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Physical fitness training for stroke patients.

The Cochrane database of systematic reviews
January 1, 1970
David H Saunders et al. (7 authors)
Journal ArticleMeta-AnalysisResearch Support, Non-U.S. Gov'tReviewSystematic ReviewHuman Study
Study Details

Study Goal

The researchers aimed to determine whether fitness training, including walking, reduces disability and improves outcomes like mobility, balance, and cognitive function in stroke survivors.

Results Summary

Cardiorespiratory training involving walking improved walking speed, capacity, and balance, with some benefits persisting post-intervention. Mixed training also showed modest improvements in walking speed and capacity, but resistance training lacked sufficient data for conclusions.

Population

Stroke survivors

Effective Dosage

Not specified

Duration

Not specified

Interactions

None mentioned

Extracted Claims (9)
InterventionDirectionEndpointPopulationDosageImpactClaim #
cardiorespiratory training
decrease
global indices of disability
stroke survivors
standardised mean difference (SMD) 0.52, 95% confidence interval (CI) 0.19 to 0.84; P value = 0.002
show moderate improvement
#1
mixed training
decrease
global indices of disability
stroke survivors
SMD 0.26, 95% CI 0.04 to 0.49; P value = 0.02
improved by a small amount
#2
cardiorespiratory training involving walking
increase
maximum walking speed
stroke survivors
mean difference (MD) 6.71 metres per minute, 95% CI 2.73 to 10.69
improved
#3
cardiorespiratory training involving walking
increase
preferred gait speed
stroke survivors
MD 4.28 metres per minute, 95% CI 1.71 to 6.84
improved
#4
cardiorespiratory training involving walking
increase
walking capacity
stroke survivors
MD 30.29 metres in six minutes, 95% CI 16.19 to 44.39
improved
#5
mixed training, involving walking
increase
preferred walking speed
stroke survivors
MD 4.54 metres per minute, 95% CI 0.95 to 8.14
increased
#6
mixed training, involving walking
increase
walking capacity
stroke survivors
MD 41.60 metres per six minutes, 95% CI 25.25 to 57.95
increased
#7
mixed training
increase
balance scores
stroke survivors
SMD 0.27, 95% CI 0.07 to 0.47
improved slightly
#8
resistance training
no change
disability
stroke survivors
-
insufficient evidence to support the use of
#9
Abstract

BACKGROUND: Levels of physical fitness are low after stroke. It is unknown whether improving physical fitness after stroke reduces disability. OBJECTIVES: To determine whether fitness training after stroke reduces death, dependence, and disability and to assess the effects of training with regard to adverse events, risk factors, physical fitness, mobility, physical function, quality of life, mood, and cognitive function. Interventions to improve cognitive function have attracted increased attention after being identified as the highest rated research priority for life after stroke. Therefore we have added this class of outcomes to this updated review. SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (last searched February 2015), the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 1: searched February 2015), MEDLINE (1966 to February 2015), EMBASE (1980 to February 2015), CINAHL (1982 to February 2015), SPORTDiscus (1949 to February 2015), and five additional databases (February 2015). We also searched ongoing trials registers, handsearched relevant journals and conference proceedings, screened reference lists, and contacted experts in the field. SELECTION CRITERIA: Randomised trials comparing either cardiorespiratory training or resistance training, or both (mixed training), with usual care, no intervention, or a non-exercise intervention in stroke survivors. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials, assessed quality and risk of bias, and extracted data. We analysed data using random-effects meta-analyses. Diverse outcome measures limited the intended analyses. MAIN RESULTS: We included 58 trials, involving 2797 participants, which comprised cardiorespiratory interventions (28 trials, 1408 participants), resistance interventions (13 trials, 432 participants), and mixed training interventions (17 trials, 957 participants). Thirteen deaths occurred before the end of the intervention and a further nine before the end of follow-up. No dependence data were reported. Diverse outcome measures restricted pooling of data. Global indices of disability show moderate improvement after cardiorespiratory training (standardised mean difference (SMD) 0.52, 95% confidence interval (CI) 0.19 to 0.84; P value = 0.002) and by a small amount after mixed training (SMD 0.26, 95% CI 0.04 to 0.49; P value = 0.02); benefits at follow-up (i.e. after training had stopped) were unclear. There were too few data to assess the effects of resistance training.Cardiorespiratory training involving walking improved maximum walking speed (mean difference (MD) 6.71 metres per minute, 95% CI 2.73 to 10.69), preferred gait speed (MD 4.28 metres per minute, 95% CI 1.71 to 6.84), and walking capacity (MD 30.29 metres in six minutes, 95% CI 16.19 to 44.39) at the end of the intervention. Mixed training, involving walking, increased preferred walking speed (MD 4.54 metres per minute, 95% CI 0.95 to 8.14), and walking capacity (MD 41.60 metres per six minutes, 95% CI 25.25 to 57.95). Balance scores improved slightly after mixed training (SMD 0.27, 95% CI 0.07 to 0.47). Some mobility benefits also persisted at the end of follow-up. The variability, quality of the included trials, and lack of data prevents conclusions about other outcomes and limits generalisability of the observed results. AUTHORS' CONCLUSIONS: Cardiorespiratory training and, to a lesser extent, mixed training reduce disability during or after usual stroke care; this could be mediated by improved mobility and balance. There is sufficient evidence to incorporate cardiorespiratory and mixed training, involving walking, within post-stroke rehabilitation programmes to improve the speed and tolerance of walking; some improvement in balance could also occur. There is insufficient evidence to support the use of resistance training. The effects of training on death and dependence after stroke are still unclear but these outcomes are rarely observed in physical fitness training trials. Cognitive function is under-investigated despite being a key outcome of interest for patients. Further well-designed randomised trials are needed to determine the optimal exercise prescription and identify long-term benefits.

Medical Subject Headings (MeSH)
Activities of Daily LivingExercise TherapyHumansPhysical FitnessRandomized Controlled Trials as TopicResistance TrainingStrokeStroke RehabilitationWalking
Study Links
Quality Scores
SafetyNot Assessed
Efficacy75/10
Quality85/10
Citation Metrics
Total Citations178
Citations/Year19.8
Relative Citation Ratio10.46
NIH Percentile98%
Research Impact Scores
APT Score0.95
Weight Score2.11
Normalized Score0.67
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