Physical fitness training for stroke patients

David H. Sanders, Mark Sanderson, Sara Hayes, Maeve Kilrane, Carolyn A. Greig, Miriam Brazzelli, Gillian E. Mead

Research output: Contribution to journalLiterature review

52 Citations (Scopus)
7 Downloads (Pure)

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 (CEN TRAL 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, hand searched 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 (S MD 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.

Original languageEnglish
Article numberCD003316
Pages (from-to)1-411
Number of pages411
JournalCochrane Database of Systematic Reviews
Issue number3
Early online date24 Mar 2016
DOIs
Publication statusPublished - 2016

Fingerprint

Stroke
Walking
Resistance Training
Cognition
Meta-Analysis
Outcome Assessment (Health Care)
MEDLINE
Prescriptions
Survivors
Quality of Life
Databases
Exercise
Walking Speed
Research

Cite this

Sanders, D. H., Sanderson, M., Hayes, S., Kilrane, M., Greig, C. A., Brazzelli, M., & Mead, G. E. (2016). Physical fitness training for stroke patients. Cochrane Database of Systematic Reviews, (3), 1-411. [CD003316]. https://doi.org/10.1002/14651858.CD003316.pub6

Physical fitness training for stroke patients. / Sanders, David H.; Sanderson, Mark; Hayes, Sara; Kilrane, Maeve ; Greig, Carolyn A.; Brazzelli, Miriam; Mead, Gillian E.

In: Cochrane Database of Systematic Reviews, No. 3, CD003316, 2016, p. 1-411.

Research output: Contribution to journalLiterature review

Sanders, DH, Sanderson, M, Hayes, S, Kilrane, M, Greig, CA, Brazzelli, M & Mead, GE 2016, 'Physical fitness training for stroke patients', Cochrane Database of Systematic Reviews, no. 3, CD003316, pp. 1-411. https://doi.org/10.1002/14651858.CD003316.pub6
Sanders, David H. ; Sanderson, Mark ; Hayes, Sara ; Kilrane, Maeve ; Greig, Carolyn A. ; Brazzelli, Miriam ; Mead, Gillian E. / Physical fitness training for stroke patients. In: Cochrane Database of Systematic Reviews. 2016 ; No. 3. pp. 1-411.
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title = "Physical fitness training for stroke patients",
abstract = "BackgroundLevels of physical fitness are low after stroke. It is unknown whether improving physical fitness after stroke reduces disability.ObjectivesTo 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 methodsWe searched the Cochrane Stroke Group Trials Register (last searched February 2015), the Cochrane Central Register of Controlled Trials (CEN TRAL 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, hand searched relevant journals and conference proceedings, screened reference lists, and contacted experts in the field.Selection criteriaRandomised 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 analysisTwo 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 resultsWe 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 (S MD 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’ conclusionsCardiorespiratory 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.",
author = "Sanders, {David H.} and Mark Sanderson and Sara Hayes and Maeve Kilrane and Greig, {Carolyn A.} and Miriam Brazzelli and Mead, {Gillian E.}",
note = "A C K N O W L E D G E M E N T S We thank the Cochrane Stroke Group editorial team for their assistance in preparing the protocol. We are grateful to Brenda Thomas for her assistance in developing the search strategies. We would also thank all investigators who provided further information about existing trials. We would also like to thank the consumer reviewers Julie Gildie and Sandra Paget for their perspectives on this work; their input relating to the clarity and accessibility of this information is invaluable. We would be grateful if people who are aware of trials potentially relevant for this review could contact David Saunders.",
year = "2016",
doi = "10.1002/14651858.CD003316.pub6",
language = "English",
pages = "1--411",
journal = "Cochrane Database of Systematic Reviews",
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TY - JOUR

T1 - Physical fitness training for stroke patients

AU - Sanders, David H.

AU - Sanderson, Mark

AU - Hayes, Sara

AU - Kilrane, Maeve

AU - Greig, Carolyn A.

AU - Brazzelli, Miriam

AU - Mead, Gillian E.

N1 - A C K N O W L E D G E M E N T S We thank the Cochrane Stroke Group editorial team for their assistance in preparing the protocol. We are grateful to Brenda Thomas for her assistance in developing the search strategies. We would also thank all investigators who provided further information about existing trials. We would also like to thank the consumer reviewers Julie Gildie and Sandra Paget for their perspectives on this work; their input relating to the clarity and accessibility of this information is invaluable. We would be grateful if people who are aware of trials potentially relevant for this review could contact David Saunders.

PY - 2016

Y1 - 2016

N2 - BackgroundLevels of physical fitness are low after stroke. It is unknown whether improving physical fitness after stroke reduces disability.ObjectivesTo 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 methodsWe searched the Cochrane Stroke Group Trials Register (last searched February 2015), the Cochrane Central Register of Controlled Trials (CEN TRAL 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, hand searched relevant journals and conference proceedings, screened reference lists, and contacted experts in the field.Selection criteriaRandomised 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 analysisTwo 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 resultsWe 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 (S MD 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’ conclusionsCardiorespiratory 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.

AB - BackgroundLevels of physical fitness are low after stroke. It is unknown whether improving physical fitness after stroke reduces disability.ObjectivesTo 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 methodsWe searched the Cochrane Stroke Group Trials Register (last searched February 2015), the Cochrane Central Register of Controlled Trials (CEN TRAL 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, hand searched relevant journals and conference proceedings, screened reference lists, and contacted experts in the field.Selection criteriaRandomised 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 analysisTwo 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 resultsWe 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 (S MD 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’ conclusionsCardiorespiratory 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.

U2 - 10.1002/14651858.CD003316.pub6

DO - 10.1002/14651858.CD003316.pub6

M3 - Literature review

SP - 1

EP - 411

JO - Cochrane Database of Systematic Reviews

JF - Cochrane Database of Systematic Reviews

SN - 1469-493X

IS - 3

M1 - CD003316

ER -