Fitness After Stroke Trial

Eligibility Criteria

• * Both sexes between the age of 20-85 years at time of consent
• * Chronic ischemic or hemorrhagic stroke 6 months to 5 years at consent. People with stroke and newly diagnosed cardiovascular complications had \>50% prevalence of recurrent stroke at 5 years. Index stroke or recurrent stroke on same side as index stroke will be allowed.
• * Ability to walk over ground with assistive devices and no continuous physical assistance from another person to perform tests for gait speed and six-minute walk test
• * Exercise continuously for minimum of 30 watts for 3 minutes on the recumbent stepper to demonstrate ability to perform the exercise test.
• * No aerobic exercise contraindications or other safety/physical concerns during the submaximal exercise test.
• * Able to communicate with investigators, follow 2-step command \& correctly answer consent comprehension questions
• * Currently participating in less than 150 minutes of physical activity/week assessed by the Rapid Assessment of Physical Activity
• * Stable blood pressure \& statin medication doses for 30 days prior to enrollment due to effects on vascular health/hemodynamics
• * Hospitalization for cardiac or pulmonary disease within past 3 months
• * Implanted pacemaker or defibrillator limiting exercise performance
• * Significant ataxia or neglect (score of 2 on NIH stroke scale item 7 or 11)
• * Reported pain that limits or interferes with activities of daily living and physical activity/exercise
• * Severe LE spasticity (Ashworth \>2) due to inability to exercise
• * Recent history (\<3 months) of illicit drug or alcohol abuse or diagnosis of significant mental illness
• * Major post-stroke depression (Patient Health Questionnaire, PHQ-9 ≥ 1084)
• * Currently participating in physical therapy targeting lower extremity function or another interventional study that may influence study outcomes
• * Other significant neurologic, orthopedic or peripheral vascular conditions that would limit exercise participation
• * Oxygen-dependent chronic obstructive pulmonary disease
• * Diagnosis of other neurological disease (Multiple Sclerosis, Alzheimer's disease, Parkinson's disease)
• * Self report pregnancy