Groundbreaking positive outcomes for application of Cardiovascular Rehabilitation in Stroke Survivors; the CROSS Trials

JFK Johnson Rehabilitation Institute’s Cardiovascular Rehabilitation of Stroke Survivors CROSS pilot

Researchers at JFK Johnson Rehabilitation Institute are leading groundbreaking research aimed at transforming recovery for people who have survived a stroke. Their research shows that adding cardiovascular rehabilitation—traditionally reserved for patients with cardiac disease, such as a heart attack—to standard post-stroke rehabilitation can significantly reduce mortality and hospital readmissions, while improving overall function and quality of life.

The Cardiovascular Rehabilitation of Stroke Survivors (CROSS) study builds on more than a decade of research at JFK Johnson demonstrating the powerful benefits of cardiovascular rehabilitation for stroke patients.

JFK Johnson’s Stroke-HEART™ Trials, which began in 2015, laid the foundation for this innovative approach. It was a large matched pair analysis study, with multiple publications from 2019-2022. The published research showed that stroke survivors who participated in the program experienced improved physical function and cardiac capacity, lower rates of hospital readmission and reduced mortality.

The current ongoing CROSS clinical trial began enrolling participants in January 2023 as a randomized control trial (RCT) and is preparing to potentially implement a multisite study of this program to accrue data and assess ease of implementation at the national level. More than 120 participants have enrolled to date in this randomized clinical trial.

Each participant completes 36 sessions of medically supervised, telemetry-monitored moderate intensity aerobic exercise, resistance training and education focused on stroke risk factors such as nutrition, smoking cessation, physical activity and medication adherence.

The CROSS study focuses on delivering moderate intensity aerobic exercise to patients in the subacute phase of stroke recovery, a period from about one to six months after stroke. Research shows that during this window, the brain experiences a heightened level of neuroplasticity—its ability to reorganize and form new neural connections.

“The initial trials showed significant improvements in functional recovery and cardiovascular capacity, along with a 22 percent decrease in one-year all cause hospital readmissions and a fourfold reduction in one-year mortality,” said Sara Cuccurullo, M.D., vice president and medical director of JFK Johnson and CROSS co-principal investigator. “Stroke and heart disease are both vascular diseases, with almost identical risk factors. It just didn’t make sense to any of us why cardiac patients are fully funded for this very robust, successful program while stroke patients are not.”

The next step is expansion to a multicenter national clinical trial. “The longer-term goal is to generate the evidence needed to make cardiovascular rehabilitation an insurance-funded standard of care for stroke survivors,” stated Talya Fleming MD, CROSS co-principal investigator.

Hayk Petrosyan, Ph.D., a research scientist at JFK Johnson, said, “Every day, we see patients reclaiming parts of their lives they thought were lost. This research has the potential to redefine what stroke recovery can look like.”

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