Aerobic Exercise and rTMS for Post-Stroke Depression

Inclusion criteria: * age \>21 * stroke at least 12 months prior * screen positive for depressive symptoms (PHQ-9 \> 5) and HAM-D17 ≥ 12 * residual paresis in the lower extremity (Fugl-Meyer LE motor score \<34) * ability to walk without assistance and without an AFO at speeds ranging from 0.2-1.0 m/s * not currently on antidepressant medications or no changes in antidepressant dosage in the last 4 weeks and clinically stable * HAM-D17 question #9 regarding suicide \<2 * provision of informed consent. I * All subjects who screen for major depressive disorder will be formally diagnosed by the project psychiatrist at each site using the Structured Clinical Interview for DSM5 (SCID-5). * All subjects who meet criteria for the training portion must complete an exercise tolerance test and be cleared for participation by the study physician. Exclusion criteria: * unable to ambulate at least 150 feet prior to stroke, or experienced intermittent claudication while walking * history of congestive heart failure, unstable cardiac arrhythmias, hypertrophic cardiomyopathy, severe aortic stenosis, angina or dyspnea at rest or during ADL's * history of COPD or oxygen dependence * history of traumatic brain injury * blindness or severe visual impairment * history of psychosis or other Axis I disorder that is primary * life expectancy \<1 yr. * severe arthritis or problems that limit participation in testing or training * history of DVT or pulmonary embolism within 6 months * uncontrolled diabetes with recent weight loss, diabetic coma, or frequent insulin reactions * severe hypertension with systolic \>200 mmHg and diastolic \>110 mmHg at rest * attempt of suicide in the last 2 years or suicidal risk assessed by SCID * history of seizures or currently prescribed anti-seizure medications * current enrollment in a trial to enhance motor recovery * currently participating in behavioral treatment for depression * currently exercising ≥ 2 times per week (≥20 minutes) * contraindications to TMS * pregnancy or other contraindications to MRI.