Exercising language: Behavioral and neurophysiological changes after high-intensity exercise training in post-stroke aphasia.

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Project Summary/Abstract Losing the ability to speak and understand language is devastating for patients with aphasia and their families, negatively impacting multiple aspects of life and emotional well-being. Unfortunately, individuals with aphasia rarely regain their language skills in full. Novel approaches are required that boost the effects of traditional therapies, leading to better outcomes for people with aphasia. The proposed study seeks to evaluate the effects of a promising adjuvant intervention - physical exercise training - on recovery in aphasia. A new exercise program, specifically designed for individuals with post-stroke aphasia, will be the means of providing a safe, stroke- and aphasia-friendly physical exercise intervention to achieve optimal physical fitness gains. This will also be the first large scale study in aphasia to systematically examine the additive and enhancing effects of combining physical exercise training with traditional language therapy. Innovative outcome measures will include not only language and cognitive measures but also measures of motor skills and psychological and psychosocial outcomes that will assess the benefits of physical exercise. Another cutting-edge aspect of the study is the inclusion of advanced physiological fitness measures and neuroimaging metrics of blood flow and cerebrovascular reactivity as outcome measures to afford a deeper understanding of the exercise-mediated behavioral and neural effects in stroke survivors. We will recruit 110 individuals with aphasia to evaluate the multifaceted impact of exercise on behavioral and physical outcomes in isolation and in combination with traditional speech-language therapy. First, the benefits of physical exercise for language, cognition, motor, and emotional and psychological well-being in individuals with aphasia will be established. Of particular importance will be an enhanced understanding of how exercise can boost the effects of existing speech-language therapies. Second, determining how exercise-induced changes in physical fitness are related to changes in language and cognitive measures will provide insight into key ingredients of successful exercise interventions. Third, evaluation of the exercise-induced neurovascular changes that relate to behavioral improvements, as measured with novel blood supply neuroimaging tools, will advance our knowledge about the brain mechanisms of the observed cognitive benefits. Finally, the validated physical exercise intervention, resulting from this project, will offer a new tool to clinicians seeking to help individuals with aphasia, either as a free-standing program to enhance physical health, cognition, and well-being, or as an adjunct therapy to standard speech-language therapy. Ultimately, this work could significantly alter our thinking about adjuvant aphasia therapies that can benefit those affected by stroke and aphasia through non- traditional means, in this case, a promising, safe, and cost-efficient adjunct intervention that can enhance all levels of functioning from general health to language to social engagement.