Motor Performance and Cortical Neural Activity During Exercise in Patients with Different Levels of Post-Stroke Fatigue

Abstract

Background and aims: Post-stroke fatigue (PSF) can independently predict mortality in stroke patients. The effect of PSF on the process of exercise and its nature remains unclear. This study aimed to investigate how motor performance and cortical activity differ between stroke patients with high versus low post-stroke fatigue during exercise.
Methods: Eighteen informed patients completed the trial, with 8 individuals in the high PSF group (HFG) and 10 individuals in the low PSF group (LFG). Maximum voluntary contraction was measured using surface electromyogram (sEMG); each participant underwent a fatigue-inducing isometric knee-extension task at 70% maximum voluntary contraction. Cortical neural activity in cortical regions of interest was assessed using a near-infrared functional imaging system, while muscle activity was monitored with sEMG. Primary outcomes included the number of knee-extensions performed and changes in oxygenated hemoglobin (HbO2) in the regions of interest.
Results: No significant difference was observed in the number of knee-extensions between groups (P = 0.110). However, significant group differences were found in HbO2 concentration of the right primary motor cortex (P = 0.010) and left primary somatosensory cortex (P = 0.010). A time effect revealed an increase in HbO2 concentration in the left frontal eye field (P = 0.040). MPF values significantly correlated with HbO2 concentration changes in the left frontal eye field for both groups (HFG, P = 0.010; LFG, P = 0.047).
Conclusions: The endurance of patients in LFG and HFG after stroke is comparable. Patients with high PSF have the characteristics of increased neural activity in the left primary somatosensory cortex and the right primary motor cortex during exercise.

Keywords

Stroke / Fatigue / Physical exertion / Cerebral cortex / Near-infrared spectroscopy / Electromyography

CRediT authorship contribution statement

Xiaoya Zhang: Conceptualization, Writing-Original Draft, Visualization. Mingyu Yin: Validation, Formal Analysis, Data Curation. Haojie Hu: Writing-Review & Editing, Validation, Investigation. Yuanwen Liu: Writing-Review & Editing, Methodology. Qilin Cheng:Writing-Review & Editing, Methodology. Liying Zhang: Writing- Review & Editing, Supervision.

Consent to participate

The study was conducted according to the Declaration of Helsinki. All participants provided written informed consent.

Ethics statement

This study was approved by the Ethics Committee of the Third Affiliated Hospital of Sun Yat-sen University with ethics approval number RG2023-077-01.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Funding

This work was supported by the Guangdong Medical Science and Technology Research Fund (Grant No. A2025007).

Declaration of competing interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Acknowledgements

Not applicable.

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