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

Case fatality
Number of deaths was reported in four trials.
In the Katz-Leurer 2003 trial one participant had died in the cardiorespiratory
training group (1/42) compared with one participant
in the control group (1/39) at the end of the scheduled follow-up
period (Analysis 2.1). Fewer deaths were observed in the
time between baseline assessment and the end of the intervention
in the intensive mixed training group of the Langhammer 2007
trial (1/32 ) than in the usual rehabilitation group (4/35) (Analysis
5.1). Three trials reported the number of deaths that occurred
between end of intervention and end of the scheduled follow-up
period in stroke survivors receiving mixed training (Cooke 2010;
Duncan 2003; Langhammer 2007). Mixed training in stroke survivors
compared with the usual rehabilitation programme did not
increase the probability of death after completion of the training
intervention (OR 0.27, 95% CI 0.05 to 1.37) (Analysis 6.1).
Death or dependence
The composite outcome of death or dependence was not reported
by any trial.
Disability
Cardiorespiratory training
Few trials of cardiorespiratory training shared the same outcome
measures and therefore few data were available for meta-analyses.
Two trials with a total of 110 participants (Cuviello-Palmer 1988;
Katz-Leurer 2003) used the Functional Independence Measure
(FIM) to assess disability outcomes after usual care and found no
significant difference between fitness training and standard rehabilitation
at the end of the intervention (SMD 0.17, 95% CI -
0.29 to 0.63) (Analysis 1.1). Similarly, Bateman 2001 did not find
any improvement in the FIM score after training, at the end of
the intervention during usual care (SMD 0.23, 95% CI -0.32 to
0.78) (Analysis 1.1). In the Bateman 2001 trial, however, the procedures
for obtaining FIM data at end of intervention were not
uniform and there was a high proportion of missing data (38%).
Mudge 2009 assessed participants after usual care using the Physical
Activity and Disability scale but found that cardiorespiratory
training was not significantly better than a control ’non-exercise’
intervention at the end of the training period (MD 19.90, 95%
CI -17.58 to 57.38) (Analysis 2.4), but confidence intervals were
wide.
At the end of follow-up three individual trials used different scales
(Rivermead Mobility Index; Nottingham Extended ADLs; Physical
Activity and Disability Scale; Frenchay Activities Index) to assess
functional activities and disability outcomes during (Bateman
2001) and after usual care (Katz-Leurer 2003; Mudge 2009). We
were not able to combine the results as the functional scales included
in these trials cover slightly different domains and because
one trial (Bateman 2001), which had a considerable proportion
of missing data (21%), reported results from more than one single
scale. No training effect was evident in each individual analysis.
Resistance training
Ouellette 2004 assessed participants’ functional abilities and disability
outcomes by means of the Late Life Function and Disability
Instrument (LLFD). This scale, however, has not been validated
in stroke survivors and we have not included it in the analyses.
The remaining trials either did not measure disability outcomes or
used subscales or specific dimensions of existing functional scales
(Inaba 1973; Winstein 2004), which we did not deem suitable for
inclusion.
Mixed training
Four trials (Duncan 1998; Duncan 2003; Langhammer 2007;
Mead 2007) assessed the effects of mixed training at the end of
the treatment phase or at follow-up using a variety of scales which
measured disability outcomes (Lawton IADL, Barthel Index, FIM,
Notthingham Extended ADLs, Rivermead Mobility Index, Stroke
Impact Scale). We were able to pool only Lawton IADL results
and Barthel Index and FIM scores in combination. There were no
significant training effects at the end of intervention (Analysis 5.2;
Analysis 5.4) or at follow-up (Analysis 6.3). It is worth noting that
two trials included in the analyses (Duncan 1998; Duncan 2003)
were confounded by increased training time and one trial by the
fact that the Barthel Index scores reached ceiling level in five out of
20 participants at baseline and 10 out of 20 participants at followup
(Duncan 1998).
Results of the remaining rating scales, reported by individual trials,
did not show any significant effect of mixed training at either the
end of intervention or at follow-up.
Effect of training on secondary outcomes
Adverse events
Physical fitness training for stroke patients (Review)
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Adverse events were not reported systematically in the included
trials.
Mead 2007 reported 11 falls in eight of 32 patients in the exercise
group and five falls in four of 34 patients in the control group (P
= ns). None of these falls occurred within training sessions.
Eight of the 32 included trials provided some comments on the
patient tolerance of the training programme and did not report
any adverse events such as falls, fractures, or injuries arising during
the intervention.
Considering all included trials, four participants (three participants
receiving the training intervention and one control) were
reported to have suffered a cerebrovascular event between baseline
and the end of the training intervention.
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