Stroke neurovascular responses to exercise: A novel rehabilitation paradigm.

Stroke is a leading cause of long-term disability, impacting the cerebrovascular, peripheral vascular and neuromotor systems. Characterising vascular responses to exercise post-stroke offers valuable insights into the impairments that might influence outcomes during neurorehabilitation. We have shown a blunted cerebrovascular response to moderate-intensity continuous exercise and high-intensity interval exercise in individuals post-stroke compared with control subjects. We have also shown an inability of the peripheral microvasculature to vasodilate in response to movement, potentially contributing to an attenuated peripheral blood flow response to submaximal and maximal isometric quadricep contractions. Reduced blood flow responses to exercise within both the cerebrovascular and peripheral vascular systems might thus have detrimental effects on the downstream tissues, influencing neuromotor function and stroke recovery. By identifying the exact mechanisms contributing to poor cerebrovascular and peripheral vascular responses to exercise, we can implement targeted interventions, such as mitochondria-targeted antioxidants and/or ischaemic conditioning. Leveraging the interdependent relationship between vascular health and neuromotor function might optimise post-stroke rehabilitation and accelerate functional recovery.