Exercise Primed Stroke Rehabilitation

Inclusion Criteria:

* experienced unilateral stroke at least 6 months prior;
* voluntarily shoulder flexion of the affected arm 20 degrees with simultaneous elbow extension 10 degrees;
* moderate arm movement impairment (UE Fugl-Meyer Assessment \> 21 but \< 52 points;
* passive range of motion in paretic shoulder, elbow, wrist, thumb and fingers within 20 degrees of normal;
* 50-90 years of age;
* ability to communicate as per the therapists' judgement at baseline testing;
* ability to complete and pass an exercise tolerance test; 8) Box \& Block test score of at least 3 blocks in 60 seconds with the affected arm.

Exclusion Criteria:

* lesion in brainstem/cerebellum as these may interfere with visual-perceptual/cognitive skills needed for motor re-learning;
* presence of other neurological disease that may impair motor learning skills;
* orthopedic condition or impaired corrected vision that alters reaching ability (e.g., prior rotator cuff tear without full recovery);
* paretic arm pain that interferes with reaching;
* unable to understand or follow 3-step directions;
* severe cognitive impairment (MoCA score 17);
* severe aphasia;
* inability to read English,
* history of congestive heart failure, unstable cardiac arrhythmias, hypertrophic cardiomyopathy, severe aortic stenosis, angina or dyspnea at rest or during ADL's;
* Severe hypertension with systolic \>200 mmHg and diastolic \>110 mmHg at rest;
* History of COPD or oxygen dependence;
* History of DVT or pulmonary embolism within 6 months;
* Uncontrolled diabetes with recent weight loss, diabetic coma, or frequent insulin reactions;
* UBACC score \< 15; and for brain stimulation procedures only:
* electronic or metallic implants;
* history of seizures;
* women of child bearing potential.