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

Vascular risk factors
A few trials reported vascular risk factors. There was no effect on
blood pressure but there was an increase in peak VO2. As well
as indicating poor cardiorespiratory fitness, low values of peak
VO2 peak are associated with an increased risk of stroke (Kurl
2003) and stroke mortality (Lee 2002). Limited data mean that
no conclusions can be drawn.
Physical fitness
Cardiorespiratory fitness
Cardiorespiratory training, and to a smaller degree mixed training,
significantly improved VO2 peak and exercise tolerance during
continuous exercise. This improvement may be beneficial because
a low VO2 peak is associated with functional limitation in elderly
people (Young 2001). In people with stroke the functional benefits
are however less clear (see for example the contradictory data by
Patterson 2007 and Michael 2007).
Gait economy may improve in response to training that contains
walking activity. A limited ’fitness reserve’ caused by a low VO2
peak coupled with poor walking economy is a common post-stroke
problem (Macko 2001). Therefore, training to improve walking
economy and increase the peak may be beneficial for walking performance
and exercise tolerance after stroke. Only few, inconsistent
data were available for the assessment of gait economy. Data
from one individual trial (Mead 2007) suggest that mixed training
may improve gait economy at the end of the training period even
though this training effect seems to disappear at follow-up. On
the whole, the data were insufficient to draw reliable conclusions
on the effect of training on gait economy as well as on the posttraining
retention of cardiorespiratory fitness.
Musculoskeletal fitness
The few trials that assessed whether resistance training or mixed
training improved muscle strength after stroke show inconsistent
results. Most of the trials that showed positive training effects
were either methodologically biased or confounded for additional
training time.
One individual trial (Mead 2007) measured explosive lower limb
extensor power but showed no immediate or retained effect of
mixed training. Non-response could be due to a lack of explosive,
fast movements during resistance training. In people with
Physical function
A variety of measures to assess functional limitations were used
in the included trials. Only a few trials shared the same outcome
stroke, explosive power is associated with function and disability
after stroke (Saunders 2008), and in elderly people explosive
power output may be more important than strength for function
and disability (Puthoff 2007). Interventions to improve explosive
power after stroke remain under-researched (Evans 2000).
Mobility
Physical fitness training for stroke patients (Review)
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Meta-analyses of the available data using a random-effects model
demonstrated that cardiorespiratory training increased walking
speed and walking capacity at the end of the training period
(Analysis 1.11; Analysis 1.13; Analysis 1.14). This training effect
was retained at follow-up, after the intervention had stopped
(Analysis 2.9; Analysis 2.10). Gait improvements in stroke survivors
after cardiorespiratory training may occur due to an increased
fitness reserve (arising from an increased VO2 peak or improved
gait economy, or both). Cardiorespiratory walking training
is, however, task-related and repetitive in nature. These elements
by themselves may facilitate motor learning and benefit gait
performance even in the absence of an obvious improvement in
physical fitness parameters.
There is also evidence that walking speed and walking capacity
may increase at the end of the training phase after mixed training
(Analysis 5.18; Analysis 5.20). These findings are based, however,
on trials which were heterogeneous and potentially confounded
by additional training time. When we looked only at the results of
the ’unconfounded’ trials, we did not find any significant training
effect (Analysis 5.19). Moreover, all trials except one (Yang 2006)
included specific walking training. Therefore, benefits may be explained
by the additional walking practice and treatment ’attention’.
Meta-analyses revealed no significant effects of resistance training
on walking outcomes. It is worth noting that most of the resistance
training interventions did not incorporate walking as a mode of
exercise. Improvements in muscle strength may not necessarily
produce functional benefits (Kim 2001), which translate into a
better walking performance. The relationships between ’fitness’
and ’function’ is indeed very complex and may arise from factors
such as non-linear associations (Buchner 1991) or the interaction
of ’co-impairments’ such as lack of balance and low muscle strength
(Rantanen 2001).
On the whole, there is evidence that measures of walking performance
improve after cardiorespiratory training and, to a lesser
degree, after mixed training but not after resistance training (see
Table 4).
measures. On the whole, no significant effects of cardiorespiratory,
resistance, or mixed training were observed on physical function
outcomes. The few trials that showed a small effect of mixed training
on the timed up and go test were confounded by increased
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