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Remote ischaemic conditioning for fatigue after stroke (RICFAST): a pilot randomised controlled trial.

Moyle, Bethany; Kudiersky, Nik; Totton, Nikki; Sassani, Matilde; Nichols, Simon; Jenkins, Tom; Redgrave, Jessica; Baig, Sheharyar; Nair, Krishnan Padmakumari Sivaraman; Majid, Arshad; Ali, Ali N.


Bethany Moyle

Nik Kudiersky

Nikki Totton

Matilde Sassani

Tom Jenkins

Jessica Redgrave

Sheharyar Baig

Krishnan Padmakumari Sivaraman Nair

Arshad Majid

Ali N. Ali


Post stroke fatigue (PSF) affects 50 % of stroke survivors and can be disabling. Remote ischaemic conditioning (RIC) can preserve mitochondrial function, improve tissue perfusion and may mitigate PSF. This pilot randomised controlled trial evaluates the safety and feasibility of using RIC for PSF and evaluated measures of cellular bioenergetics. 24 people with debilitating PSF (7 item Fatigue Severity Score, FSS-7 > 4) were randomised (1:1) in this single-centre phase 2 study to RIC (blood pressure cuff inflation around the upper arm 200 mmHg for 5 min followed by 5 min of deflation), or sham (inflation pressure 20 mmHg), repeated 4 cycles, 3 times per week for 6 weeks. Primary outcomes were safety, acceptability and compliance. Secondary outcomes included FSS-7, 6 min walking test (6MWT), peak oxygen consumption (V̇O2peak), ventilatory anaerobic threshold (VAT), and muscle adenosine triphosphate (ATP) content measured using 31-phosphorous magnetic resonance spectroscopy of tibialis anterior. RIC was safe (no serious adverse events, adverse events mild) and adherence excellent (91 % sessions completed). Exploratory analysis revealed lower FSS-7 scores in the RIC group compared to sham at 6 weeks (between group difference FSS-7 -0.7, 95 %CI -2.0 to 0.6), 3 months (-1.0, 95 %CI -2.2 to 0.2) and 6 months (-0.9, 95 %CI -2.0 to 0.2). There were trends towards increased VAT, increased muscle ATP content and improved 6MWT in the RIC group. RIC is safe and acceptable for people with PSF and may result in clinically meaningful improvements in fatigue and muscle bioenergetics that require further investigation in larger studies.


MOYLE, B., KUDIERSKY, N., TOTTON, N., SASSANI, M., NICHOLS, S., JENKINS, T., REDGRAVE, J., BAIG, S., NAIR, K.P.S., MAJID, A. and ALI, A.N. 2023. Remote ischaemic conditioning for fatigue after stroke (RICFAST): a pilot randomised controlled trial. Journal of stroke and cerebrovascular diseases [online], 32(12), article number 107420. Available from:

Journal Article Type Article
Acceptance Date Oct 6, 2023
Online Publication Date Oct 11, 2023
Publication Date Dec 31, 2023
Deposit Date Nov 27, 2023
Publicly Available Date Nov 27, 2023
Journal Journal of Stroke and Cerebrovascular Diseases
Print ISSN 1052-3057
Electronic ISSN 1532-8511
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 32
Issue 12
Article Number 107420
Keywords Stroke; Fatigue; Remote ischaemic conditioning; Bioenergetics
Public URL