title: Muscle, functional and cognitive adaptations after flywheel resistance training in stroke patients: a pilot randomized controlled trial.
abstract: BACKGROUND
  Resistance exercise (RE) improves neuromuscular function and physical performance after stroke. Yet, the effects of RE emphasizing eccentric (ECC; lengthening) actions on muscle hypertrophy and cognitive function in stroke patients are currently unknown. Thus, this study explored the effects of ECC-overload RE training on skeletal muscle size and function, and cognitive performance in individuals with stroke.
  
  
  METHODS
  Thirty-two individuals with chronic stroke (≥6 months post-stroke) were randomly assigned into a training group (TG; n = 16) performing ECC-overload flywheel RE of the more-affected lower limb (12 weeks, 2 times/week; 4 sets of 7 maximal closed-chain knee extensions; <2 min of contractile activity per session) or a control group (CG; n = 16), maintaining daily routines. Before and after the intervention, quadriceps femoris volume, maximal force and power for each leg were assessed, and functional and dual task performance, and cognitive functions were measured.
  
  
  RESULTS
  Quadriceps femoris volume of the more-affected leg increased by 9.4 % in TG. Muscle power of the more-affected, trained (48.2 %), and the less-affected, untrained limb (28.1 %) increased after training. TG showed enhanced balance (8.9 %), gait performance (10.6 %), dual-task performance, executive functions (working memory, verbal fluency tasks), attention, and speed of information processing. CG showed no changes.
  
  
  CONCLUSIONS
  ECC-overload flywheel resistance exercise comprising 4 min of contractile activity per week offers a powerful aid to regain muscle mass and function, and functional performance in individuals with stroke. While the current intervention improved cognitive functions, the cause-effect relationship, if any, with the concomitant neuromuscular adaptations remains to be explored.
  
  
  BACKGROUND
  Clinical Trials NCT02120846.
authors.affiliation: Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden. rodrigo.gonzalo@ki.se.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Fernandez-Gonzalo
authors.affiliation: Research Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT. Universitat Autònoma de Barcelona, Sabadell, Spain.
authors.forename: Sol
authors.initials: S
authors.lastname: Fernandez-Gonzalo
authors.affiliation: Research Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT. Universitat Autònoma de Barcelona, Sabadell, Spain.|Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Marc
authors.initials: M
authors.lastname: Turon
authors.affiliation: Department of Radiology, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT. Universitat Autònoma de Barcelona, Sabadell, Spain.|Diagnostic Imaging, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Prieto
authors.affiliation: Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Per A
authors.initials: PA
authors.lastname: Tesch
authors.affiliation: Department of Neurology, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT. Universitat Autònoma de Barcelona, Sabadell, Spain.
authors.forename: Maria del Carmen
authors.initials: Mdel C
authors.lastname: García-Carreira
mesh_terms: D000368:Aged; D005260:Female; D005684:Gait / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D018482:Muscle, Skeletal / Q000502:physiology; D000066530:Neurological Rehabilitation / Q000379:methods*; D010865:Pilot Projects; D055070:Resistance Training / Q000379:methods*; D000071939:Stroke Rehabilitation
keywords: Eccentric overload; Executive function; Muscle hypertrophy; Muscle-brain interaction