Brain stimulation plus exercise may lift depression and boost walking after stroke

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

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.