Aerobic Exercise and Early Mobilisation in the Acute Phase of Stroke

Stroke is a leading cause of long-term disability. Clinical guidelines recommend early mobilisation and early initiation of aerobic exercise to optimise recovery. However, the safety and efficacy of these interventions remain uncertain. Early mobilisation aims to prevent bed rest-related complications and enhance neuroplasticity, but evidence suggests this method could be detrimental due to cerebral hypoperfusion. Aerobic exercise is advocated to counteract deconditioning, enhance function and improve cardiovascular health, but is rarely implemented in the acute phase of stroke. Moreover, evidence supporting its use in the acute phase of stroke is lacking. This thesis investigated these interventions, aiming to address key gaps in the evidence base. Study 1 assessed cerebral blood velocity (CBv) responses to early mobilisation using transcranial Doppler ultrasound. Standing induced a sustained decline in ipsilesional CBv by ~10%. An exploratory analysis indicated that CBv responses were not associated with clinical outcomes, but this was underpowered. Study 2 was a randomised feasibility trial of an aerobic exercise intervention initiated 1–7 days post-stroke. The 5-session, light- to moderate-intensity recumbent cycling intervention was safe, attenuated quadriceps muscle atrophy and potentially improved disability outcomes. Study 3 examined acute CBv and neurotrophic responses to a single bout of recumbent aerobic exercise (~10 days post-stroke), using transcranial Doppler ultrasound and enzyme-linked immunosorbent assays. CBv increased bilaterally during exercise by ~10–11% without causing adverse events, whereas peripheral BDNF measured after exercise did not change. Study 4 explored patient and therapist perspectives about aerobic exercise. Patients generally found the intervention acceptable and beneficial, whereas therapists expressed mixed views, highlighting uncertainties about efficacy, concerns regarding fatigue and maladaptation, and resource constraints. Collectively, these findings demonstrate that early mobilisation may compromise cerebral perfusion, whereas recumbent aerobic exercise safely increases CBv. In addition, aerobic exercise training is feasible, safe, and shows promise as an early stroke rehabilitation strategy