Information

No publications provided

Responsible Party: Andreas R. Luft, MD, Department of Neurology, University Hospital Tuebingen
ClinicalTrials.gov Identifier: NCT00614224     History of Changes
Other Study ID Numbers: BOSCH-TAEX-001
Study First Received: January 31, 2008
Last Updated: January 31, 2008
Health Authority: Germany: Ethics Commission

Additional relevant MeSH terms:
Cerebral Infarction
Stroke
Brain Diseases
Brain Infarction
Brain Ischemia
Cardiovascular Diseases
Central Nervous System Diseases
Cerebrovascular Disorders
Nervous System Diseases
Vascular Diseases

ClinicalTrials.gov processed this record on November 25, 2014