Physical fitness training for stroke patients

• Published in: Cochrane database of systematic reviews 2016-03, Vol.3 (3), p.CD003316
• Main Authors: Saunders, David H, Sanderson, Mark, Hayes, Sara, Kilrane, Maeve, Greig, Carolyn A, Brazzelli, Miriam, Mead, Gillian E
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Exercise Therapy - methods; Humans; Medicine General & Introductory Medical Sciences; Physical Fitness; Randomized Controlled Trials as Topic; Resistance Training; Stroke - mortality; Stroke Rehabilitation; Walking - physiology
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.CD003316.pub6

Levels of physical fitness are low after stroke. It is unknown whether improving physical fitness after stroke reduces disability. 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. 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. 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. 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. 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