Welcome to the Determining Optimal post-Stroke Exercise (DOSE) Home Page!

The DOSE randomized controlled trial is registered on Clinicaltrials.gov.  Please click here to view.

The purpose of the DOSE trial was to determine the optimum exercise dose to improve walking function early after a stroke when it is known that neuroplasticity is greatest. The trial operated over 6 sites across 3 provinces in Canada. Patients were approximately one month post-stroke. The protocol was unique in being progressed by heart rate and step counters to reach specified targets. Physical therapists and rehabilitation assistants could utilize any exercises or equipment that was available to them (e.g., steppers, treadmill) to reach these targets.  The 4-week once daily DOSE protocol improved walking function and quality of life by clinically meaningful amounts when applied on stroke rehabilitation admission. Gains in walking endurance were retained at a 1 year follow-up period over usual care.


Papers published from the DOSE study:


Protocol paper for the DOSE study

  • Klassen TD, Dukelow SP, Bayley MT, Benavente O, Hill MD, Krassioukov A, Liu-Ambrose T, Pooyania S, Poulin MJ, Yao J, Eng JJ. Determining optimal poststroke exercise: Study protocol for a randomized controlled trial investigating therapeutic intensity and dose on functional recovery during stroke inpatient rehabilitation. Int J Stroke. 2018 Jan 1:1747493018785064. doi: 10.1177/1747493018785064.  (View abstract)

This primary paper found that the once daily DOSE protocol improved walking function and quality of life by clinically meaningful amounts after the 4-week intervention applied on stroke rehabilitation admission. Gains in walking endurance were retained at a 1 year follow-up period over usual care

  • Klassen TD, Dukelow SP, Bayley MT, Benavente O, Hill MD, Krassioukov A, Liu-Ambrose T, Pooyania S, Poulin MJ, Schneeberg A, Yao J, Eng JJ.. Higher Doses Improve Walking Recovery During Stroke Inpatient Rehabilitation. Stroke. 2020;51(9):2639-2648. doi: 10.1161/STROKEAHA.120.029245. (View abstract)

Secondary analyses of the DOSE trial found improvements in cognition

  • Peters S, Lohse KR, Klassen TD, Liu-Ambrose T, Dukelow SP, Bayley MT, Hill MD, Pooyania S, Yao J, Eng JJ. Higher intensity walking improves global cognition during inpatient rehabilitation: a secondary analysis of a randomized control trial. Front Neurol. 2023;14:2614-2617. doi: 10.3389/fneur.2023.1023488. (View abstract

Based on the DOSE study, this study modeled the step number and aerobic minute targets that clinicians can use to progress their patients 

  • Peters S, Klassen T, Schneeberg A, Dukelow S, Bayley M, Hill M, Pooyania S, Yao J, Eng J.. Step Number and Aerobic Minute Exercise Prescription and Progression in Stroke: A Roadmap. Neurorehabilitation Neural Repair. 2022:36:97-102 (View abstract)

Secondary analyses showed no effect of the DOSE protocol on blood pressure, however, blood pressure increased over the 12 months post-stroke in all groups

  • Hung SH, Tierney C, Klassen TD, Schneeberg A, Bayley MT, Dukelow SP, Hill MD, Krassioukov A, Pooyania S, Poulin MJ, Yao J, Eng JJ.. Blood pressure trajectory of inpatient stroke rehabilitation patients from the Determining Optimal Post-Stroke Exercise (DOSE) trial over the first 12 months post-stroke. Front Neurol 2023: 14;1245881 (View abstract)

This study explored stroke patient perceptions of the DOSE protocol. People with stroke perceived no barriers to participating in higher intensity rehabilitation.  In contrast, therapist’s beliefs about quality of movement, as well as issues around staffing were perceived barriers

  • Janssen J, Klassen TD, Connell LA, Eng JJ. Factors Influencing the Delivery of Intensive Rehabilitation in Stroke: Patient Perceptions Versus Rehabilitation Therapist Perceptions. Phys Ther 2020;100:307-316. doi: 10.1093/ptj/pzz159. (View abstract)

This study explored the DOSE therapists’ perceptions of providing the DOSE study intervention to the participants

  • Connell LA, Klassen TK, Janssen J, Thetford C, Eng JJ. Delivering Intensive Rehabilitation in Stroke: Factors Influencing Implementation. Phys Ther. 2018 Apr 1;98(4):243-250. doi: 10.1093/ptj/pzy018. (View abstract)

This study examined the validity of the Fitbit One compared to the “gold standard” StepWatch Activity Monitor for assessing patients’ step count during their physical therapy sessions while in stroke inpatient rehabilitation

  • Klassen TD, Semrau JA, Dukelow SP, Bayley MT, Hill MD, Eng JJ. Consumer-Based Physical Activity Monitor as a Practical Way to Measure Walking Intensity During Inpatient Stroke Rehabilitation. Stroke. 2017 Sep;48(9):2614-2617. doi: 10.1161/STROKEAHA.117.018175. (View abstract)