Study of Blood Flow Restriction and Cognitive-Motor Dual Task Training to Improve Strength, Gait, and Balance in People With Subacute Stroke

Subacute stroke is defined as the period between 7 days and 6 months after stroke onset, a critical window during which neuroplasticity and functional recovery are highly active. During this phase, individualized and task-specific interventions can enhance motor recovery. Blood flow restriction (BFR) training is a promising low-load exercise modality that induces physiological effects similar to high-intensity training by restricting venous return using a proximal cuff. Studies suggest that BFR training at 40% of arterial occlusion pressure (AOP) can safely stimulate muscle hypertrophy and strength, particularly in populations with limited exercise capacity, such as stroke survivors.

Additionally, dual task training, which combines motor and cognitive tasks, has been shown to improve executive function and gait performance by increasing prefrontal cortex activity. While each approach has independent benefits, the combination of peripheral muscle activation through BFR and central stimulation via cognitive-motor dual tasks may provide synergistic effects on functional recovery.

This randomized controlled trial will compare an intervention group receiving BFR training (40% AOP) with concurrent dual task gait training to a control group performing the same cognitive-motor dual tasks without BFR. Both groups will train three times per week for 5 weeks. Outcome measures will assess changes in lower limb strength, gait ability, and fall stability before and after the intervention. The study also addresses safety and standardization concerns in BFR application by using pulse oximeter-based AOP measurement protocols.

By providing evidence on the efficacy and safety of combining BFR and dual-task training in subacute stroke rehabilitation, this study aims to contribute to the development of individualized, clinically applicable intervention strategies.

Inclusion criteria

• Patients diagnosed with subacute stroke within 1 to 6 months after onset
• Able to walk at least 10 meters, with or without assistive devices
• Modified Ashworth Scale score less than 1
• Korean Mini-Mental State Examination (K-MMSE) score of 24 or higher

Exclusion criteria

• History of psychiatric disorders or cognitive impairment
• Presence of peripheral neuropathy
• Resting systolic blood pressure ≥160 mmHg or diastolic blood pressure ≥100 mmHg despite medication
• Diagnosis of heart failure or unstable angina
• History of bypass surgery within the past 3 months
• Serious musculoskeletal disorders affecting gait (e.g., amputation, fracture)