Periodised power training in community-dwelling adults with chronic stroke: a protocol for the Power Exercise for Stroke Recovery (POWER) pilot randomised controlled trial.

Muscle power may be more important than muscle strength for preserving mobility after stroke.

• The rationale for the study is grounded in evidence that power training (resistance training with the intent to move as fast as possible) addresses this gap.
• Prior power training trials in stroke were described as 'limited in their approaches to exercise prescription, namely providing minimal emphasis on periodisation strategies.'
• Periodisation strategies such as developing strength before power are highlighted as important elements missing from previous trials.

A prior feasibility study showed that the POWER intervention was feasible and could improve muscle power, mobility, and health-related quality of life in people with stroke.

• The authors state they 'recently showed that POWER was feasible and could improve muscle power, mobility and health-related quality of life in people with stroke.'
• This prior work informed the decision to proceed to a pilot randomised controlled trial.
• The pilot RCT is described as 'the next stage in investigation' before a fully scaled trial.

The POWER pilot RCT will enroll 60 adults with chronic stroke across two Canadian sites.

• Participants must be ≥6 months following mild to moderate stroke.
• The trial will be conducted at McMaster University and the University of British Columbia in Canada.
• Participants will be randomly allocated to one of two thrice-weekly, 10-week resistance training interventions: POWER or STRENGTH.

The POWER intervention uses a periodised design with an initial strength-building phase followed by a power training phase, while the STRENGTH intervention uses a moderate-intensity strength-building programme throughout.

• Both programmes begin with a 1-week familiarisation period consisting of low-intensity versions of the programmes.
• The POWER group undergoes an intense strength-building phase from weeks 2–5, followed by a power training phase from weeks 6–10.
• The STRENGTH group engages in a moderate-intensity strength-building programme from weeks 2–10.
• Both interventions are delivered three times per week over 10 weeks.

The primary outcome of the pilot trial is feasibility of process, resources, and scientific feasibility, evaluated using a priori criteria for acceptance.

• Feasibility domains include process (e.g., randomisation, blinding), resources (e.g., assessor burden), and scientific feasibility (e.g., adverse events).
• A priori criteria for acceptance are specified to determine whether the trial design is feasible before a fully scaled trial.
• Clinical outcomes include comfortable and fast Timed Up and Go Tests as the primary clinical measures.
• Clinical outcomes and questionnaires are assessed at baseline, post-intervention, and 8-week follow-up.

The trial has received ethical approval at both institutions and is registered as a clinical trial.

• Ethics approval was granted by the Hamilton Integrated Research Ethics Board (#18235) and the University of British Columbia Clinical Research Ethics Board (#H25-00325).
• The trial is registered under ClinicalTrials.gov identifier NCT06780995.
• Trial results will be published and disseminated to local stroke recovery groups, clinicians, and researchers.