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

AbstractObjective and importanceResidual 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 presentationThree participants with a history of stroke and at least mild depressive symptoms (Patient Health Questionare-9 ≥5).InterventionBoth 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.ResultsDepressive symptoms improved in all three participants, with all demonstrating response (≥50% ...