Preliminary Findings

The APEX project is supported by a grant from the National Institute on Deafness and Other Communication Disorders (R56DC020700).

In all, results of our pilot studies support the feasibility and fidelity of the novel HI-FIIV exercise program for stroke survivors. This new intervention addresses an important clinical need and is poised for successful implementation in a larger clinical trial exploring its multifaceted impact on aphasia recovery.

June 2024

APEX pilot study of the HI-FIIV program for stroke survivors with aphasia

In the winter-spring of 2024, we conducted a small study to evaluate how well the HI-FIIV program works for stroke survivors with aphasia. Our pilot data clearly demonstrated that people with aphasia can successfully engage in the high-intensity exercise program. The program effectively accommodated participants with varying degrees of language and motor impairments, including severe hemiparesis, and showed very promising trends in terms of behavioral changes. Specifically, the study addressed the following questions:

Can stroke survivors with reduced mobility and fitness levels safely engage in and complete a high-intensity interval training (HIIT) exercise program?

  • Individuals with aphasia can safely and successfully engage in the high-intensity APEX exercise program.
  • The program’s structure effectively accommodates participants with varying degrees of motor and language impairments.
  • All participants with aphasia safely completed the HIIT exercise program with no incidents concerning the safety of the APEX program itself.

Can participants with aphasia adhere to a rigorous exercise program?

  • Stroke survivors were consistently engaged and highly motivated to attend in-person classes held 3 times a week and adhere to the exercise regimen.
  • Attendance rates among participants with aphasia were exceptionally high, with 98% attendance across all 24 sessions.
  • Participants displayed high levels of enthusiasm and motivation, eagerly completing the exercise regimen.

Can PWA achieve a true cardiovascular workout with HI-FIIV?

  • The HI-FIIV program elicited appropriate physiological response in participants with aphasia, with heart rates aligning with existing HIIT guidelines.
  • As can be seen in the Figure below, all participants achieved their heart rate goals, validating the program’s high-intensity nature and the application of this HIIT format in the stroke population.
Graph of Participants' heart rates from the pilot study, showing a trend sharply increasing heart rate during high intensity exercise and decreasing heart rate during low intensity and rest periods.
This Figure shows an averaged heart rate (HR) graph for one of the high-intensity exercise sessions (top Panel A). Below sample HR graphs of individual participants are shown (bottom Panel B). Colors indicate different HR zones, ranging from 50%-60% (white) to 90-100% (red) of maximal heart rate. The graphs show elevated HR during high-intensity exercises (gray bars) interspersed with HR recovery as would be expected from a HIIT protocol. Even Participants 1 & 3 with right-sided hemiparesis showed a HR profile similar to Participant 2 without motor impairments as well as to the group average.

Can participation in the HI-FIIV program lead to changes in physical fitness?

  • Stroke survivors with aphasia demonstrated clinically meaningful improvements in multiple domains of physical fitness, including aerobic endurance, lower body strength, dynamic and static balance.
  • Improvements in aerobic endurance were particularly notable. Aerobic endurance is an indicator of cardiovascular fitness and is directly linked to cardiovascular health.
  • Two participants with right-sided hemiparesis also had a marked increase in gait speed.

This Figure shows examples of changes on the physical fitness measures from pre- to post-intervention. The bars indicate group averages at pre (light blue bars) and post-intervention (navy bars), the colored lines show individual data. The data highlight that all participants showed pronounced improvements on physical fitness measures following the HI-FIIV program.

Can participation in the HI-FIIV program lead to changes in cognitive and language abilities?

  • Participants also showed promising improvements in multiple cognitive and language abilities, including executive control, working memory, sentence-level comprehension, and verbal fluency.

November 2023

Pilot study of the HI-FIIV program in healthy older controls

The HI-FIIV program was found to be safe and feasible in healthy older adults with no adverse events and high levels of adherence. Recorded heart rates aligned with HIIT guidelines in high-intensity and recovery periods, validating the fidelity of the protocol. Further, functional fitness gains were observed in aerobic endurance, lower body strength, agility, gait, balance, and joint mobility. Exercise-mediated positive trends in cognition were noted in working memory and executive control tasks. These results support further exploration of the HI-FIIV program in stroke survivors.