Power Assisted Circuit Exercise for Stroke (PACE4S): A Refinement Study
Stroke
Type of exercise All exercise will be performed on three seated PACE machines manufactured by Innerva: Cross Cycle, Chest and Legs, and Tricep Dip Leg Press. Participants will be supervised whilst transferring on and off the machines by the research assistant(s). Where required, accessories to aid use of the equipment will be provided, e.g. bolster cushion, assistive glove. Participants will be encouraged to exercise on all three machines during each session, but this will be tailored according to participant ability and confidence. Frequency Two sessions per week with a minimum of 48 hours between each session. This may be refined for Phase Two according to participants' reported fatigue, observed tolerance of the intervention, and attendance/completion data. Intensity Exercise intensity will be monitored through heart rate, rate of perceived exertion (Borg Scale), and observed exertion (skin changes, perspiration, breathlessness). Each session will include a low-intensity 5-minute warm-up and a 5 to 10-minute cool-down aiming to return to a resting state. The target heart rate during the conditioning phase of each exercise session will be 40% to 70% age-predicted heart rate reserve. Duration Maximum session duration will be 60 minutes, including warm-up, cool-down, transfers between machines, and monitoring. The target duration for each session will be 40 minutes and will be tailored according to reported fatigue levels and observed exercise tolerance. The intervention will be scheduled over eight consecutive weeks, comprising a total of 16 sessions. Supervision The Chief Investigator and Chartered Physiotherapist (RY) will supervise the first two exercise sessions for each participant. Two trained research assistants will attend and assist each session. Students enrolled on pre-registration physiotherapy courses at Sheffield Hallam University will have the opportunity to observe and support intervention delivery through the schedule of professional placements
1. Community dwelling adult aged 18 years or older (The study will not be delivered to people receiving in-patient rehabilitation) 2. Confirmed diagnosis of stroke; haemorrhagic or ischaemic (People with recurrent strokes will be eligible for recruitment) 3. Modified Rankin Scale score of 3 or 4 (We aim to target people living with some mobility impairment and/or dependence in activities of daily living. This will ensure that people typically excluded from previous exercise trials for stroke will have the opportunity to participate. The criteria developed by [London and Karmal 2025] will be implemented during the screening process to determine Modified Rankin Scale score) 4. Able to comprehend purpose of the study and provide informed consent (During the screening telephone call or home visit the Chief Investigator who is a Chartered Physiotherapist with expertise in stroke rehabilitation, will consider whether the potential participant has comprehended the purpose of the study and the commitment associated with participation. We do not plan to conduct quantified tests of mental capacity (e.g. Mini Mental Test) as this would not represent real world practice)
1. Contraindication to exercise according to American College of Sport’s Medicine (The screening telephone call or home visit will include questions about past medical history,current investigations,active treatments and prescribed medication. Wherever there is a concern about safety to engage in exercise due to a co-existing medical condition(s) recruitment to the study will be deferred and a medical review from either the GP or Co-Investigator,Dr Ali Ali (stroke consultant) will be requested) 2. The baseline assessment will include a submaximal exercise test with a target intensity of 85% age-predicted maximum heart rate (adjusted for beta-blockers). Heart rate,observed exertion and reported exertion will be monitored throughout the test. Blood pressure and oxygen saturation will be checked prior to and immediately after testing. Any abnormal responses to exercise will trigger medical review and deferred recruitment to the study. 3. Body weight greater than 150KG (The PACE equipment is CE Certified to support people weighing up to 150 KG. Weight will be checked during the baseline assessment. Any person weighing more than 150KG will be supported in accessing alternative physical activity options and nutritional advice) 4. Functional Ambulation Category less than 1 (People who are dependent on hoists or transfer aids to move between seated surfaces will not be eligible to join the study due to risk of injury to themselves or the research assistants) 5. Unable to follow verbal or non-verbal prompts or instructions (The ability to follow single-stage instructions which will be conveyed through a combination of verbal and non-verbal prompts with support from translators or carers as required will be assessed during the baseline assessment)