The effect of the aerobic exercise associated to the modified constraint-induced movement therapy in chronic hemiparetic individuals: a randomized clinical trial

Abstract

Introduction: Recovery of upper limb movements in individuals after a stroke is still a challenge. The modified constraint-induced movement therapy (mCIMT) presents strong evidence for increasing the use and the recovery of sensorimotor function of the paretic upper limb. Recent studies have also shown that the combination of aerobic exercise (AE) with moderate-high intensity with specific-task training can maximize functional gains. Objectives: To verify the effect of moderate-high intensity aerobic exercise training in association to mCIMT to improve the use and the sensorimotor performance of paretic upper limb in chronic hemiparetic individuals. Methods: Individuals with chronic hemiparesis will be randomized into two groups: AE + mCIMT and Control + CIMTm. The mCIMT will restrain the non-paretic upper limb by 90% of time, and will provide massive task-oriented training of the paretic upper limb for 3 hours/day for 10 days associated to behavior interventions for improving treatment adherence. Aerobic exercise will be conducted in the stationary bicycle at moderate to high intensity (60-85% of reserve heart rate), considering the Cardiorespiratory Stress Test. People will be evaluated pre-intervention, 3, 30 and 90 days post-intervention by the following instruments: Motor Activity Log (MAL), Nottingham Sensory Assessment, Wolf Motor Function Test (WMFT), Box and Block Test, Nine-Hole Peg Test and three-dimensional kinematic evaluation of the trunk, scapula, shoulder, elbow and wrist. Data will be tested to normality and homogeneous test (Kolmogorov-Smirnov and Levene test, respectively). Parametric data will be submitted to Anova two-way test with repeated measures and Bonferroni adjustment. A 5% significant level will be considered. For nonparametric data, the Friedman test followed by Wilcoxon test with Bonferroni adjustment will be used to compare the ratings for each group. In this case, it will be considered a 1,7% significance level. To compare the groups in each assessment the Mann-Whitney test is used. A 5% significance level will be considered.