This well-controlled pilot randomized clinical trial is not without limitations. Larger multicenter trials employing active controls performing conventional physiotherapy, occupational therapy or other types of RE training, and comprising long-term follow-up are warranted to manifest our novel findings and explore the mechanisms behind ECC-overload RE-induced cognitive adaptations. In addition, the hemispheric lateralization of stroke should be controlled for in the randomization process. The current study design dealt with this potential flaw by introducing hemispheric lateralization as a covariate in all statistical models for cognitive variables. If meeting the premises of the present outcome, we suggest the ECC-overload flywheel RE paradigm should be implemented in rehabilitation settings as a safe and viable method to promote neuromuscular and cognitive adaptations, while significantly reducing time needed for therapy