# Priming the Rehabilitation Engine: Aerobic Exercise as the Fuel to Spark Behavioral Improvements in Stroke

> **NIH VA IK2** · RALPH H JOHNSON VA MEDICAL CENTER · 2022 · —

## Abstract

Stroke is a leading cause of disability in the United States and poses a significant burden to Veterans. The
effectiveness of current intervention approaches is limited and many individuals following stroke live with
persistent functional, cognitive and psychological impairments that significantly reduce long-term quality of life.
The prevalence of post-stroke disability coupled with reduced stroke mortality rates reflects an increasing need
to develop effective rehabilitation strategies aimed at reducing disability and improving quality of life for Veteran
stroke survivors. Aerobic exercise (AEx) promotes numerous functional, cognitive, and psychological benefits.
Additionally, AEx may enhance neuroplasticity through increases in circulating brain-derived neurotrophic factor
(BDNF) and corticomotor excitability (CME). Emerging evidence also supports the use of AEx as a priming tool
to enhance motor outcomes following targeted rehabilitation. Our conceptual framework involves priming with
AEx prior to targeted motor rehabilitation to enhance the ‘neuroplastic environment” and make the brain more
amenable to adaptation, thereby enhancing response to rehabilitation. Specifically, we propose to pair AEx with
an upper extremity virtual reality rehabilitation game called Duck Duck Punch (DDP), developed by our team
(Co-mentor: Woodbury) as the platform for examining the adjunctive potential of AEx. Therefore the primary
aim of this proposal is to evaluate the priming effects of AEx on a motor rehabilitation intervention (i.e.
DDP) for chronic stroke survivors. This will be accomplished by examining a cohort of stroke survivors who
will be randomly assigned to receive 8 weeks (3 sessions/week) of DDP preceded by either 15 minutes of AEx
(AEx+DDP) or a stretching control (CON+DDP). Assessment of physical function before and after the
intervention will provide insight into the ability of AEx to enhance the response to motor rehabilitation. The
secondary aim of this proposal is to gain insight into the mechanisms that underlie the priming effects of AEx
through assessment of circulating BDNF and CME. Additionally, since stroke survivors often experience
cognitive and psychological impairments we will also explore the influence of cognitive and psychological
function on response to AEx+DDP. A potentially exciting possibility is that AEx facilitates an enhanced
neuroplastic environment, which fosters improved function in a variety of aspects of stroke recovery including
physical, cognitive, and psychological function. This proposal will be supported by the infrastructure and
resources provided by the South Carolina Research Center for Recovery from Stroke (NIH P20 GM109040).
Furthermore, the combination of the Ralph H. Johnson VA Medical Center and its affiliated academic institution,
Medical University of South Carolina is uniquely positioned to fill the aforementioned gap in understanding for
several reasons: 1) Charleston, South Carolina has one of the h...

## Key facts

- **NIH application ID:** 10400049
- **Project number:** 5IK2RX003540-02
- **Recipient organization:** RALPH H JOHNSON VA MEDICAL CENTER
- **Principal Investigator:** Ryan Ross
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2021-02-01 → 2026-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10400049

## Citation

> US National Institutes of Health, RePORTER application 10400049, Priming the Rehabilitation Engine: Aerobic Exercise as the Fuel to Spark Behavioral Improvements in Stroke (5IK2RX003540-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10400049. Licensed CC0.

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