Although the effects of physical fitness training on death, dependence, and disability after stroke are unclear, there is sufficient evidence to incorporate cardiorespiratory training that involves walking within poststroke rehabilitation programs to improve speed, tolerance, and independence during walking, say authors of a meta-analysis published in November in the Cochrane Database of Systematic Reviews.
The authors searched the Cochrane Stroke Group Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, SPORTDiscus, and 5 additional databases. They also searched ongoing trials registers, handsearched relevant journals and conference proceedings, screened reference lists, and contacted experts in the field.
Selection criteria included randomized trials comparing either cardiorespiratory training or resistance training, or both, with no intervention, a nonexercise intervention, or usual care in stroke survivors. Two review authors independently selected trials, assessed quality, and extracted data. The authors analyzed data using random-effects meta-analyses. Diverse outcome measures limited the intended analyses.
The analysis included 32 trials, involving 1,414 participants, which comprised cardiorespiratory (14 trials, 651 participants), resistance (7 trials, 246 participants), and mixed training interventions (11 trials, 517 participants). Five deaths were reported at the end of the intervention and 9 at the end of follow-up. The majority of the estimates of effect were not significant. Cardiorespiratory training involving walking improved maximum walking speed (mean difference [MD] 8.66 meters per minute), preferred gait speed (MD 4.68 meters per minute), and walking capacity (MD 47.13 meters per 6 minutes) 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 meters per minute) and walking capacity (MD 30.59 meters per 6 minutes), but effects were smaller and there was heterogeneity among 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.
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