High-Intensity Interval Training After Stroke: An Opportunity to Promote Functional Recovery, Cardiovascular Health, and Neuroplasticity

Andrew Marr of the UK however blames high-intensity exercise for his stroke. Your doctor should know the pros and cons of this.

Can too much exercise cause a stroke?

High-Intensity Interval Training After Stroke: An Opportunity to Promote Functional Recovery, Cardiovascular Health, and Neuroplasticity  

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Jennifer Crozier¹

Jennifer Crozier

1McMaster University, Hamilton, Ontario, Canada
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, Marc Roig, PhD²

Marc Roig

2McGill University, Montreal, Quebec, Canada
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, Janice J. Eng, PhD³

Janice J. Eng

3University of British Columbia, Vancouver, British Columbia, Canada
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Marilyn MacKay-Lyons, PhD⁴

Marilyn MacKay-Lyons

4Dalhousie University, Halifax, Nova Scotia, Canada
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, Joyce Fung, PhD²

Joyce Fung

2McGill University, Montreal, Quebec, Canada
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, Michelle Ploughman, PhD⁵

Michelle Ploughman

5Memorial University, St. John’s, Newfoundland and Labrador, Canada
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, Damian M. Bailey, PhD⁶

Damian M. Bailey

6University of South Wales, Glyntaff, Wales, UK
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, Shane N. Sweet, PhD²⁷

Shane N. Sweet

2McGill University, Montreal, Quebec, Canada7Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
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, Nicholas Giacomantonio⁴

Nicholas Giacomantonio

4Dalhousie University, Halifax, Nova Scotia, Canada
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, Alexander Thiel²

Alexander Thiel

2McGill University, Montreal, Quebec, Canada
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, Michael Trivino²

Michael Trivino

2McGill University, Montreal, Quebec, Canada
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, Ada Tang, PhD¹

Ada Tang

1McMaster University, Hamilton, Ontario, Canada
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First Published April 20, 2018 Research Article

https://doi.org/10.1177/1545968318766663

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Article Information

Article first published online: April 20, 2018

https://doi.org/10.1177/1545968318766663

Jennifer Crozier¹, Marc Roig, PhD², Janice J. Eng, PhD³, Marilyn MacKay-Lyons, PhD⁴, Joyce Fung, PhD², Michelle Ploughman, PhD⁵, Damian M. Bailey, PhD⁶, Shane N. Sweet, PhD^{2, 7}, Nicholas Giacomantonio⁴, Alexander Thiel², Michael Trivino², Ada Tang, PhD¹

¹McMaster University, Hamilton, Ontario, Canada

²McGill University, Montreal, Quebec, Canada

³University of British Columbia, Vancouver, British Columbia, Canada

⁴Dalhousie University, Halifax, Nova Scotia, Canada

⁵Memorial University, St. John’s, Newfoundland and Labrador, Canada

⁶University of South Wales, Glyntaff, Wales, UK

⁷Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada

Corresponding Author: Ada Tang, School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, Ontario, L8S 1C7, Canada. Email: atang@mcmaster.ca

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Abstract

Introduction. Stroke is the leading cause of adult disability. Individuals poststroke possess less than half of the cardiorespiratory fitness (CRF) as their nonstroke counterparts, leading to inactivity, deconditioning, and an increased risk of cardiovascular events. Preserving cardiovascular health is critical to lower stroke risk; however, stroke rehabilitation typically provides limited opportunity for cardiovascular exercise. Optimal cardiovascular training parameters to maximize recovery in stroke survivors also remains unknown. While stroke rehabilitation recommendations suggest the use of moderate-intensity continuous exercise (MICE) to improve CRF, neither is it routinely implemented in clinical practice, nor is the intensity always sufficient to elicit a training effect. High-intensity interval training (HIIT) has emerged as a potentially effective alternative that encompasses brief high-intensity bursts of exercise interspersed with bouts of recovery, aiming to maximize cardiovascular exercise intensity in a time-efficient manner. HIIT may provide an alternative exercise intervention and invoke more pronounced benefits poststroke.
Objectives. To provide an updated review of HIIT poststroke through (a) synthesizing current evidence; (b) proposing preliminary considerations of HIIT parameters to optimize benefit; (c) discussing potential mechanisms underlying changes in function, cardiovascular health, and neuroplasticity following HIIT; and (d) discussing clinical implications and directions for future research.
Results. Preliminary evidence from 10 studies report HIIT-associated improvements in functional, cardiovascular, and neuroplastic outcomes poststroke; however, optimal HIIT parameters remain unknown.  
Conclusion. Larger randomized controlled trials are necessary to establish (a) effectiveness, safety, and optimal training parameters within more heterogeneous poststroke populations; (b) potential mechanisms of HIIT-associated improvements; and (c) adherence and psychosocial outcomes.