Physical fitness training for stroke patients (Review) - Update Software

Post-stroke physical activity and fitness levels are low, and these
low levels are associated with common post-stroke functional limitations.
Increased fitness and physical function could benefit a
range of other common post-stroke problems, such as reducing
fatigue, reducing the incidence of falls and fractures, compensating
for the increased energetic cost of a hemiparetic gait, reducing
disability and improving independence, and improving quality of
life and mood. Therefore, increasing fitness may benefit a range
of common post-stroke problems.
Physical therapies are known to promote structural brain remodelling
(Gauthier 2008) and this can influence post-stroke motor
deficits. There is systematic review evidence that repetitive practice
of some common day-to-day activities produces some modest improvements
in mobility and ADL in stroke patients (French 2010).
Therefore, participation in repetitive, task-related fitness training
may have functional benefits even if fitness is not improved.
Engagement with group training activities may have some psychosocial
benefits in people with stroke (Carin-Levy 2009; Mead
2005; Patterson 2009). Therefore, simply participating in physical
fitness training may be beneficial, particularly where group
activities are involved.
Physical fitness training is known to be beneficial for people with
a number of conditions that are comorbid conditions or risk factors
for stroke. Systematic review evidence shows that interventions
involving physical fitness training reduce blood pressure
(Dickinson 2006), improve vascular risk factors in obesity (Shaw
2006) and type II diabetes (Thomas 2006), reduce mortality in
coronary heart disease (CHD) patients (Jolliffe 2000), and may
have some benefits for patients diagnosed with depression (Mead
2008). Therefore, post-stroke cardiorespiratory training, in particular,
could reduce morbidity and mortality through secondary
prevention of stroke and comorbid disease.
In summary, physical fitness training does not simply provide a
mechanism to increase fitness, it has multiple mechanisms of action
and has a spectrum of plausible benefits that are relevant to
many people with stroke. However, there may also be risks, such
as training-induced soft tissue injuries, altered muscle tone, falls,
and vascular events.
Why it is important to do this review
Physical fitness training for stroke survivors remains under-investigated
in two key areas. Firstly, the range of possible benefits is
not fully explored. Secondly, the optimal exercise prescription for
people with stroke has yet to be defined. There is clearly a growing
interest in physical fitness interventions for stroke. The 2004
original version of this review contained only 12 trials, the 2009
update doubled the number of included trials to 24 and this has
been among the top 10 most accessed Cochrane stroke reviews
(Saunders 2004; Saunders 2009). Considering the degree of incomplete
knowledge and the high level of interest we believe it is
important to update this review.
O B J E C T I V E S
To determine the effects of cardiorespiratory training and resistance
training, individually or in combination (mixed training),
compared with no intervention, usual care, or other specific control
interventions in stroke survivors.
M E T H O D S
Criteria for considering studies for this review
Types of studies
Physical fitness training for stroke patients (Review)
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
All trials described as randomised controlled trials (RCTs), singleblinded
or open, that examined the effects of cardiorespiratory,
resistance, or mixed training using any of the following six comparisons.
• Cardiorespiratory training versus control: (1) at the end of
intervention, (2) at the end of follow-up.
• Resistance training versus control: (3) at the end of
intervention, (4) at the end of follow-up.
• Mixed training (cardiorespiratory plus resistance training)
versus control: (5) at the end of intervention, (6) at the end of
follow-up.
In this review ’end of intervention’ refers to the time-point when a
training programme finishes; ’end of follow-up’ refers to any timepoint
occurring after the end of the intervention. Measures at the
end of follow-up allow us to examine whether training effects (if
any) are retained after training is completed.
We included studies in which controls were exposed to either physical
activity occurring during usual care or no training after usual
care. By ’no training’ we meant either no intervention or a nonexercise
intervention (for example cognitive tasks or sham training).
Therefore, we deemed the following comparisons suitable
for inclusion:
• training plus usual care versus usual care (during usual care);
• training versus no training (after usual care).
We included only full-text reports of published and unpublished
trials. We did not include conference proceedings (that is abstract
and poster presentations) because usually they provide only limited
data and do not allow full assessment of study quality. We did not
exclude trials on the basis of their sample size. We included studies
published in languages other than English only when a translation
could be arranged. Where investigators published several reports
based on data from a single study population, we selected the most
recent or most complete report for data extraction and we listed
the other reports as duplicate publications.
4