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 a BRAZILIAN CLINICAL TEST RECORD (ReBEC): U1111-1222-4588 on the 2018/10/16
Highlights
The contribution of complications to the mortality of patients with stroke is variable between 12.5% to 22.7%1,2.Individuals with stroke have depressed parasympathetic activity mainly in the acute phase, exacerbated cardiovascular responses with increased sympathetic activity, unbalanced heart rate and blood pressure, decreased Heart Rate Variability (HRV), arrhythmias, and a higher risk of sudden death[3,4,5,6].Dorrance & Fink (2015)[7] observed that post-stroke Autonomic Nervous System (ANS) dysfunction increases the circulation of catecholamine levels in the heart, and enhances post-stroke patients’ morbidity and mortality
A great concern about the impact of physical fitness on stroke survivors to prevent cardiovascular risks has been observed in recent times, which shows the importance of physical exercise
Through the possible beneficial effects of exercise for the body, the improvement in the quality of life can be a consequence[25,26]. Study design This is a protocol for a double-blind study, controlled by sham and randomized that will follow the recommendations of the Consolidated Standards of Reporting Trials (CONSORT) (Figure 1) and the recommendations of the standard protocol items for clinical trials (SPIRIT)
Summary
Dorrance & Fink (2015)[7] observed that post-stroke Autonomic Nervous System (ANS) dysfunction increases the circulation of catecholamine levels in the heart, and enhances post-stroke patients’ morbidity and mortality. It is not yet clear whether this disfunction is an effect of increased sympathetic nervous system (SNS) activity, reduced parasympathetic nervous system (PNS) activity, or a change in the balance of the two. 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.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
