Aerobic Exercise and Phono-Motor Therapy: A Hybrid Paradigm for Reading Rehabilitation in Aphasia

Pranav Reddy, Kessler Foundation, West Orange, United States
Desiree Armas, Kessler Foundation, West Orange, United States
Elizabeth Madden, Florida State University, Tallahassee, United States
William Graves, Rutgers University-Newark, Newark, United States
Olga Boukrina, Kessler Foundation, West Orange, United States


Approximately 70% of individuals with aphasia, a disorder affecting communication, experience significant reading deficits that impact their autonomy and well-being. This study aims to assess the feasibility and initial efficacy of a novel neurorehabilitation approach combining aerobic exercise training (AET) with a targeted phono-motor treatment (PMT) aimed at generalizable improvements in reading. We hypothesize that this hybrid approach will prove effective, given that AET has been shown to increase cerebral perfusion (blood flow) in stroke survivors, and reduced perfusion is inversely associated with language recovery.

Participants and Methods:

The study included individuals with a single, chronic left-hemisphere stroke exhibiting reading deficits. Two male participants (M age(SD)=65.5(12.5), M Aphasia Quotient (AQ)=78.05(29.21)) completed behavioral assessments and MRI scans (including Arterial Spin Labeling measuring cerebral perfusion) at baseline and post-treatment. They received 40 sessions of combined AET and PMT 5x/week for 2 hours. Each session began with 30 min (5-min warmup and cooldown) of stationary cycling at 60% maximal heart rate (HR) range, measured using a Polar Beat HR monitor. For the remaining 90 min, participants received PMT. Treatment involved multi-modal (e.g., auditory, visual, articulatory-kinematic, orthographic) training with all English consonants and vowels before progressing to multi-syllabic phonological sequences. In contrast to other PMT research, letters were introduced at treatment onset to more directly target reading. Primary treatment outcomes were assessed using reading aloud of single monosyllabic words and pronounceable nonwords. Accuracy was determined by consensus of 3 raters. For comparison, we provide data from a different group of 4 stroke participants who received 60 hours of PMT alone (1 woman, 3 men, M age 57.8(10.7), M AQ=65(39.88)). 


Relative to baseline, the first participant (AET-01) showed an 8% increase in left hemisphere perfusion after one cycling session and a 25% increase post-treatment. AET-02, who had a large lesion affecting most of the left hemisphere (338ml), exhibited a 4% left and a 45% right hemisphere perfusion increase after one cycling session. Post-treatment, AET-02 had a 0.3% increase in left and a 94% increase in right perfusion. Word reading accuracy improved by 7% (AET-01: +6%; AET-02: +8%) and nonword reading accuracy by 12% (AET-01: +24%; AET-02: +0%). Both participants had a 9.4% improvement in Western Aphasia Battery AQ (Baseline: 65(28.2); outcome: 71.1(27.5)). Participants in the PMT alone group improved by 5% on word reading and 23% on nonword reading. These outcomes were not statistically different. Given the small sample and initial differences in age, baseline aphasia severity, and lesion size, our comparison supports the positive effect of PMT on reading, while the additional positive impact of AET remains to be confirmed in a larger sample. 


This study supports the feasibility of a daily intensive exercise protocol combined with reading therapy in stroke patients with aphasia over multiple weeks. We show early promising effects of AET on cerebral perfusion in stroke survivors. While we did not conclusively demonstrate that the hybrid approach is superior to PMT alone, the small sample size and variability in lesion sizes suggest that larger-scale studies are needed for further investigation.

Category: Stroke/Cerebrovascular Injury and Disease (Adult)

Keyword 1: aphasia
Keyword 2: reading disorders
Keyword 3: stroke