Aerobic Exercise for 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.