Exercise and RIC and TCD
The effects of acute exercise and remote ischaemic conditioning (RIC) on cerebral blood flow velocity in patients with ischaemic stroke and healthy controls.
Sheffield Teaching Hospitals NHS FT
STH project number, STH20750
Duration of Study in the UK
0 years, 8 months, 31 days
Aerobic exercise can be undertaken by most people, even if they’re disabled or cannot sit or stand up. Small studies using magnetic resonance imaging (MRI) in chronic stroke patients have shown moderate aerobic exercise increases cerebral blood flow. However, no studies have evaluated the safety of aerobic exercise acutely after stroke, nor whether it affects cerebral blood flow (CBF).
Remote ischaemic conditioning (RIC), ischaemia induced to a limb for short periods of time by inflating pressure cuffs around arms or legs to above systolic pressures (mmHg), often results in improved collateralisation of blood supply and improved efficiencies of cellular metabolism.
We will evaluate the feasibility of measuring real-time CBFv using trans-cranial Doppler (TCD) flow studies on acute stroke patients and healthy controls who have undergone low or moderate intensity exercise or RIC. We’ll also investigate whether changes in CBFv are detectable through the major carotid and intracranial vessels in patients and compare changes to healthy controls.
Participants will choose whether to undergo 30 minutes of light intensity leg-cycling or 4 cycles of upper limb RIC. CBFv at the MCA on both sides will be measured using a TCD headset, with repeated measures of ICA velocity (ICAv) at 5 minute intervals. TCD monitoring of the MCA and ICA will continue for 30 minutes post intervention.
Participants will repeat the protocol 24 to 48 hours later, aiming for moderate intensity leg- cycling and with RIC being performed to the opposite arm. A short verbal questionnaire will be completed on how comfortable participants found the relevant intervention.
Analysis will concentrate on safety (no serious adverse events relating to the intervention, and less than 10 adverse events in total), acceptability (average comfort score > 3/5 Likert scale) and feasibility (> 80% measurements completed) of undertaking each protocol. Changes in CBFv following exercise or RIC and how long any changes lasted will be analysed and compared to healthy control. Participants in the exercise group will be given the option to complete an MRI and biomarker substudy, to provide further detail on the CBF changes using MRI spectroscopy and changes in blood biomarkers after exercise.
Yorkshire & The Humber - South Yorkshire Research Ethics Committee
Date of REC Opinion
9 May 2019
Further Information Favourable Opinion