The effect of dual task-oriented circuit training on neuroplasticity and walking adaptability in subacute stroke patients: A pilot and feasibility study

BACKGROUND: Stroke remains a leading cause of long-term disability worldwide, with a substantial proportion of survivors experiencing persistent limitations in functional mobility. Although many individuals regain the ability to walk in structured clinical environments, only a minority achieve independent community ambulation due to cognitive-motor interference (CMI). The subacute phase is characterized by heightened neuroplastic potential and responsiveness to rehabilitation. Dual Task-Oriented Circuit Training (DTOCT) integrates task-oriented circuit training with concurrent cognitive challenges and may provide a functionally relevant approach to addressing cognitive-motor interference. However, its feasibility, safety, and preliminary effects in subacute stroke remain unclear. METHODS: This three-arm, participant-blinded, randomized pilot and feasibility trial will recruit 36 individuals with subacute stroke and allocate them equally to DTOCT, Task-Oriented Circuit Training (TOCT), or Dual Task Training (DTT). Participants will receive three supervised sessions per week for 4 weeks (12 sessions). Primary outcomes will assess feasibility and safety, including adherence, retention, adverse events, heart rate, blood pressure, and perceived exertion. Secondary exploratory outcomes will include walking endurance assessed using the 6-Minute Walk Test, gait speed using the 10-Meter Walk Test, walking adaptability using the Standardized Walking Obstacle Course, and serum brain-derived neurotrophic factor as an exploratory peripheral biomarker associated with neuroplasticity. DISCUSSION: This pilot study is designed to determine the feasibility and safety of DTOCT and to generate preliminary effect estimates for clinical and neurobiological outcomes. The findings will inform primary outcome selection, intervention refinement, and sample-size estimation for a subsequent adequately powered randomized controlled trial rather than establish definitive efficacy or superiority. TRIAL REGISTRATION: ClinicalTrials.gov. Identifier: NCT07494357 (registered prospectively). Protocol ID: IKFR-202603.01).