Combining therapeutic approaches: rTMS and aerobic exercise in post-stroke depression: a case series

Abstract

Objective and importance Residual effects of stroke include well-documented functional limitations and high prevalence of depression. Repetitive transcranial magnetic stimulation (rTMS) and aerobic exercise (AEx) are established techniques that improve depressive symptoms, but a combination of the two has yet to be reported. The purpose of this case series is to examine the safety, feasibility, and impact of combined rTMS and AEx on post-stroke depression and functional mobility. Clinical presentation Three participants with a history of stroke and at least mild depressive symptoms (Patient Health Questionare-9 ≥5). Intervention Both rTMS and AEx were completed 3 times/week for 8-weeks. rTMS was applied to the left dorsolateral prefrontal cortex, 5000 pulses/session at 10 Hz, at an intensity of 120% of resting motor threshold. AEx consisted of 40 min of treadmill walking at 50–70% of heart rate reserve. Results Depressive symptoms improved in all three participants, with all demonstrating response (≥50% improvement in symptoms) and likely remission. All participants improved their Six Minute Walk Test distance and Participants 1 and 2 also improved Berg Balance Scale scores. Participants 1 and 3 improved overground walking speeds. No serious adverse events occurred with the application of rTMS or AEx and the participants’ subjective reports indicated positive responses. Adherence rate for both rTMS and AEx was 98%. Conclusion Combined treatment of rTMS and AEx appears safe, feasible, and tolerable in individuals with a history of stroke and at least mild depressive symptoms. All participants had good compliance and demonstrated improvements in both depressive symptoms and walking capacity.

Effects of Repetitive Transcranial Magnetic Stimulation (rTMS) Combined with Aerobic Exercise on the Recovery of Motor Function in Ischemic Stroke Rat Model

“…The combination of rTMS and aerobic exercise has been assessed in several studies to examine the potential benefits on motor function in several diseases. Previous research reported that combined therapy was feasible and could improve depressive symptoms and walking capacity [20]. Wang et al reported that the combination of rTMS and treadmill training enhanced the effect of treadmill training on the modulation of corticomotor inhibition and improvement in walking performance in Parkinson's disease patients [21].…”

Potential Involvement of Adiponectin Signaling in Regulating Physical Exercise-Elicited Hippocampal Neurogenesis and Dendritic Morphology in Stressed Mice

“…Furthermore, various anti-depressive treatments such as antidepressants, physical exercise as well as electro-convulsion significantly enhance neurogenesis (Hanson et al, 2011). Particularly, exercise which proves to be an effective and economical treatment for depression (Duman et al, 2008;Carek et al, 2011;Abdollahi et al, 2017;VanDerwerker et al, 2018) has also been known to enhance neurogenesis (Beauquis et al, 2010;Lee et al, 2016;Nishii et al, 2017;Leem et al, 2018;Yau et al, 2018), a process involves the generation of new neurons and neuronal connections in the sub-ventricular area of the lateral ventricle and the DG of the hippocampus (Curtis et al, 2012;Miller et al, 2013). In the present study, hippocampal cellular changes were examined by staining with three various markers BrdU, Ki67 and DCX.…”

Repetitive transcranial magnetic stimulation treatment for peripartum depression: systematic review & meta-analysis

“…One type of brain stimulation, repetitive transcranial magnetic stimulation (rTMS), stimulates the brain’s dorsolateral prefrontal cortex (DLPFC) with magnetic fields to induce the degeneration of neurons and activate the neural system of the brain to relieve depression [ 37 ]. Using rTMS to treat PPD is still reluctant [ 38 – 40 ], although studies have shown that rTMS is safe [ 41 ] and effective for treating several neurological diseases [ 42 – 44 ].…”