The aim of this study is to investigate the effect of post-stroke sarcopenia on prognosis and clinical outcomes in patients with ischemic stroke and to compare the effects of High Intensity Interval Training (HIIT) and Moderate Intensity Continuous Training (MCIT) exercise programs on muscle mass, as well as on functional capacity, quality of life, and clinical outcomes.
Sarcopenia is a skeletal muscle disease characterized by progressive and generalized loss of muscle mass, muscle strength, and physical performance, and is associated with an increased risk of falls, fractures, functional dependency, and mortality. Although aging is one of the most important causes of sarcopenia, factors such as acute and chronic diseases, physical inactivity, inflammation, and malnutrition also play a critical role in its development. Stroke is one of the leading causes of mortality and long-term disability worldwide, and muscle loss occurring in the post-stroke period negatively affects the functional recovery process of patients. The loss of muscle mass and muscle strength that develops after stroke is not limited to the paretic extremity; significant muscle atrophy can also be observed on the non-paretic side. This condition is defined in the literature as "stroke-related sarcopenia". Stroke-related sarcopenia arises through multifactorial mechanisms such as changes in muscle fiber type, motor unit loss, decreased neuromuscular activation, increased inflammatory response, and physical inactivity. Studies have shown that there is a marked reduction in motor unit number in the early period after stroke, and that this condition is associated with loss of muscle strength. In addition, it has been reported that post-stroke sarcopenia has negative effects on activities of daily living, walking capacity, and quality of life. Exercise is considered one of the most effective interventions for the prevention and treatment of sarcopenia. The positive effects of aerobic and resistance exercises on muscle mass and functional performance have been demonstrated in many studies. In recent years, the effects of High Intensity Interval Training (HIIT) and Moderate Intensity Continuous Training (MCIT) approaches on the cardiovascular and musculoskeletal systems have been increasingly investigated. HIIT is an exercise model in which short periods of high-intensity exercise are alternated with low-intensity recovery periods and is notable for providing high physiological adaptation within a limited time. MCIT, on the other hand, is an exercise approach performed at a longer duration and at a constant intensity. Although both exercise methods have been reported to be safe and feasible in stroke rehabilitation, data regarding their comparative effects on post-stroke sarcopenia are limited. In the literature, the number of randomized controlled trials evaluating changes in muscle structure during the stroke rehabilitation process using objective measurement methods such as muscle ultrasonography is quite limited. Therefore, investigating the effects of different exercise approaches applied in the post-stroke period on sarcopenia, functional capacity, and clinical outcomes is important for both clinical practice and the planning of rehabilitation programs. This study aims to investigate the effect of sarcopenia on prognosis and clinical outcomes in patients with ischemic stroke and to compare the effects of HIIT and MCIT exercise programs on muscle mass, as well as on functional and clinical parameters.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
32
High-Intensity Interval Training (HIIT) will be delivered on a cycle ergometer under physiotherapist supervision. Each session includes a 5-minute warm-up at 50% of maximum heart rate (HRmax), followed by five cycles of 1 minute at 80% HRmax and 2 minutes of active recovery at 60% HRmax, and a 5-minute cool-down at 50% HRmax. Sessions will be performed 3 times per week for 6 weeks, with intensity progressed by 5% every two weeks as tolerated.
Moderate-Intensity Continuous Training (MCIT) will be delivered on a cycle ergometer under physiotherapist supervision. Each session includes a 5-minute warm-up at 50% of maximum heart rate (HRmax), followed by 20 minutes of continuous exercise at 80% HRmax, and a 5-minute cool-down at 50% HRmax. Sessions will be performed 3 times per week for 6 weeks, with intensity progressed by 5% every two weeks as tolerated.
Fenerbahçe University
Istanbul, Ataşehir, Turkey (Türkiye)
RECRUITINGChange in quadriceps muscle thickness measured by ultrasonography
Quadriceps muscle thickness (rectus femoris and vastus intermedius) will be measured bilaterally using ultrasound imaging. The primary endpoint will be the change from baseline to post-intervention.
Time frame: Baseline and 6 weeks
Handgrip strength
Handgrip strength will be measured using a Jamar dynamometer. The outcome will be the change from baseline to post-intervention (highest value of three trials will be used).
Time frame: Baseline and 6 weeks
Six-Minute Walk Test distance
Functional capacity will be assessed using the Six-Minute Walk Test. The outcome will be the change in walking distance (meters) from baseline to post-intervention.
Time frame: Baseline and 6 weeks
Fugl-Meyer Assessment Lower Extremity score
Lower extremity motor function will be assessed using the Fugl-Meyer Assessment (Lower Extremity), which ranges from 0 to 34, with higher scores indicating better motor function.
Time frame: Baseline and 6 weeks
Functional Independence Measure (FIM) score
Functional status and independence in activities of daily living will be assessed using the Functional Independence Measure (FIM), which ranges from 18 to 126, with higher scores indicating greater independence (better functional outcome).
Time frame: Baseline and 6 weeks
SF-36 quality of life score
Health-related quality of life will be assessed using the Short Form-36 (SF-36), with domain and/or summary scores transformed to a 0 to 100 scale, where higher scores indicate better health-related quality of life.
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Time frame: Baseline and 6 weeks
30-Second Sit-to-Stand Test repetitions
Lower extremity muscle endurance will be assessed using the 30-Second Sit-to-Stand Test. The outcome will be the change in the number of completed repetitions from baseline to post-intervention.
Time frame: Baseline and 6 weeks
International Physical Activity Questionnaire (IPAQ) score
Physical activity level will be assessed using the International Physical Activity Questionnaire (IPAQ), reported as MET-minutes/week (range: 0 to no fixed upper limit), with higher values indicating greater levels of physical activity (better outcome).
Time frame: Baseline and 6 weeks