Power Exercise for Stroke Recovery: The POWER Pilot Trial (POWER-P)

NCT ID: NCT06780995

Last Updated: 2025-12-23

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 60 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-09-15
• Study Completion Date: 2027-09-30

Brief Summary

Weakness is one of the most common consequences of stroke. For the over 750,000 Canadians living with stroke, many daily activities like standing from a chair, walking and balance not only require strength but often efforts in bursts, known as muscle power. Strength training can improve muscle strength and, when performed at higher speeds, can help build muscle power. Current guidelines for stroke recommend strength training but these are commonly performed at lower intensities and do not include any focus on building muscle power. There has been very little research on power training after stroke.

A 10-week power training program for people living with stroke, Power Exercise for Stroke Recovery (POWER-Feasibility, NCT05816811) was recently evaluated. POWER includes 3 phases of progressive exercise: building familiarity with the upper and lower body exercises, then strength, and lastly muscle power. The results from POWER-Feasibility are promising, suggesting that POWER is safe and may improve stroke recovery. POWER-Feasibility was a small study (15 participants), and POWER was not compared to a control intervention.

A pilot randomized controlled trial of POWER (POWER-Pilot) will now be conducted. Sixty people who are at least 6 months after stroke will be recruited. They will be randomly assigned to participate in POWER or standard strength training for stroke at lower intensities and without focus on power training. The feasibility of a randomized study will be examined, and whether POWER can improve walking, strength and balance compared to the control group. Results from POWER-Pilot will help design a larger randomized trial in the future (POWER-RCT), and may ultimately be important for stroke rehabilitation teams to better understand whether power training can help people recovering from stroke.

Detailed Description

With the population aging, nearly 750,000 Canadians live with stroke, surpassing previous projections by 15 years. Post-stroke deficits, including loss of strength, balance and walking ability, are highly common. Sarcopenia, often associated with aging yet highly prevalent in stroke, underlie these deficits and contribute to lower discharge rates after hospitalization.

Community stroke exercise programs can improve strength and function to aid in recovery beyond hospital care. Most programs however follow conservative resistance exercise training (RET) approaches, as stroke guidelines are based on limited evidence. Unlike benefits of RET shown in mobility in older adults, stroke trials have shown large improvements in strength without concurrent changes in mobility, motor function or walking.

Power-focused RET involves moving lighter weights at high speed to develop muscle power, which may be more important than strength alone for activities critical for independent living such as climbing stairs, balance, and walking speed. A novel, progressive power training-focused community program for stroke (Power Exercise for Stroke Recovery, POWER) was developed to influence recovery of physical function. Following a successful single-group feasibility study of POWER (POWER-Feasibility, NCT05816811), a phase II pilot randomized trial (POWER-Pilot) is needed.

This pilot randomized trial aims to answer the following questions: 1) What is the feasibility of a multi-site randomized design to evaluate Power Exercise for Stroke Recovery (POWER), a power-focused training program for people living in the community with stroke? 2) What are the preliminary estimates of the effect of POWER compared to conventionally recommended RET (Strength Training Engaging Guidelines to Enhance Total Health, STRENGTH) for people living in the community with stroke on outcomes of functional mobility (walking, balance), post-stroke fatigue, psychological wellbeing, cognition, and health-related quality of life?

Sixty participants (6 months post-stroke, completed rehabilitation) will be randomized to POWER or STRENGTH. POWER involves 3 progressive phases: 1) Familiarization (1 week), 2) Strength (4 weeks, 2-3 sets, 5-8 repetitions), and 3) Power (5 weeks, 2-3 sets, 15-20 repetitions, fast tempo). STRENGTH is based on current RET clinical practice guidelines for stroke with no focus on power. POWER and STRENGTH matched in length, frequency (3x/week) and format (in-person supervision) but differentiated by approach to exercise progression, intensity, and tempo.

Feasibility indicators such as randomization and blinding have predefined success and progression thresholds. Estimates of the effect of POWER include functional mobility (Timed Up and Go, primary clinical outcome), walking speed, post-stroke fatigue, psychological well-being, cognition, balance, and quality of life, and will be assessed pre-post, and at 8-week follow-up. Sex and gender-related factors associated with feasibility and changes in clinical outcomes as social determinants of exercise participation post-stroke will also be examined.

Feasibility outcomes and effect estimates from POWER-Pilot will guide scalability for a fully powered RCT and future cost-effectiveness evaluation, shaping exercise best practices and facilitating hospital-to-community transition through broader implementation in community programs.

Conditions

Stroke

Keywords

Stroke; Aging; Resistance training; Power training; Physical function; Community exercise; Quality of life; Rehabilitation

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: OTHER
• Blinding Strategy: SINGLE

Study Groups

Power Exercise for Stroke Recovery (POWER)

POWER involves 3 progressive phases: 1) Familiarization (1 week), 2) Strength (4 weeks, 2-3 sets, 5-8 repetitions), and 3) Power (5 weeks, 2-3 sets, 15-20 repetitions, fast tempo).

