Psychosocial Responses to a Cardiovascular Exercise Randomized Controlled Trial: Does Intensity Matter for Individuals Post-Stroke?

Abstract

Objective: This study compared the effect of cardiovascular high-intensity interval training (HIIT) vs. moderate-intensity continuous training (MICT) on psychosocial responses to exercise, motivation and enjoyment, in individuals with chronic stroke.

Design: A secondary analysis of motivation and enjoyment outcomes collected from a randomized controlled trial (NCT03614585) comparing 12-weeks of HIIT vs MICT in participants with chronic stroke (6-60 months post-stroke) was conducted.

Setting: General community.

Participants: Seventy-one individuals with chronic stroke (mean ± SD, age: 65.5 ± 8.4 years, 19.4 ± 13.4 months post-stroke, 38% female) and mild disability (median ± IQR, NIH Stroke Scale score 1 ± 2).

Interventions: Twelve-week, 3x/per week progressive cardiovascular HIIT or MICT program conducted on NuStep recumbent steppers.

Main outcome measures: Motivation (Behavioral Regulation in Exercise Questionnaire-3) was measured at week 1, 6 and 12. Enjoyment outcomes comprised of affective response (Feeling Scale) assessed at each training session, and post-exercise enjoyment (Physical Activity Enjoyment Scale) assessed at week 6 and 12. Linear mixed models, examining group, time and group × time point interactions in motivation constructs and composite scores, mean affective response per session, and post-exercise enjoyment were used to compare the effect of HIIT vs. MICT.

Results: HIIT elicited a lower affective response (mean difference [95% CI]: -1.18 [-1.90, -0.47]; p = 0.002), that also progressively declined during sessions, in contrast to MICT (group × time point interaction: F [2,63.5] = 3.99, p = 0.02). HIIT and MICT did not elicit any significant difference between groups or change over time for post-exercise enjoyment or any motivation constructs (p>0.05).

Conclusions: Despite lower affective response during exercise, HIIT and MICT elicit equivalent motivation and post-exercise enjoyment. This study provides further support for the implementation of HIIT in stroke rehabilitation by demonstrating sustained responses of motivation and post-enjoyment. Future studies should consider potential strategies that positively reinforce these important psychosocial responses to implement HIIT in post-stroke rehabilitation.