Physical fitness training for stroke patients

Miriam Brazzelli, David H. Saunders, Carolyn A. Greig, Gillian E. Mead

Research output: Contribution to journalLiterature review

47 Citations (Scopus)

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. The secondary aims were to determine the effects of training on physical fitness, mobility, physical function, quality of life, mood, and incidence of adverse events.

Search strategy

We searched the Cochrane Stroke Group Trials Register (last searched April 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, July 2010), MEDLINE (1966 to March 2010), EMBASE (1980 to March 2010), CINAHL (1982 to March 2010), SPORTDiscus (1949 to March 2010), and five additional databases (March 2010). 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, with no intervention, a non-exercise intervention, or usual care in stroke survivors.

Data collection and analysis

Two review authors independently selected trials, assessed quality, and extracted data. We analysed data using random-effects meta-analyses. Diverse outcome measures limited the intended analyses.

Main results

We included 32 trials, involving 1414 participants, which comprised cardiorespiratory (14 trials, 651 participants), resistance (seven trials, 246 participants), and mixed training interventions (11 trials, 517 participants). Five deaths were reported at the end of the intervention and nine at the end of follow-up. No dependence data were reported. Diverse outcome measures made data pooling difficult. The majority of the estimates of effect were not significant. Cardiorespiratory training involving walking improved maximum walking speed (mean difference (MD) 8.66 metres per minute, 95% confidence interval (CI) 2.98 to 14.34), preferred gait speed (MD 4.68 metres per minute, 95% CI 1.40 to 7.96) and walking capacity (MD 47.13 metres per six minutes, 95% CI 19.39 to 74.88) at the end of the intervention. These training effects were retained at the end of follow-up. Mixed training, involving walking, increased preferred walking speed (MD 2.93 metres per minute, 95% CI 0.02 to 5.84) and walking capacity (MD 30.59 metres per six minutes, 95% CI 8.90 to 52.28) but effects were smaller and there was heterogeneity amongst the trial results. There were insufficient data to assess the effects of resistance training. The variability in the quality of included trials hampered the reliability and generalizability of the observed results.

Authors' conclusions

The effects of training on death, dependence, and disability after stroke are unclear. There is sufficient evidence to incorporate cardiorespiratory training involving walking within post-stroke rehabilitation programmes to improve speed, tolerance, and independence during walking. Further well-designed trials are needed to determine the optimal exercise prescription and identify long-term benefits.

Original languageEnglish
Article numberCD003316
Number of pages247
JournalCochrane Database of Systematic Reviews
Issue number11
DOIs
Publication statusPublished - 9 Nov 2011

Fingerprint

Physical Fitness
Walking
Stroke
Confidence Intervals
Resistance Training
Meta-Analysis
Outcome Assessment (Health Care)
MEDLINE
Libraries
Prescriptions
Survivors
Quality of Life
Databases
Incidence
Walking Speed

Keywords

  • older-adults
  • resistance Training
  • randomized controlled trials as topic
  • exercise therapy
  • quality-of-life
  • physical fitness
  • humans
  • american-heart-association
  • subacute stroke
  • body-weight support
  • randomized controlled-trial
  • muscle strength
  • traumatic brain injury
  • stroke [mortality; rehabilitation]
  • controlled pilot trial
  • arm function

Cite this

Physical fitness training for stroke patients. / Brazzelli, Miriam; Saunders, David H.; Greig, Carolyn A.; Mead, Gillian E.

In: Cochrane Database of Systematic Reviews, No. 11, CD003316, 09.11.2011.