Group Type: EXPERIMENTAL

Power Exercise for Stroke Recovery (POWER)

Intervention Type: OTHER

POWER incorporates 3 progressive phases: Phase 1 Familiarization (Week 1) as a low-intensity version of the training program to acclimate participants to the movements (body weight resisted or light weights, RPE 2-3 "Fairly light" to "Moderate"). Phase 2 Strength (Weeks 2-5) progresses loads to achieve volitional fatigue within 6-8 repetitions (RPE 7-9 "Very hard" to "Very very hard"). Phase 3 Power (Weeks 6-10) will use intensities RPE 4-6 ("Somewhat hard" to "Very hard"), and exercises will be executed at the highest possible velocity to focus on muscle power. The Power phase is intentionally designed with exercises to emphasize functional movements such as fast sit to stands, lunging and calf raises.

Strength Training Engaging Guidelines to Enhance Total Health (STRENGTH)

STRENGTH is based on current resistance exercise training (RET) clinical practice guidelines for stroke with no focus on power.

Group Type: ACTIVE_COMPARATOR

Strength Training Engaging Guidelines to Enhance Total Health (STRENGTH)

Intervention Type: OTHER

STRENGTH is based on current clinical practice guidelines for RET after stroke. It will include the same Familiarization week as the POWER program (Week 1), followed by progressive conventional RET involving 3 sets of 10-15 repetitions at moderate to high intensities (RPE 4-5 "Somewhat hard" to "Hard") (Weeks 2-10). The external resistance will be progressed to maintain this target RPE range. STRENGTH is matched with POWER in length (60-minute sessions over 10 weeks), frequency (3x/week) and format (in-person supervision).

Interventions

Power Exercise for Stroke Recovery (POWER)

POWER incorporates 3 progressive phases: Phase 1 Familiarization (Week 1) as a low-intensity version of the training program to acclimate participants to the movements (body weight resisted or light weights, RPE 2-3 "Fairly light" to "Moderate"). Phase 2 Strength (Weeks 2-5) progresses loads to achieve volitional fatigue within 6-8 repetitions (RPE 7-9 "Very hard" to "Very very hard"). Phase 3 Power (Weeks 6-10) will use intensities RPE 4-6 ("Somewhat hard" to "Very hard"), and exercises will be executed at the highest possible velocity to focus on muscle power. The Power phase is intentionally designed with exercises to emphasize functional movements such as fast sit to stands, lunging and calf raises.

Intervention Type: OTHER

Strength Training Engaging Guidelines to Enhance Total Health (STRENGTH)

STRENGTH is based on current clinical practice guidelines for RET after stroke. It will include the same Familiarization week as the POWER program (Week 1), followed by progressive conventional RET involving 3 sets of 10-15 repetitions at moderate to high intensities (RPE 4-5 "Somewhat hard" to "Hard") (Weeks 2-10). The external resistance will be progressed to maintain this target RPE range. STRENGTH is matched with POWER in length (60-minute sessions over 10 weeks), frequency (3x/week) and format (in-person supervision).

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

1. ≥19 years old

2. ≥6 months poststroke,

3. able to walk >10 meters with or without an assistive device

4. have mild to moderate stroke severity (modified Rankin Scale ≤3)

5. without significant cognitive impairment that would preclude safe exercise, screened via Montreal Cognitive Assessment-Blind score <18

Exclusion Criteria

1. Any contraindications to exercise for people with cardiovascular disease, such as unstable angina, uncontrolled hypertension, orthostatic blood pressure with exercise, or uncontrolled arrhythmias or

2. Actively engaged in or have made plans to engage in stroke rehabilitation services

• Minimum Eligible Age: 19 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

McMaster University

OTHER

Sponsor Role: lead

Responsible Party

Ada Tang

Professor, Assistant Dean

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

The University of British Columbia - Okanagan Campus

Kelowna, British Columbia, Canada

Site Status: RECRUITING

McMaster University

Hamilton, Ontario, Canada

Site Status: RECRUITING

Countries

Canada

Central Contacts

Ada Tang, PT PhD

Role: CONTACT

Phone: 289-426-5768

Email: atang@mcmaster.ca

Hanna Fang

Role: CONTACT

Phone: 289-426-0468

Email: fangh@mcmaster.ca

Facility Contacts

Brodie Sakakibara, PhD

Role: primary

Kenneth Noguchi, PhD

Role: backup

Ada Tang, PT PhD

Role: primary

Hanna Fang

Role: backup

Other Identifiers

POWER-Pilot

Identifier Type: -

Identifier Source: org_study_id