Abstract
Background:Individuals after a stroke have an imbalance in the autonomic nervous system, which increases the risk of death or recurrent episodes of stroke. Transcranial Direct Current Stimulation (tDCS) combined with aerobic exercise has shown an effect on the modulation of this system.Objective:The Heart Rate Variability (HRV) and the distance traveled on the exercise bike will be assessed to verify the additional impact of tDCS combined with aerobic exercise on individuals with chronic stroke sequelae.Methods:The 34 adult individuals with diagnoses of chronic stroke will be randomized into two aerobic exercise intervention groups: G1 (with active tDCS) and G2 (with sham tDCS), three times a week, for 12 weeks.Procedures:tDCS will be implemented during the aerobic exercise with the anodal electrode positioned over the lateral dorsal prefrontal left cortex, and the cathodal electrode over the contralateral supraorbital region, with 2mA, for 20 minutes. Assessments will be carried out pre, immediately after the intervention, and on the 12th, 24th, 36th interventions, and 30 days later.The HRV data that are pulse interval (PI), square root of the mean of the squares of the differences between adjacent normal RR intervals (rMSSD), absolute high frequency (HF), absolute low frequency (LF), high and low frequency ratio (LF / HF) will be collected using a cardio frequency meter. The analysis of the distance traveled on the exercise bike before and after interventions will be analyzed in meters.Discussion:The autonomic control via brain networks after a stroke can be altered and can promote an increase in sympathetic tone, and a higher risk of sudden death or relapse of stroke. It is crucial to demonstrate the effectiveness of available treatments to improve the autonomic function.Trial registration:The study is registered as aBRAZILIAN CLINICAL TEST RECORD(ReBEC): U1111-1222-4588 on the 2018/10/16
Highlights
Dysfunction of the Autonomic Nervous System (ANS) increases the risk of cerebrovascular accident (CVA)
Farinatti et al.[20] investigated the effect of Transcranial Direct Current Stimulation (tDCS) applied before an aerobic exercise session in normotensive men; as a result, they observed decreased parasympathetic activity while sympathovagal balance increased after tDCS. These results demonstrated that non-invasive technique of brain stimulation (NIBS) applied over the prefrontal cortex (PFC) can modulate the autonomic nervous system’s activity
This study’s hypothesis is that aerobic training will improve study participants’ cognition and that TDCS added to exercise will enhance these effects. Study design This is a protocol for a double-blind, sham controlled, randomized study following the recommendations of the Consolidated Standards of Reporting Trials (CONSORT) (Figure 1) and the recommendations of the standard protocol items for clinical trials (SPIRIT) (Figure 2)
Summary
Dysfunction of the Autonomic Nervous System (ANS) increases the risk of cerebrovascular accident (CVA). HRV dysfunction is related to poor outcome in patients with acute brain injury and chronic cerebrovascular event[10,11,12]; Heinz et al.[13] observed a decrease in HRV in individuals with a 65-month average duration of injury. These findings suggest that monitoring heart rate behavior may become a helpful indicator of the outcome of cerebral injury and show the importance of treatments aimed at modulating this system.
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