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

we did not include these data in the analyses due to the high proportion
of missing values (21%) in this trial.
Two trials with a total of 148 participants (Duncan 2003; Yang
2006) did not show any significant improvement in ankle dorsiflexion
strength after mixed training (Analysis 5.10) but there was
considerable heterogeneity between their results (Chi 2 17.67, df
= 1) and both trials were confounded for increased training time.
Yang 2006 also reported a range of lower limb strength improvements,
but all measurements were potentially biased as they were
obtained by means of a hand-held dynamometer, which is not a
reliable, objective method of measurement.
The same two trials also assessed the effect of mixed training on
knee extension strength. Data for knee extension strength were also
available from the Cooke 2010 trial. The pooled SMD indicated
a small effect size in favour of the mixed training group at the
end of intervention (SMD 0.36, 95% CI -0.02 to 0.73) (Analysis
5.11). The Cooke 2010 trial showed that this training effect was
not retained at the end of the scheduled follow-up (Analysis 6.8).
Cooke 2010 also assessed knee flexion strength but no significant
training effect was observed either at the end of intervention or at
follow-up (Analysis 5.12; Analysis 6.7). Another trial (Mead 2007)
assessed the extensor power of the lower affected limb at the end
of the training period and at follow-up but found no differences
between mixed training and a ’non-exercise’ control intervention
(Analysis 5.17; Analysis 6.9).
The pooled results of two trials assessing grip strength of the paretic
hand (Duncan 2003; Langhammer 2007) did not show any significant
improvement after mixed training at the end of the intervention
phase (SMD -0.05, 95% CI -0.36 to 0.26). Langhammer
2007 also provided follow-up data for grip strength, which failed
to demonstrate any training effect over time (Analysis 6.10).
One trial (Donaldson 2009) assessed the effect of mixed training
on elbow extension, elbow flexion, and grip force at the end of
intervention but did not detect any significant training effect (
Analysis 5.13; Analysis 5.14; Analysis 5.16).
Mobility
Physical fitness training for stroke patients (Review)
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cardiorespiratory training (Comparisons 1 and 2)
Two trials, which included three relevant comparisons and 73
participants, measured the effect of treadmill gait training using the
Functional Ambulation Category (FAC) scale (da Cunha 2002;
Pohl 2002). The pooled MD showed that the FAC score measured
at the end of intervention was significant lower in stroke survivors
who received cardiorespiratory training during usual care (MD
0.53, 95% CI 0.21 to 0.85; level of heterogeneity Chi 2 = 1.38, df
= 2, P = 0.50) (Analysis 1.10).
Seven trials with a total of 365 participants measured maximum
walking speed (metres per minute) at the end of the intervention
period during (Bateman 2001; da Cunha 2002; Eich 2004; Pohl
2002) and after (Moore 2010; Mudge 2009; Salbach 2004) usual
care. The cardiorespiratory training in all these trials was walking
specific apart from two trials that used cycle ergometry (Bateman
2001) and circuit training (Mudge 2009) respectively. The pooled
mean difference was significantly in favour of the training group
(MD 8.66, 95% CI 2.98 to 14.34; level of heterogeneity Chi 2 =
10.89, df = 7, P = 0.14) (Analysis 1.11). We also analysed the results
of these seven trials according to whether they met the ACSM
criteria for cardiorespiratory training (Analysis 1.12). Surprisingly,
the trials that met the ACSM criteria did not show any difference
between intervention groups whilst those that did not meet the
criteria (or in which the criteria were not clearly reported) showed
a significant cardiorespiratory training effect.
Three trials also provided follow-up data on maximum walking
speed (Bateman 2001; Eich 2004; Mudge 2009) and a significant
training effect was observed at the end of follow-up, three months
after training had finished (MD 8.21, 95% CI 3.38 to 13.05; level
of heterogeneity Chi 2 = 0.70, df = 2, P = 0.70) (Analysis 2.9).
A funnel plot of the seven studies (including eight relevant comparisons)
that measured maximum walking speed showed a tendency
toward asymmetry, suggesting potential publication bias (Figure
1). However, there were too few data points to explore this further
reliably.
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