Sleep is essential to our health and well-being. Poor sleep quality is linked to chronic health problems, such as heart disease, diabetes, cognitive impairment, and dementia. After a stroke, people often experience difficulties in getting a good night’s sleep. Approximately half of stroke survivors have trouble falling and/or staying asleep. Poor sleep quality among stroke survivors increases the risk of recurrent stroke by 3-fold and the risk of early death by 76%. Hence, stroke survivors need strategies to promote better sleep. Fortunately, evidence shows that exercise can improve sleep quality even among those with sleep problems. Whether exercise training can improve sleep quality in adults with chronic stroke (i.e., at least 12 months since their stroke) and poor sleep quality is unknown. This study will investigate the effect of twice-weekly exercise training on sleep quality over a 6-month period in persons with chronic stroke (i.e., had a stroke more than 12 months ago) and poor sleep quality. We will also investigate the effect of exercise training on sleep duration, time spent in physical activity and sitting, thinking abilities, cardiovascular health, mood, and quality of life. The Canadian Institutes of Health Research funds this BC-based research to principal investigator Professor Teresa Liu-Ambrose, a Tier 1 Canada Research Chair in Healthy Aging at the University of British Columbia (UBC). Professor Liu-Ambrose’s research program focuses on the promotion of mobility and cognitive outcomes in older adults with chronic stroke and mild cognitive impairment through lifestyle interventions. Postdoctoral fellow Guilherme Moraes Balbim has received the StrokeCOG & Michael Smith Research BC Postdoctoral Fellowship to assist with recruitment, personnel training, manage participant flow and the study timeline, oversee data management and quality, conduct data analysis, lead the writing of scientific articles and knowledge translation materials, and present findings in scientific conferences and knowledge translation initiatives. Our proposed research will inform how to get better sleep after a stroke to promote recovery, long-term health, and well-being.
Program: StrokeCog
Optimizing stroke recovery in women through accessible modalities of health service delivery: A sex-and gender-based analysis of the TeleRehabilitation with Aims to Improve Lower Extremity Recovery (TRAIL) Clinical Trial
People with stroke often report the need for ongoing therapy after leaving the hospital, especially for rehabilitation to further improve leg function, walking and balance. This is particularly important when we consider that stroke affects men and women differently. Virtual rehabilitation programs may enable more women to benefit from stroke rehabilitation by reducing the need for in-person care and removing barriers such as the need for travel. The TeleRehabilitation with Aims to Improve Lower extremity recovery post-stroke (TRAIL) program is a 4-week virtual exercise program focused on improving recovery of leg function after stroke. We are conducting a clinical trial of TRAIL to examine how the program impacts walking, balance, quality of life in people with stroke with different sexes and genders. We are also interested in learning whether men and women with stroke differ in how they participate in TRAIL. Participants will be randomly assigned (50/50 chance) to the TRAIL program or a 4-week education program. We will measure walking, balance, quality of life before and after to see how men and women may differ in their response to the programs. This research will allow us to better understand how virtual rehabilitation programs can help women recover after stroke.
Resisting Vascular Cognitive Impairment: The Effects of Resistance Training on Myelin, Cortical Volume, and Mobility in Older Individuals
Combating dementia is a public health priority. Worldwide, vascular cognitive impairment (VCI) is a leading cause of dementia. Many brain changes occur in people with VCI, including myelin loss. Myelin is an understudied part of the brain white matter that is critical for transmission of signals between brain regions. People with VCI have considerable myelin loss, which could impact grey matter in cortical regions that are responsible for cognitive abilities (i.e., thinking) and physical functioning (e.g., walking). Therefore, it is important to find ways to prevent myelin loss people with VCI. Animal studies suggest that physical exercise could minimize myelin loss. We are interested in finding out if exercise in the form of strength training (e.g., lifting weights) is an effective strategy for slowing down myelin loss. In this project, we will analyze data from a 12-month study in persons with VCI who received either strength training or a control intervention. We will compare the two groups on myelin content, cortical volume, cognitive abilities and physical functioning. We will look closely at changes in brain regions located in the frontal lobe. These regions are responsible for key cognitive abilities and physical functioning. Counteracting myelin loss with exercise could preserve cognitive abilities and reduce risk of dementia and loss of function. Our proposal is also timely as the number of persons with VCI will only increase with the world’s aging population. This investigation takes place in BC and is conducted by Dr. Nárlon Boa Sorte Silva. He is a postdoctoral research fellow at UBC’s Department of Physical Therapy and School of Biomedical Engineering supervised by Dr. Roger Tam (UBC’s School of Biomedical Engineering) and co-supervised by Dr. Teresa Liu-Ambrose (UBC’s Department of Physical Therapy). Dr. Boa Sorte Silva is funded by StrokeCog-Canadian Clinical Trials Platform and by MSHR BC.
Keywords: randomized controlled trial; exercise; cerebral small vessel disease; brain health; cognition; mobility.
End of Award Update – September 2024
Results
Our project is a 12-month randomized controlled trial assessing the impact of an exercise intervention on cerebral white matter myelin, cortex, and mobility outcomes in older individuals living with subcortical ischemic vascular cognitive impairment (SIVCI). The main aspects of the project were completed between 2017 and 2023 this includes recruitment, baseline and 12-month data collection. For the aims of the current fellowship, Dr. Nárlon C Boa Sorte Silva has completed the analysis relating to the primary objective: to assess the impact of the intervention on myelin levels in white matter tracts supporting frontal lobe cortical regions. The results will be included in a manuscript currently under preparation. Analysis and reporting of secondary objectives are currently underway.
Impact
Funding from StrokeCog and MSHR BC on this project was essential to support Dr. Silva’s postdoctoral research. The impact is still being assessed as the main results have not yet been made public, given the short funding window of 6 months. However, notable achievements related to the project in first 6 months of the funding include:
- Winning the Best Poster Presentation Postdoc Category at the 2024 Clinical Trials Training Summit in Montréal, Canada
- Presenting at a Featured Research Session and chairing a Perspectives Session at the 2024 AAIC in Philadelphia, USA
- Receiving the 2-year US $160,000 Alzheimer’s Association Research Fellowship (AARF) award
Dr. Silva has also joined the Department of Health, Kinesiology, and Applied Physiology at Concordia University and it is expected that he will be nominated Canada Research Chair Tier 2 in Applied Physiology of Healthy and Activity Aging. Support from MSHR BC was crucial in achieving this critical milestone in Dr. Silva’s career.
Potential Influence
The impact and influence of the findings of our research are still being assessed. We are hopeful that the main results will help inform interventions for individuals living with SIVCI once the main results are made public in the upcoming months. Dr. Silva is currently working on the analysis of secondary objectives related to this project and he hopes to soon make the findings public.
Next Steps
Dr. Silva in his new role at Concordia University will continue to pursue research in healthy and active aging, especially healthy brain aging. The knowledge gained from the current project will help inform his next steps particularly regarding interventions for individuals in midlife who are at risk of vascular-related neurodegeneration and cognitive impairment.