Periodised power training in community-dwelling adults with chronic stroke: a protocol for the Power Exercise for Stroke Recovery (POWER) pilot randomised controlled trial.

Introduction: Resistance training (RT) can improve muscle strength in people with stroke. However, muscle power may be more important than strength to preserve mobility after stroke. Power training (ie, RT with the intent to move as fast as possible) has shown to be feasible in people with stroke but trials to date were limited in their approaches to exercise prescription, namely providing minimal emphasis on periodisation strategies (eg, developing strength before power). We developed a periodised power training intervention, Power Exercise for Stroke Recovery (POWER), and recently showed that POWER was feasible and could improve muscle power, mobility and health-related quality of life in people with stroke. We propose the next stage in investigation-a pilot multisite randomised controlled trial to test the feasibility of the trial

Design: before embarking on a fully scaled trial.

Methods: and analysis This study will be a pilot multisite randomised controlled trial conducted at McMaster University and the University of British Columbia in Canada. 60 people ≥6 months following mild to moderate stroke will be randomly allocated to one of two, thrice-weekly, 10-week RT interventions: (1) periodised power training intervention (POWER) or (2) conventional RT intervention following current physical activity recommendations (STRENGTH). Both training programmes begin with a 1-week familiarisation period consisting of low-intensity versions of the programmes. The POWER group will begin with an intense strength-building phase (weeks 2-5), followed by a power training phase (weeks 6-10). The STRENGTH group will engage in a moderate-intensity strength-building programme from weeks 2-10. The primary outcome of this trial is feasibility of the process (eg, randomisation, blinding), resources (eg, assessor burden) and scientific feasibility (eg, adverse events), using a priori criteria for acceptance. Clinical outcomes (primary: comfortable and fast Timed Up and Go Tests) and questionnaires will be assessed at baseline, post-intervention and 8-week follow-up. Ethics and dissemination This trial has received ethical approval at both institutions (Hamilton Integrated Research Ethics Board #18235, University of British Columbia Clinical Research Ethics Board #H25-00325). Trial

Results: will be published and made available to local stroke recovery groups, clinicians and researchers in our network. Trial registration number NCT06780995.