Research output: Contribution to journalLiterature review

Brazzelli, Miriam ; Saunders, David H. ; Greig, Carolyn A. ; Mead, Gillian E. / Physical fitness training for stroke patients. In: Cochrane Database of Systematic Reviews. 2011 ; No. 11.
@article{22b078a33a3142aa9e143714f0379eb3,
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. The secondary aims were to determine the effects of training on physical fitness, mobility, physical function, quality of life, mood, and incidence of adverse events.Search strategyWe searched the Cochrane Stroke Group Trials Register (last searched April 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, July 2010), MEDLINE (1966 to March 2010), EMBASE (1980 to March 2010), CINAHL (1982 to March 2010), SPORTDiscus (1949 to March 2010), and five additional databases (March 2010). We also searched ongoing trials registers, handsearched 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, with no intervention, a non-exercise intervention, or usual care in stroke survivors.Data collection and analysisTwo review authors independently selected trials, assessed quality, and extracted data. We analysed data using random-effects meta-analyses. Diverse outcome measures limited the intended analyses.Main resultsWe included 32 trials, involving 1414 participants, which comprised cardiorespiratory (14 trials, 651 participants), resistance (seven trials, 246 participants), and mixed training interventions (11 trials, 517 participants). Five deaths were reported at the end of the intervention and nine at the end of follow-up. No dependence data were reported. Diverse outcome measures made data pooling difficult. The majority of the estimates of effect were not significant. Cardiorespiratory training involving walking improved maximum walking speed (mean difference (MD) 8.66 metres per minute, 95{\%} confidence interval (CI) 2.98 to 14.34), preferred gait speed (MD 4.68 metres per minute, 95{\%} CI 1.40 to 7.96) and walking capacity (MD 47.13 metres per six minutes, 95{\%} CI 19.39 to 74.88) at the end of the intervention. These training effects were retained at the end of follow-up. Mixed training, involving walking, increased preferred walking speed (MD 2.93 metres per minute, 95{\%} CI 0.02 to 5.84) and walking capacity (MD 30.59 metres per six minutes, 95{\%} CI 8.90 to 52.28) but effects were smaller and there was heterogeneity amongst the trial results. There were insufficient data to assess the effects of resistance training. The variability in the quality of included trials hampered the reliability and generalizability of the observed results.Authors' conclusionsThe effects of training on death, dependence, and disability after stroke are unclear. There is sufficient evidence to incorporate cardiorespiratory training involving walking within post-stroke rehabilitation programmes to improve speed, tolerance, and independence during walking. Further well-designed trials are needed to determine the optimal exercise prescription and identify long-term benefits.",
keywords = "older-adults, resistance Training, randomized controlled trials as topic, exercise therapy, quality-of-life, physical fitness, humans, american-heart-association, subacute stroke, body-weight support, randomized controlled-trial, muscle strength, traumatic brain injury, stroke [mortality; rehabilitation], controlled pilot trial, arm function",
author = "Miriam Brazzelli and Saunders, {David H.} and Greig, {Carolyn A.} and Mead, {Gillian E.}",
year = "2011",
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TY - JOUR

T1 - Physical fitness training for stroke patients

AU - Brazzelli, Miriam

AU - Saunders, David H.

AU - Greig, Carolyn A.

AU - Mead, Gillian E.

