Effects of Moderate- to High-Intensity Multimodal Circuit Training on Molecular Biomarkers of Learning and Inflammation in People Who Have Had a Stroke: A Randomized Clinical Trial

• Grant number: 24/15042-5
• Support Opportunities: Scholarships in Brazil - Support Program for Fixating Young Doctors
• Start date: November 01, 2024
• End date: October 31, 2025
• Field of knowledge: Health Sciences - Physiotherapy and Occupational Therapy
• Principal Investigator: Thiago Luiz de Russo
• Grantee: Jean Alex Matos Ribeiro
• Host Institution: Centro de Ciências Biológicas e da Saúde (CCBS). Universidade Federal de São Carlos (UFSCAR). São Carlos , SP, Brazil
• Associated research grant: 24/02169-7 - Effects of moderate to high-intensity multimodal circuit training on molecular biomarkers of learning and inflammation in individuals who have had a stroke: randomized clinical trial, AP.R

Abstract

Introduction: Individuals who have had a Stroke typically exhibit low levels of physical activity but high levels of sedentary behavior, regardless of the post-stroke phase. These movement behaviors can impact the cardiovascular system of these individuals, increasing the likelihood of recurrent cerebrovascular events. Previous studies from our group have shown that serum concentrations of neuroprotective biomarkers, such as insulin-like growth factor-1 (IGF-1) and brain-derived neurotrophic factor (BDNF), are decreased in people who have had a stroke. Additionally, we have demonstrated that the more inactive a stroke survivor is, the higher the activity of inflammatory enzymes, such as matrix metalloproteinase-9 (MMP-9). Understanding how moderate to high-intensity multimodal circuit training affects serum biomarkers can provide insights into the modulatory mechanisms of aerobic exercise in stroke survivors. High-intensity exercise has been associated with the regulation of various biomarkers that are believed to contribute to the cognitive, motor, and cardiovascular benefits of exercise. Circuit training improves walking ability and facilitates postural transitions; however, there is a gap in understanding whether this strategy can regulate molecular mechanisms related to behavioral change and control cardiovascular alterations. This also opens up perspectives for studying the use of pharmacological agents as adjuncts to training. Objective: To investigate the effects of circuit training on molecular biomarkers linked to neuroplasticity/learning and inflammation pathways in stroke survivors. Methodology: This is a randomized clinical trial that will follow the CONSORT recommendations (FAPESP regular project 2023/04712-7). Individuals in the chronic phase of stroke who can walk independently will be randomized into two groups: an intervention group that will receive a progressive multimodal circuit training protocol with moderate to high intensity (50-80% of HRreserve); and a control group that will receive light-intensity balance training sessions (HRaverage <40%). Both groups will undergo the exercise protocol 3 times per week for 12 weeks. Assessments will be conducted pre- and post-intervention, including the measurement of the number of steps and time spent in a seated position using an activity monitor, as well as the collection of blood samples from the antecubital vein to measure BDNF, Irisin, VEGF, IGF-1, IGFBP3, TNF-alpha, and IL-10 concentrations using the ELISA method and the activity of gelatinases such as MMP-2 and -9. If the variables exhibit normal and homogeneous distribution, a Two-Way Anova test with repeated measures will be applied. Pearson's test will be used to assess the correlation between sedentary behavior variables and biomarkers. A significance level of 5% will be considered.