2.6. Intervention

Table 1 shows the intervention program, which will be 60 min/session twice weekly for 8 weeks.

Intervention protocol.

The intervention program for the experimental group will consist of 60 min sessions of whole-body exercise, with the duration of each session increasing to a maximum duration of 45 min based on individual ability. The intervention program is a circuit training program that was designed according to the principles of specificity and progressive overload. A program comprising three sets of four to seven movements and exercises that combine aerobic and resistance training has been established. The participants will complete one set of movements. To minimize fatigue, the participants will alternate between upper- and lower-body exercises, and we will allow 1–2 min of recovery time after each set of exercises.

The circuit training combined aerobic and resistance training program will be conducted at 65–80% of the individual’s maximum heart rate measured at baseline. The instructions given to the participants will be to perform the exercise program with an intensity of 12–13 on the rate of perceived exertion scale [48], which is considered “somewhat hard.”

Resistance exercise training will involve the use of a TheraBand (Hygenic Corporation, Akron, OH, USA) for 7 upper-body exercises (shoulder press, seated rows, back row, lat pulldown, chest press, biceps curl, and triceps extension) and 10 lower-body exercises (squat, lunge, deadlift, back extension, bridge, crunch, sit-up, reverse crunch, leg raise, and superman position). The TheraBand’s exercise intensity is indicated by the band’s color. To determine the exercise intensity of the TheraBand, we will use the TheraBand Perceived Exertion Scale for Resistance Exercise with elastic bands [49]. The participants will perform a lateral raise for 15 maximum repetitions (RMs) without separating the upper and lower limbs to select the band color based on the scale [49,50]. The participants will then be asked to perform three sets of 12–15 repetitions for all upper- and lower-body exercises using the TheraBand and power training protocol [51], with a concentric contraction phase implemented as soon as possible, a 1 s pause, and an eccentric contraction phase exceeding 2 s. This power training protocol emphasizes concentric contractions by increasing the speed of motion. It focuses on concentric contractions by increasing movement speed. Aerobic exercise will consist of seven activities (jumping jack, sidestep, pogo jump, knee up, high knee, front step, and back step) that can be performed without equipment or machines.

During the first 2 weeks, the participants will engage in body-weight exercises using their own weight to avoid injury and become accustomed to the training. This approach will be adopted to prevent injury that may arise from intense workouts. During weeks 3–5, participants will use their bands to perform 15 RM exercises. From week 6, the participants will use a higher intensity band. To help the participants with stroke who have difficulty using one hand, a glove will be used to secure the TheraBand during exercise. The intensity of the aerobic exercise will be adjusted by the training instructor based on each participant’s condition. A qualified exercise trainer will supervise the exercise program and monitor the participants’ maximum individual heart rates using a heart rate monitor (Polar, Kempele, Finland) and iPad (Apple, Cupertino, CA, USA). The exercises will gradually be increased in intensity and difficulty with more repetitions and sets. The control group will perform ADLs without any intervention. These participants will be asked to continue with their usual lifestyle habits. They will receive the usual care, including the usual stroke services available to the participants, including but not limited to medical consultations offered by hospitals and rehabilitation services by community-based organizations. The participants in the control group will not receive any specific exercise training from this study scheme.