Remote ischaemic conditioning for fatigue after stroke (RICFAST): A pilot randomised controlled trial

Area of Science:

• Neurology
• Cardiovascular Medicine
• Cellular Bioenergetics

Background:

• Post-stroke fatigue (PSF) significantly impacts 50% of stroke survivors.
• Remote ischaemic conditioning (RIC) shows potential in preserving mitochondrial function and improving tissue perfusion.
• RIC may offer a novel therapeutic approach to mitigate debilitating PSF.

Purpose of the Study:

• To evaluate the safety and feasibility of RIC in managing PSF.
• To assess the impact of RIC on cellular bioenergetics and fatigue levels.
• To explore RIC's potential for improving functional outcomes in stroke survivors.

Main Methods:

• A pilot randomized controlled trial involving 24 participants with PSF (Fatigue Severity Score [FSS-7] > 4).
• Participants were randomized to either RIC (200 mmHg cuff inflation) or sham (20 mmHg) for 6 weeks, 3 times per week.
• Outcomes included safety, acceptability, compliance, FSS-7, 6-minute walking test (6MWT), peak oxygen consumption (V̇O2peak), ventilatory anaerobic threshold (VAT), and muscle adenosine triphosphate (ATP) content.

Main Results:

• RIC was found to be safe with mild adverse events and excellent adherence (91%).
• Exploratory analysis indicated a trend towards lower FSS-7 scores in the RIC group compared to sham at 6 weeks, 3 months, and 6 months.
• Trends suggested improvements in VAT, muscle ATP content, and 6MWT in the RIC group.

Conclusions:

• RIC is a safe and acceptable intervention for individuals experiencing PSF.
• RIC demonstrates potential for clinically meaningful improvements in fatigue and muscle bioenergetics.
• Larger studies are warranted to further investigate the efficacy of RIC for PSF.