ESOC 2025 | PISCES-ZODIAC: testing a Zoom-based exercise intervention to slow cognitive decline after stroke

So one of the things that happens after a stroke that people don’t really think about is there’s an association with cognitive decline and there’s an association with developing brain atrophy or shrinkage. We often think of the changes that happen just after a stroke, but in fact, we’ve shown in an observational study of stroke patients that the brain loses more brain volume than you’d expect, so stroke survivors actually have a greater rate of degeneration. We know from also lots of data, including studies where we’ve looked at our stroke survivors, that those people who are more active, who spend more time in physical activities and also those who actually meet the guidelines for moderate to vigorous physical activity, have got to some extent less brain shrinkage, but also that they’ve got better cognition, so they’ve got better attention, and they accumulate white matter damage at a less rate. So we know that there are many brain benefits from exercise. You know, we know that it’s good to prevent cognitive decline; it can prevent people from developing dementia. So we thought, why don’t we actually do an exercise study to see if it stopped people’s brains from shrinking after a stroke? So we recruited a group of 110; we got 107 who were randomized in the end, ischemic stroke participants that we could exercise two months after stroke. We gave them eight weeks of an exercise intervention, which was cardiorespiratory exercise, what you’d think of as aerobic exercise, and then we also gave them some resistance training as well, because it’s now known that we need to do both. We need to do a bit of huff and puff, and we need to do some muscle work. And we compared it to an active control intervention because people were consented to an exercise study. So if we had just given them the cardiorespiratory exercise versus nothing, they would have been unblinded. The active control was a balance and stretching intervention. We tested them at two months before the intervention, at four months, at the end of intervention, and at 12 months, and our primary outcome was to say, does the brain, particularly one part of the brain called the hippocampus, which is really important for memory, does this exercise intervention stop that region from shrinking more? So we looked at volume change, brain volume change, atrophy. We had a secondary outcome, which was cognition, and that was a test that captured attention and how quickly you process things, and to some extent, planning, all things that are really affected after a stroke. We ended up recruiting, as I said, 107 people, and they were balanced in terms of the groups in terms of age, sex, years of education, their baseline function, how severe the stroke was. They were also balanced in terms of their vascular risk factors, and they were balanced in terms of how much intervention they got with our exercise people. We did not find there was a difference in the two groups in brain volume change in this area, the hippocampus. However, we did find that those who had the cardiorespiratory intervention had better cognition. They had more preserved cognition on both this measure of speed of processing and another global composite measure, if you like. When we looked at the brain volume change that the groups had compared to an observational study where participants had no intervention at all, we found that there was, in fact, much less brain volume change in both groups, suggesting that potentially both interventions, whether you do huff and puff or whether you are doing balance and stretching, actually benefited the brain. In fact, the brain volume change was the same as the stroke-free healthy controls in my prior studies. So I think that this is really encouraging evidence that cardiovascular or cardiorespiratory exercise is safe after a stroke. I think it’s encouraging that it may reduce; it might be associated with any type of intervention; might be associated with reduced brain volume, but encouragingly, we’ve demonstrated that it’s associated with better cognition. It’s the first time this has ever been shown in a stroke study.

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