Abstract
Introduction: Post-stroke individuals exhibit a concerning pattern of physical inactivity and increased sedentary behavior, as they engage in limited walking and spend extended periods of the day seated, thereby elevating the risk of developing various health problems, including new stroke episodes. Multimodal circuit training has been recommended by guidelines to enhance the mobility of this population. This type of exercise provides strength, flexibility, and balance training, which are essential for the sensorimotor recovery of these individuals. Furthermore, when organized to emphasize and sustain intensity levels based on heart rate (HR), it can be considered an excellent aerobic exercise. Currently, the effectiveness of multimodal circuit training, with moderate and high HR intensities, on real-world walking capacity and behavior change in individuals who have experienced a stroke is unknown. In this context, investigating the movement behavior, measured by activity monitors, could complement the understanding of the physical components of social participation in these individuals. Objective: To evaluate the effectiveness of a multimodal circuit exercise protocol in increasing the number of steps and reducing sedentary time in individuals affected by stroke. Methodology: This is a randomized and randomized clinical trial. We will enroll 48 individuals with at least 6 months post-stroke, who are capable of walking independently. The individuals will be randomized into two groups based on their ambulation level and age, and they will receive physical exercise protocols three times a week over 12 weeks. The intervention group will receive a progressive multimodal circuit exercise protocol with moderate to high intensity (target heart rate of 50-80% of HR reserve), while the control group will receive light-intensity balance training sessions (target heart rate <40%). Assessments will be conducted pre- and post-intervention, up to one week, with a 3-month follow-up. The primary outcome will be the number of steps per day and time spent seated, while secondary outcomes will include quality of life, sensorimotor impairment, functional balance, walking speed, grip strength, self-perceived level of assistance, performance quality, walking confidence, and walking endurance. For intergroup and intragroup comparisons, as well as post-intervention and follow-up comparisons, we will use Two-Way ANOVA for repeated measures or the Friedman analysis (with alpha adjusted by Bonferroni correction). The significance level will be set at 5% (p-value <0.05). The analyses will be conducted using Statistical Package for the Social Sciences version 22. (AU)
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