Exercise Effect on Cerebral Artery Hemodynamic and Morphology in Stroke Patients: A Randomized Trial

Aims: Stroke is a leading cause of death and disability worldwide and occurs primarily due to impaired cerebrovascular health. Aerobic exercise training (AET) has the potential to improve deconditioned cerebrovascular status in post-stroke patients, but its utility remains underexplored. This study assessed the effects of AET on cerebral artery morphology and hemodynamics in post-stroke patients using advanced ultrasonography techniques. Methods: A randomized controlled trial (RCT) involving post-stroke patients randomly assigned to either a 12-week, high-intensity supervised cycling AET program (3 sessions per week, 30 min per session) or stretching (control) program was conducted. Duplex carotid ultrasound novel applications assessed pre- and post-intervention morphological features (carotid intima-media thickness (CIMT), arterial stiffness, and 3D features) and hemodynamics (resistive index (RI), pulsatility index (PI)). Transcranial color-coded Doppler (TCCD) assessed middle cerebral artery (MCA) hemodynamics. Results: A total of 42 post-stroke patients, mean age (64.4 ± 7.6 years) were enrolled (cycling AET, n = 21 and stretching, n = 21). Mixed design ANOVA revealed significant time*exercise group interactions for CIMT, compliance, and distensibility (all p < 0.05). Cycling AET significantly improved CIMT (between group mean difference (MD) = −0.04 mm, p < 0.043), distensibility (MD = 0.003 (1/kPa)), compliance (MD = 0.11 mm/kPa, all p < 0.001). Modest within-group improvements were observed in internal carotid artery, RI (MD = −0.05, p < 0.001), and PI (MD = −0.2, p < 0.001). No significant changes observed in MCA hemodynamics. Conclusion: High-intensity cycling AET improved cerebral arteries' morphology and modestly enhanced extracranial hemodynamics in post-stroke patients, without affecting MCA hemodynamics. Further studies are recommended to explore long-term vascular benefits of AET. Trial Registration: ClinicalTrials.gov identifier: NCT05706168.