Effects of Exercise on Endothelial Function in Stroke Patients

NCT ID: NCT00604877

Last Updated: 2008-01-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

140 participants

Study Classification

INTERVENTIONAL

Study Start Date

2003-08-31

Study Completion Date

2008-05-31

Brief Summary

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This study examines the hypothesis that 6 months of treadmill aerobic exercise training improves fibrinolysis (clot defense mechanism) and vasomotor function in chronic hemiparetic (muscular weakness or partial paralysis restricted to one side of the body) stroke patients compared to a control intervention, and that these changes are associated with reduced plasma insulin levels and improved insulin sensitivity / glucose metabolism in this population.

Detailed Description

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Stroke is the leading cause of disability and third leading cause of death in the United States. Each year approximately 750,000 individuals suffer a stroke, after which they remain at high risk for recurrent stroke and cardiovascular events. Incidence of stroke nearly doubles with each successive decade in older adults, with about 90% of strokes occurring in individuals over 55 years of age.

Following stroke, physical inactivity in advancing age increases the incidence of elevated insulin levels and the insulin resistance syndrome, which are powerful factors that heighten risk for recurrent stroke and myocardial infarction (MI) by impairing fibrinolysis and vasomotor reactivity. Currently, prevention of recurrent stroke and MI depends on best medical management, including antiplatelet therapy, which has limited efficacy. Though aerobic exercise training (AEX) has been shown to improve insulin-glucose metabolism, fibrinolysis profiles, and vasomotor reactivity in healthy elderly and type 2 diabetics, there are no data on the effects of AEX on insulin sensitivity and related vascular endothelial cell function in the chronic hemiparetic stroke population. This trial addresses a significant public health gap, in that aerobic exercise rehabilitation therapy has never been systematically studied as a means to improve cardiovascular health profiles in this population.

Conditions

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Stroke Cerebrovascular Disorders

Keywords

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exercise glucose metabolism insulin sensitivity Vascular Function

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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1

Group Type EXPERIMENTAL

Treadmill Exercise

Intervention Type BEHAVIORAL

3 times per week for 6 months, with target of 45 minutes at 60-70% heart rate range

2

Group Type ACTIVE_COMPARATOR

Stretching/ROM

Intervention Type BEHAVIORAL

3 times per week for 6 months, passive and active stretching and range of motion (ROM) exercises for the upper and lower extremities

Interventions

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Treadmill Exercise

3 times per week for 6 months, with target of 45 minutes at 60-70% heart rate range

Intervention Type BEHAVIORAL

Stretching/ROM

3 times per week for 6 months, passive and active stretching and range of motion (ROM) exercises for the upper and lower extremities

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Ischemic Stroke greater than 6 months prior in men or women ages 40-85
* Residual hemiparetic gait deficits
* Already completed all conventional inpatient and outpatient physical therapy
* Adequate language and neurocognitive function to participate in exercise testing and training

Exclusion Criteria

* Already performing greater than 20 minutes aerobic exercise 3 times per week
* All insulin dependent diabetics; non-insulin dependent diabetics with fasting glucose greater than 180 mg/dl
* Alcohol consumption greater than 2oz. liquor or equivalent per day
* Cardiac history of: (a) unstable angina, (b) recent (less than 3 months) myocardial infarction, (c) symptomatic congestive heart failure, (d) hemodynamically significant valvular dysfunction
* Medical History of: (a) recent (less than 3 months) hospitalization for severe medical disease, (b) PAOD (Peripheral Arterial Obstructive Disease) with claudication, (c) orthopedic or chronic pain condition restricting exercise, (d) pulmonary or renal failure, (e) active cancer, (f) poorly controlled hypertension (greater than 160/100) (g) Anemia defined by hematocrit less than 30
* Neurological History of: (a) dementia with Mini-Mental Status Score less than 23 (less than 17 if education level at or below 8th grade), and diagnostic confirmation by neurologist or geropsychiatrist, (b) severe receptive or global aphasia which confounds testing and training, operationally defined as unable to follow 2 point commands, (c) hemiparetic gait from prior stroke preceding the index stroke defining eligibility, (d) non-stroke neurological disorder restricting exercise (e.g. Parkinson's Syndrome), (e) untreated major depression
* Pregnancy
Minimum Eligible Age

40 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute on Aging (NIA)

NIH

Sponsor Role lead

Responsible Party

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University of Maryland School of Medicine

Principal Investigators

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Frederick M. Ivey, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Maryland, Baltimore

Locations

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Baltimore VA Medical Center/ University of Maryland School of Medicine

Baltimore, Maryland, United States

Site Status

Countries

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United States

References

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Ivey FM, Ryan AS, Hafer-Macko CE, Goldberg AP, Macko RF. Treadmill aerobic training improves glucose tolerance and indices of insulin sensitivity in disabled stroke survivors: a preliminary report. Stroke. 2007 Oct;38(10):2752-8. doi: 10.1161/STROKEAHA.107.490391. Epub 2007 Aug 16.

Reference Type BACKGROUND
PMID: 17702957 (View on PubMed)

Ivey FM, Ryan AS, Hafer-Macko CE, Garrity BM, Sorkin JD, Goldberg AP, Macko RF. High prevalence of abnormal glucose metabolism and poor sensitivity of fasting plasma glucose in the chronic phase of stroke. Cerebrovasc Dis. 2006;22(5-6):368-71. doi: 10.1159/000094853. Epub 2006 Aug 3.

Reference Type BACKGROUND
PMID: 16888377 (View on PubMed)

Ivey FM, Macko RF, Ryan AS, Hafer-Macko CE. Cardiovascular health and fitness after stroke. Top Stroke Rehabil. 2005 Winter;12(1):1-16. doi: 10.1310/GEEU-YRUY-VJ72-LEAR.

Reference Type BACKGROUND
PMID: 15735997 (View on PubMed)

Ivey FM, Gardner AW, Dobrovolny CL, Macko RF. Unilateral impairment of leg blood flow in chronic stroke patients. Cerebrovasc Dis. 2004;18(4):283-9. doi: 10.1159/000080353. Epub 2004 Aug 24.

Reference Type BACKGROUND
PMID: 15331874 (View on PubMed)

Other Identifiers

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5K01AG019242

Identifier Type: NIH

Identifier Source: secondary_id

View Link

AG0092

Identifier Type: -

Identifier Source: org_study_id