Why is this research needed?

One in two stroke survivors experiences fatigue: a lack of physical and/or mental energy that doesn't get any better with rest. The effects of fatigue after a stroke vary from person to person but can include impacts on our bodies, minds, emotions and social connections. For one person, fatigue might make it very difficult to do rehabilitation exercises. For another, it could mean not being able to return to school or play with friends.

Sometimes fatigue gets better on its own over time, but not for everyone. There are currently no treatments available for fatigue, so many stroke survivors simply have to learn to manage fatigue. The RICFAST 2 team hope to change that. They've identified that remote ischaemic conditioning, or RIC, could reduce fatigue symptoms and now want to understand how to deliver RIC and why it works.

What are the aims of this research?

RIC involves briefly and repeatedly cutting off the blood supply to one arm. While this may sound surprising, our bodies actually experience this kind of thing regularly, for example during physical exercise. As the muscles in one part of the body work harder during exercise, more blood flows to that area to supply energy. This means less blood flows to other areas. RIC has the same effect, but doesn't require exercise or medical supervision beyond initial training in how to do it - it can be done sitting in a chair at home.

We don't fully understand why, but RIC seems to reduce fatigue. Previously, the RICFAST 2 team did a preliminary trial of RIC as a treatment for fatigue after stroke. After 6 weeks of regular RIC sessions, participants were likely to be able to walk further and reported lower levels of fatigue for at least six months.

The team now want to do a larger trial. Specifically, they will:

  • Explore different treatment schedules. For example, are these treatment schedules feasible for stroke survivors and healthcare professionals? Is a shorter but more intense schedule of RIC likely to lead to more improvement in fatigue symptoms?
  • Investigate what's happening at the cellular level to understand more about how RIC works to treat fatigue.
  • Find out whether people with different types of fatigue symptoms respond differently to RIC. For example, does RIC work for mental fatigue as well as physical fatigue?
  • Look at whether wearable technology like smartwatches could be used to explore the links between fatigue and physical activity. Evidence here is very limited, so understanding more could make it easier to investigate fatigue in the future.

What is the benefit of this research?

The RICFAST 2 trial will improve our understanding of whether and how RIC could be used to treat post-stroke fatigue: whether it's acceptable and feasible for the people using it, why it works, and whether some people benefit more from others. This will lay the groundwork for a much larger clinical trial that can supply the evidence needed for healthcare professionals to decide whether to use RIC as a treatment for fatigue.

RIC is low-cost and can easily be done at home, making it accessible to most stroke survivors. Ultimately, if RICFAST 2 and the later clinical trial are successful, stroke survivors will at last have a treatment for fatigue that could help make it easier to live independently and enjoy life.

What PSP priorities does this research link to?

From 2019 to 2021, we worked with the James Lind Alliance on the Stroke Priority Setting Partnership (PSP). During the PSP process, we collaborated with people with lived experience of stroke and stroke professionals to find out what they thought were the top priorities in stroke research. From this, we identified the top ten priorities in two areas: prevention, diagnosis and short-term care, and rehabilitation and long-term care.

Now, when researchers apply to us for funding, we require that their work addresses at least one of these priorities, or a priority from the Childhood Neurological Disabilities PSP Top 10 as it relates to childhood stroke.

RICFAST 2 addresses the following priority from the Stroke PSP:

  • Rehab and long-term care 4: What causes fatigue and how can it be treated and self-managed

Meet the team

RICFAST 2 is led by Professor Arshad Majid and Dr Ali Ali.

Arshad is the Chair of Cerebrovascular Disease at the University of Sheffield. He is an expert on clinical trials and is also leading the TRICEPS trial on arm recovery after stroke, which is partly funded by the Stroke Association through Dr Sheharyar Baig's PhD on vagus nerve stimulation as a potential way to improve the effectiveness of physiotherapy after stroke.

Ali is a Senior Clinical Lecturer in Cerebrovascular Disease at the University of Sheffield. He led the pilot study on remote ischaemic conditioning that led to RICFAST 2.

The other members of the team include:

  • Eric Murphy, a stroke survivor and retired physics teacher who used his experience of post-stroke fatigue to contribute to the development of RICFAST 2 and will continue to guide its future progress.
  • Avril Drummond, Professor of Healthcare Research at the University of Nottingham and an expert on clinical trials.
  • Gillian Mead, Professor of Stroke and Elderly Care Medicine at the University of Edinburgh and an expert on clinical trials.
  • Professor Li Su, Head of the Artificial Intelligence and Computational Neuroscience Group at the University of Sheffield. He is an expert on brain scanning and data analysis.
  • Tim Chico, Professor of Cardiovascular Medicine at the University of Sheffield and an expert on wearable smart technology.
  • Tom Maden-Wilkinson, Assistant Professor of Musculoskeletal health at Sheffield Hallam University and an expert on how muscle cells create and use energy.
  • Gordon McGregor, Professor of Exercise Physiology at the University of Warwick and an expert on measuring exercise and fitness.
  • Dr Jon Dickson, Senior Clinical Lecturer in Population Health at the University of Sheffield. Jon leads on equality, diversity and inclusion considerations and participant recruitment for RICFAST 2.