Home-based supervised cardiorespiratory interval training decreases post-stroke fatigue and improves cardiorespiratory fitness—an RCT

Introduction Post-stroke fatigue (PSF) affects nearly half of all stroke survivors and significantly hinders rehabilitation and daily functioning. There is no established treatment. Low cardiorespiratory fitness may contribute to PSF, suggesting aerobic training as a potential intervention.

In this two-center, randomized, open-label, blinded-endpoint trial, we evaluated a home-based supervised cardiorespiratory interval training program (HS-CITP) in individuals with PSF (Swedish Fatigue Assessment Scale [S-FAS] ≥28) 1–7 months post-stroke. Participants were randomized (1:1) to either HS-CITP or usual care with self-directed activity following early supported discharge. The intervention included three weekly cycling sessions at 70%–80% of maximum heart rate over eight weeks. The primary outcome was self-reported fatigue (S-FAS); the secondary outcome was peak oxygen uptake (VO₂peak, mL/kg/min) post-intervention.

Forty-five participants were randomized; 43 completed follow-up (HS-CITP: n=22; control: n=21). Adherence to HS-CITP was 92%, with no adverse events. Compared with the control group, HS-CITP significantly reduced fatigue (mean between-group difference −5.35 S-FAS points; 95% CI −9.03 to −3.67; p<.001) and improved cardiorespiratory fitness (+4.48 VO₂peak mL/kg/min; 95% CI 3.41–5.54; p<.001).

Supervised home-based interval training significantly reduced PSF and improved fitness, with high adherence and no safety concerns. These findings support integrating structured aerobic exercise into stroke rehabilitation. Larger, longer-term trials are needed to confirm the durability of this benefit. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03458884 Competing Interest Statement The authors have declared no competing interest. Clinical Trial NCT03458884 Funding Statement This work was supported by the Swedish Stroke Foundation, the Northern Swedish Stroke Fund, the Västerbotten Council, the medical faculty of Umeå University, Norrbacka-Eugenia Foundation, and Region Gävleborg Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the Swedish Ethical Review Authority (Umeå Dnr 2015-420-3M and Gävle Dnr 2019-03207). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data are available without restrictions from the corresponding author on reasonable request. Non-standard Abbreviations and nonstandard acronyms - ESD - Early Supported Discharge - HIIT - High-intensity interval training - HS-CITP - Home-based, supervised cardiorespiratory interval training program - LIVI - Lugnet Sports Science Institute laboratory - PSF - Post-stroke Fatigue - RPE - Borg Rating of Perceived Exertion scale - S-FAS - Swedish Fatigue Assessment Scale - UMEX - Umeå Movement and Exercise Laboratory - VO₂peak - Peak oxygen consumption