PY - 2011/11/9

Y1 - 2011/11/9

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. The secondary aims were to determine the effects of training on physical fitness, mobility, physical function, quality of life, mood, and incidence of adverse events.Search strategyWe searched the Cochrane Stroke Group Trials Register (last searched April 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, July 2010), MEDLINE (1966 to March 2010), EMBASE (1980 to March 2010), CINAHL (1982 to March 2010), SPORTDiscus (1949 to March 2010), and five additional databases (March 2010). We also searched ongoing trials registers, handsearched 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, with no intervention, a non-exercise intervention, or usual care in stroke survivors.Data collection and analysisTwo review authors independently selected trials, assessed quality, and extracted data. We analysed data using random-effects meta-analyses. Diverse outcome measures limited the intended analyses.Main resultsWe included 32 trials, involving 1414 participants, which comprised cardiorespiratory (14 trials, 651 participants), resistance (seven trials, 246 participants), and mixed training interventions (11 trials, 517 participants). Five deaths were reported at the end of the intervention and nine at the end of follow-up. No dependence data were reported. Diverse outcome measures made data pooling difficult. The majority of the estimates of effect were not significant. Cardiorespiratory training involving walking improved maximum walking speed (mean difference (MD) 8.66 metres per minute, 95% confidence interval (CI) 2.98 to 14.34), preferred gait speed (MD 4.68 metres per minute, 95% CI 1.40 to 7.96) and walking capacity (MD 47.13 metres per six minutes, 95% CI 19.39 to 74.88) at the end of the intervention. These training effects were retained at the end of follow-up. Mixed training, involving walking, increased preferred walking speed (MD 2.93 metres per minute, 95% CI 0.02 to 5.84) and walking capacity (MD 30.59 metres per six minutes, 95% CI 8.90 to 52.28) but effects were smaller and there was heterogeneity amongst the trial results. There were insufficient data to assess the effects of resistance training. The variability in the quality of included trials hampered the reliability and generalizability of the observed results.Authors' conclusionsThe effects of training on death, dependence, and disability after stroke are unclear. There is sufficient evidence to incorporate cardiorespiratory training involving walking within post-stroke rehabilitation programmes to improve speed, tolerance, and independence during walking. Further well-designed 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. The secondary aims were to determine the effects of training on physical fitness, mobility, physical function, quality of life, mood, and incidence of adverse events.Search strategyWe searched the Cochrane Stroke Group Trials Register (last searched April 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, July 2010), MEDLINE (1966 to March 2010), EMBASE (1980 to March 2010), CINAHL (1982 to March 2010), SPORTDiscus (1949 to March 2010), and five additional databases (March 2010). We also searched ongoing trials registers, handsearched 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, with no intervention, a non-exercise intervention, or usual care in stroke survivors.Data collection and analysisTwo review authors independently selected trials, assessed quality, and extracted data. We analysed data using random-effects meta-analyses. Diverse outcome measures limited the intended analyses.Main resultsWe included 32 trials, involving 1414 participants, which comprised cardiorespiratory (14 trials, 651 participants), resistance (seven trials, 246 participants), and mixed training interventions (11 trials, 517 participants). Five deaths were reported at the end of the intervention and nine at the end of follow-up. No dependence data were reported. Diverse outcome measures made data pooling difficult. The majority of the estimates of effect were not significant. Cardiorespiratory training involving walking improved maximum walking speed (mean difference (MD) 8.66 metres per minute, 95% confidence interval (CI) 2.98 to 14.34), preferred gait speed (MD 4.68 metres per minute, 95% CI 1.40 to 7.96) and walking capacity (MD 47.13 metres per six minutes, 95% CI 19.39 to 74.88) at the end of the intervention. These training effects were retained at the end of follow-up. Mixed training, involving walking, increased preferred walking speed (MD 2.93 metres per minute, 95% CI 0.02 to 5.84) and walking capacity (MD 30.59 metres per six minutes, 95% CI 8.90 to 52.28) but effects were smaller and there was heterogeneity amongst the trial results. There were insufficient data to assess the effects of resistance training. The variability in the quality of included trials hampered the reliability and generalizability of the observed results.Authors' conclusionsThe effects of training on death, dependence, and disability after stroke are unclear. There is sufficient evidence to incorporate cardiorespiratory training involving walking within post-stroke rehabilitation programmes to improve speed, tolerance, and independence during walking. Further well-designed trials are needed to determine the optimal exercise prescription and identify long-term benefits.

KW - older-adults

KW - resistance Training

KW - randomized controlled trials as topic

KW - exercise therapy

KW - quality-of-life

KW - physical fitness

KW - humans

KW - american-heart-association

KW - subacute stroke

KW - body-weight support

KW - randomized controlled-trial

KW - muscle strength

KW - traumatic brain injury

KW - stroke [mortality; rehabilitation]

KW - controlled pilot trial

KW - arm function

U2 - 10.1002/14651858.CD003316.pub4

DO - 10.1002/14651858.CD003316.pub4

M3 - Literature review

JO - Cochrane Database of Systematic Reviews

JF - Cochrane Database of Systematic Reviews

SN - 1469-493X

IS - 11

M1 - CD003316

ER -