Exercising language: Behavioral and neurophysiological changes after high-intensity exercise training in post-stroke aphasia

Project Summary/Abstract Losing the ability to speak and understand language is devastating for patients with aphasia and their families, negatively impacting multiple aspects of life and emotional well-being. Unfortunately, individuals with aphasia rarely regain their language skills in full. Novel approaches are required that boost the effects of traditional therapies, leading to better outcomes for people with aphasia. The proposed study seeks to evaluate the effects of a promising adjuvant intervention – high-intensity physical exercise training - on recovery in aphasia. A new exercise program, specifically designed for individuals with post-stroke motor and language deficits and with documented safety, feasibility and fidelity in this clinical population, will be the means of providing a safe, stroke- and aphasia-friendly high-intensity exercise intervention to achieve optimal physical and behavioral gains. Innovative outcome measures will include not only language and cognitive measures but also measures of motor skills and psychological and psychosocial outcomes that will holistically assess the benefits of physical exercise. Another cutting-edge aspect of the study is the inclusion of advanced physiological fitness measures and neuroimaging metrics of blood flow and cerebrovascular reactivity as outcome measures, to afford a deeper understanding of the exercise-mediated behavioral and neural effects in stroke survivors. We will recruit 110 individuals with aphasia to evaluate the multi-faceted impact of high-intensity exercise on outcomes and compare its effects to an active control condition involving standard-of-care low-intensity exercise. Participants will be randomly assigned to one of the two conditions. The overall format of the control intervention will be very similar to the target intervention, i.e., it will offer the same level of social and activity benefits but without the cardiovascular demands and strengthening components of the high intensity target condition. This will allow us to precisely isolate the key ingredients behind expected exercise-induced changes in language and cognition and definitively test whether the high-intensity aspect of the exercise – the premise of this project – leads to behavioral gains. First, the benefits of high-intensity exercise for language, cognition, motor, and emotional and psychological well-being in individuals with aphasia will be established. Second, it will be determined how exercise-induced changes in physical fitness are related to changes in language and cognitive measures. Third, to advance our knowledge about the brain mechanisms of the observed cognitive and language benefits, exercise-induced neurovascular changes that relate to behavioral improvements will be carefully evaluated. The validated physical exercise intervention resulting from this project will offer a new tool to clinicians seeking to help individuals with aphasia, either as a free-standing program to enhance physical health, cognition, and well-being, or as a supplementary therapy to standard speech-language therapy. Ultimately, this work could significantly alter our thinking about ancillary aphasia therapies that can benefit those with stroke and aphasia through non-traditional means, in this case, a promising, safe, cost-efficient adjunct intervention.