This pilot study aims to assess the feasibility, safety, and initial efficacy of an integrated Dual Task-Oriented Circuit Training (DTOCT) program for individuals in the subacute phase of stroke recovery. Although numerous patients recover the capacity to walk in a regulated hospital environment, they frequently encounter difficulties with "community ambulation," the capability to traverse real-world settings while multitasking (e.g., walking while conversing or circumventing barriers). This study will examine if the integration of high-intensity circuit training with cognitive difficulties can promote neuroplasticity and enhance the patient's capacity to safely traverse intricate daily settings.
Diagnosed with a first-ever subacute stroke (defined as 2 weeks to 5 months post-onset) with anterior circulation involvement.
Diagnosis confirmed via neuroimaging (CT or MRI).
Men and women aged 40 to 65 years.
Motor recovery in the lower limbs corresponding to Brunnstrom stages 4 to
Expressive or receptive aphasia that impedes task comprehension
Unstable cardiovascular or medical conditions (e.g., severe hypertension, congestive heart failure) for which moderate exercise is contraindicated.
Moderate to severe depression, indicated by a Patient Health Questionnaire-9 (PHQ-9) score of ≥ 15.
Parallel
Dual task oriented circuit training
Behavioral1\. Experimental Arm: Dual Task-Oriented Circuit Training (DTOCT) Intervention Name: Behavioral: Dual Task-Oriented Circuit Training (DTOCT) Description: Participants will undergo an integrated 60-minute rehabilitation session, 3 times per week for 4 weeks (total 12 sessions). Each session includes 25-50 minutes of active circuit training across five specialized stations: Dual-Task Walking: Straight walking (3-8m) while performing forward/backward number sequencing. Obstacle Walking: Stepping over cone or hurdle obstacles (5-14cm) while naming object categories from long-term memory. Stair Navigation: Ascending/descending stairs (10-17cm step height) while identifying colors and shapes. Walking with Navigation: Navigating an oval path (3-8m) while performing an incongruent Stroop color-word task. ADL Stimulation: Walking while carrying a cup of liquid or a shopping bag to train executive function and working memory. Training intensity and cognitive difficulty are progressed weekly
Task Oriented Circuit Training
Behavioral2\. Active Comparator Arm: Task-Oriented Circuit Training (TOCT) Intervention Name: Behavioral: Task-Oriented Circuit Training (TOCT) Description: Participants will focus exclusively on functional motor relearning and cardiovascular endurance through 6 circuit-based stations: Standing and Reaching: Multidirectional reaching to targets while standing. Sit-to-Stand: Transitions using chairs of various heights to strengthen extensors. Anterior/Posterior Stepping: Stepping onto blocks of various heights. Lateral Stepping: Side-stepping for lateral stability. Forward Step-Up: Strengthening for stair climbing mechanics. Heel Raise: Improving gait push-off mechanics. Each station is performed for 2.5 to 5 minutes with 1-minute rest periods. Training is conducted 3 times per week for 4 weeks (total 12 sessions), with each session lasting 60 minutes including warm-up and cool-down. No explicit secondary cognitive tasks are added.
Dual task training
Behavioral3\. Active Comparator Arm: Pure Dual-Task Training (DT) Intervention Name: Behavioral: Pure Dual-Task Training (DT) Description: Participants will perform standard, non-circuit walking at a self-selected comfortable speed while executing simultaneous cognitive demands. The protocol includes: Backward Counting: Continuous subtraction from a random 3-digit number. Stroop Task: Identifying font colors or semantic meanings of incongruent words. Memory Tasks: Sequential recall of shopping lists (3-5 items) and reverse word recall (2-4 words). Verbal Fluency: Generating word chains or category naming. Each session consists of two 15-minute sets of core dual-task training (30 minutes total activity) within a 60-minute therapist-supervised visit. Training is conducted 3 times per week for 4 weeks (total 12 sessions). Cognitive difficulty is adjusted weekly to maintain an optimal challenge.
Adherence Rate
Description: Percentage of attended sessions (out of 12) during the 4-week intervention period.
Retention Rate
Proportion of participants who complete the full 4-week protocol and follow-up assessments
Incidence of Adverse Events
Frequency of falls or medical adverse events documented during the training sessions.
Mean Exercise Heart Rate
Evaluation of cardiovascular demand and tolerability during the circuit training stations. Measured using a digital heart rate monitor. Unit of Measure: Beats per minute (bpm)
Change from Baseline in 6-Minute Walk Test (6MWT)
Change in total distance walked in meters during the 6-Minute Walk Test from baseline to 4 weeks.
Change from Baseline in 10-Meter Walk Test (10MWT)
Change in gait speed measured in meters per second (m/s) in 10 meter walk test
Change from Baseline of Completion Time in Standardized Walking Obstacle Course (SWOC)
Mean time taken to complete the 12.2-meter curved course across three conditions (normal, tray, dark-glasses) and measured using a stopwatch. The total time in seconds taken to complete the 12.2-meter curved obstacle course under three conditions (normal, tray, and dark-glasses). A shorter time indicates better walking adaptability. Unit of Measure: Seconds
Change from Baseline in Standardized Walking Obstacle Course (SWOC) Step Count
Mean number of contacts between the foot and ground during course completion across three conditions Unit of measure : Number of steps
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