OBJECTIVE: To explore the physiological factors influencing exercise-induced changes in peak oxygen consumption and function post-stroke. DESIGN: Single centre, single-blind, randomised controlled pilot trial. SETTING: Community stroke services, North East England. PARTICIPANTS: Forty adults (> 50 years, independent with/without stick) with stroke (> 6 months) were recruited from 117 eligible participants. Twenty participants were randomised to the 'intervention' group and twenty to the 'control' group. No drop outs or adverse events were reported. INTERVENTIONS: Intervention group: 19 week (3x1 hour) progressive mixed (aerobic/strength/balance/flexibility) community group exercise programme. CONTROL GROUP: Matched duration home stretching programme. MAIN OUTCOME MEASURES: Pre and post-intervention: (1) maximal cardiopulmonary exercise testing with non-invasive (bioreactance) cardiac output measurements and (2) functional outcome: six minute walk test; Timed Up and Go and Berg Balance Scale. RESULTS: Exercise improved peak oxygen consumption (18 +/- 5 to 21 +/- 5 ml/kg/min p < 0.01) and peak arterial-venous oxygen difference (9.2 +/- 2.7 to 11.4 +/- 2.9 mlO2/100 ml of blood p < 0.01), but did not alter cardiac output (17.2 +/- 4 to 17.7 +/- 4.2 L/min, p = 0.44), or cardiac power output (4.8 +/- 1.3 to 5.0 +/- 1.35 Watts, p = 0.45). A significant relationship existed between change in peak oxygen consumption and change in peak arterial-venous oxygen difference (r = 0.507 p < 0.05), but not with cardiac output. Change in peak oxygen consumption did not strongly correlate with change in function. CONCLUSION: Exercise induced peripheral muscle, but not cardiac output adaptations after stroke. Implications for stroke clinical care should be explored further in a broader cohort. TRIAL REGISTRATION: Trial identifier ISRCTN41026907, URL http://www.controlled-trials.com/ISRCTN41026907.

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