Trials (May 2024)

ZOom Delivered Intervention Against Cognitive decline (ZODIAC) COVID-19 pandemic adaptations to the Post-Ischaemic Stroke Cardiovascular Exercise Study (PISCES): protocol for a randomised controlled trial of remotely delivered fitness training for brain health

  • Amy Brodtmann,
  • Alex Billett,
  • Rachael Telfer,
  • Kim Adkins,
  • Laura White,
  • Laura J. E. McCambridge,
  • Louise M. Burrell,
  • Vincent Thijs,
  • Sharon Kramer,
  • Emilio Werden,
  • Barbara R. Cardoso,
  • Matthew Pase,
  • Stanley Hughwa Hung,
  • Leonid Churilov,
  • Julie Bernhardt,
  • Kathryn Hayward,
  • Liam Johnson

DOI
https://doi.org/10.1186/s13063-024-08154-1
Journal volume & issue
Vol. 25, no. 1
pp. 1 – 12

Abstract

Read online

Abstract Background Stroke increases subsequent dementia risk yet there are no specific post-stroke therapies to protect cognition. Cardiorespiratory exercise is recommended for secondary prevention of stroke and may be neuroprotective. The Post Ischaemic Stroke Cardiovascular Exercise Study (PISCES) aims to reduce post-stroke secondary neurodegeneration and cognitive decline. During the pandemic, we pivoted to a ZOom Delivered Intervention Against Cognitive decline (ZODIAC) protocol, reducing pandemic-amplified barriers to exercise. Methods We present pandemic adaptions for a multicentre phase IIb assessor-blinded randomised controlled trial of ischaemic stroke survivors testing the efficacy and feasibility of an 8-week home-based exercise intervention delivered at 2 months post-stroke. We compare cardiorespiratory exercise (intervention arm) versus balance and stretching (active control arm). Participants are assessed with magnetic resonance imaging (MRI), fitness, blood, microbiome, and neuropsychological tests at three study visits: before and after the exercise intervention and at 12 months. Modifications to the original protocol include pre-exercise safety home visits, commercial delivery of exercise equipment to facilitate assessor blinding, and reconsideration of statistical plan to allow pooling of the studies. We have reduced in-person study visits from 27 to 3. Primary outcome remains between-group (intervention versus control) difference in brain volume change; secondary outcome is between-group difference in global cognitive ability to allow remote administration of a validated cognitive scale. Discussion Remotely delivered exercise interventions reduce participant burden and may reduce barriers to recruitment. A decrease in the number of in-person study visits can be supported by greater information capture via self-reported questionnaires and phone surveys. Trial registration Prospectively ACTRN12616000942459. Registered on July 2016.

Keywords