September 3, 2020

A CPSR-funded study provides the first preliminary evidence that patients with stroke can improve their walking recovery and quality of life with higher doses of aerobic and stepping activity in the early and critical time period for brain recovery after stroke.

The Phase II Canadian DOSE (Determining Optimal post-Stroke Exercise) clinical trial, published in the September issue of the journal Stroke, compared two different ‘doses’ of exercise therapy alongside usual care between 2014 and 2018. Seventy-five patients were tracked for long-term followup. The study involved clinicians at six inpatient rehabilitation centres.

Benefits gained during a more intensive rehabilitation program in the early weeks after stroke --with higher movement repetitions (steps) and greater exertion (heart rate) -- were found to be retained long term and resulted in better outcomes than standard care.

Findings from the DOSE trial are “important because they heralded one of the first demonstrations of precision dosing and outcomes in subacute stroke survivors using a specified exercise program while identifying time for maximal improved gait speed,” writes Dr. Steven Wolf of Atlanta’s Emory University in an accompanying editorial.

As part of DOSE, therapists used heart-rate monitors and step counters and they reported that these simple, low-cost tools improved their confidence to push people harder during exercise sessions.

The study was originally funded by CPSR as a project aimed at the “Development of an inpatient stroke rehabilitation clinical trials network” from which the DOSE protocol was developed. The DOSE study was a precursor to the formation of CanStroke Recovery, an important national clinical trials platform created by CPSR to test and validate new approaches to stroke recovery.

“DOSE demonstrated the huge benefits of researchers coming together to recruit patients and to target what we thought was a really important question to move the field forward,” says research leader Dr. Janice Eng of the University of British Columbia.

An implementation trial of DOSE is slated to begin this fall at smaller research centres, including Fredericton, Saskatoon and Kelowna, Dr. Eng says. The trial has been delayed during the COVID-19 pandemic.

A grant is currently in preparation for submission to the US National Institutes of Health to adapt the DOSE protocol to a U.S-based system.

“DOSE findings and the ongoing work of CPSR researchers to probe new and more effective therapies are critical to restoring lives affected by stroke,” says Katie Lafferty, CEO of CPSR. “We are enormously excited that the CanStroke Recovery Platform will now pave the way for important discoveries.”

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