Our Exercise Program

High-Intensity Functional Interval InterVention (HI-FIIV) is a High-Intensity Interval Training (HIIT) full-body circuit workout optimized to accommodate the range of motor abilities and general deconditioning observed in stroke survivors.

The HI-FIIV exercise program we developed is unique in the following ways:

  • Includes functional exercises to be performed at high cardiovascular intensities, enabling participants to achieve at least 80% of their maximal heart rate,
  • Incorporates strengthening components,
  • Includes functional recovery exercises designed to improve balance,
  • Progresses in challenge throughout the whole intervention period, 
  • Incorporates real-time feedback on heart rate to ensure that appropriate intensities are achieved,
  • Is safe and accessible to individuals with motor and language deficits.

This video offers an overview of our new exercise intervention, with more detailed information provided below:

The HI-FIIV protocol includes 12 weeks of exercise training performed 3x/week in a HIIT format with each exercise class lasting 45-50 minutes comprised of a 10-minute warm-up, 25-30 minute workout in HIIT format, and a 10-minute cooldown. The HIIT protocol includes 4 different high-intensity exercises done for 30-60 seconds (duration increasing throughout the intervention) and 4 different postural stability recovery exercises done for 60 seconds (duration unchanged throughout the intervention).

Participants with aphasia completing the HI-FIIV program during the APEX pilot study.

High-Intensity

The high-intensity characteristics of the HI-FIIV program are first and foremost designed to increase cardiovascular fitness, as a means of maximizing cognitive and language gains, with the added benefit of improving muscular endurance and balance by way of the circuit training format. In contrast to prior high-intensity rehabilitation trials focused on the recovery of a particular locomotor skill, and involving specific and costly equipment, the HI-FIIV program is not limited by the constraints of task specificity. Instead, the proposed intervention protocol relies on cardiovascular exercise principles: rhythmic use of large muscle groups to elevate heart rate.

Active Recovery

Low-intensity balance and sensory training exercises during these active recovery intervals are intended to address the motor control deficits affecting some stroke patients and may elicit adaptations to physical measures beyond those for cardiovascular fitness. The active recovery intervals also reduce the likelihood of venous pooling, orthostatic hypotension, and falls.

Challenging

The reduction in work-recovery intervals over the course of the intervention is intended to maintain the challenge of the training program as participants improve exercise tolerance and cardiovascular fitness. Also, there are modest increases in movement complexity of all exercises every 4 weeks of the intervention to mirror participants’ potential improvements in motor performance. Further, weighted vests are introduced and their weight is increased throughout the program, to further augment cardiovascular demands as participants get fitter.

Heart Rate Monitoring

During each class, we continuously monitor participants’ heart rates and display them on a large monitor at the front of the room. This offers a very effective mechanism for providing feedback in real-time to participants on how hard they are exercising. It helps ensure that intensity targets for both high-intensity and recovery intervals of the HIIT workout are consistently being achieved.

Heart rate monitoring results as they are displayed on the screen during the exercise sessions.

Accessible

Our goal was to develop an accessible exercise program that could be delivered both in-person and online, reducing participation barriers and ensuring long-term adherence to the training. The intervention does not require specialized fitness equipment, a large gym space, or complex bodily movements that need to be closely supervised by a fitness professional. The only required exercise equipment is weighted vests that increase cardiovascular demand. To accommodate individuals with hemiparesis, we intentionally avoided using any weights or resistance bands that require single-hand gripping. 

Safe

The exercises used in our training were modified to accommodate varying fitness and motor ability levels, thus ensuring both accessibility and safety. Overall, HIIT has been shown to be safe for stroke patients and is associated with very low occurrences of adverse health events. To further mitigate this risk, participants are instructed to monitor their sensations of exertion and differentiate between expected acute sensations (e.g., muscle fatigue, increased heart and breathing rate) versus symptoms of a medical complication (e.g., angina, joint pain, shortness of breath). Also, real-time heart rate monitoring provides an additional precaution that participants are not overly exerting themselves.

For more information about the role of exercise in stroke recovery and specifically High-Intensity Interval Training for stroke rehabilitation see recent publications:

Crozier et al. 2018, Gibala et al. 2018, MacKay-Lyon et al. 2020, Anjos et al., 2022