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

ical function outcomes did not improve after resistance training
interventions, probably because functionally relevant movements
are difficult to incorporate into resistance training interventions.
Timing of training
Due to limited data being available, we were unable to perform
subgroup analyses to compare interventions during usual care with
interventions after usual care.
Retention of benefits
Functional advantages observed at the end of rehabilitation interventions
are known to be transient, disappearing at a later stage
(Kwakkel 1999; Kwakkel 2002). This is probably due to continued
improvements in the control group rather than deterioration
in function (Langhorne 2002). Fitness improvements observed at
the end of training interventions are also known to deteriorate.
Few trials included in this review assessed possible retention of
benefits over time. Most of the functional improvements observed
at the end of the training period were not sustained at later assessments.
We found, however, that cardiorespiratory training effects
on measures of walking performance were retained at the end of
the follow-up period. This retention effect could have arisen from
an increase in habitual levels of physical activity (including walking)
facilitated by participation in a training intervention. The
extent to which short-term fitness training influences longer-term
habitual physical activity after stroke is still unknown. Currently,
there are no data examining either long-term fitness training interventions
or interventions to facilitate continued exercise after the
training intervention is completed. Long-term assessments should
be incorporated into future trials of physical fitness training.
Effect of physical activity performed by control groups
Training effects arising from physical activity in the control group
could partly explain the lack of effect observed in some of the
included trials.
Effect of trial quality
There are insufficient data to reliably examine the effects of trial
quality on estimates of effect. Overall, the methodological quality
of most of the 32 included trials was modest. Only four trials
enrolled more than 80 participants, and 12 trials had 20 or
fewer participants. Only 16 trials employed adequate methods of
sequence generation and 19 trials had blinded outcome assessors
(but some degree of unmasking occurred in three of these trials).
The rate of attendance could only be determined in half of the
included trials.
Summary of review findings
• Most available data relate to ambulatory people in the
chronic phase (more than one month) post-stroke.
• It is feasible for stroke survivors to participate in a variety of
short-term fitness training regimens presented in a range of
settings, either during usual stroke care or after hospital
discharge.
• There are insufficient data to assess death and dependence
outcomes reliably.
• From the limited data reported in the included trials, there
is an indication that participation in fitness training programmes
is safe and does not result in serious adverse events.
• Global indices of disability are not consistently reported in
trials of fitness training. No conclusions can be drawn from the
available data.
• There is some evidence that cardiorespiratory training may
improve physical fitness outcomes.
• There is clear evidence that cardiorespiratory training
improves measures of walking performance (e.g. walking speed
and walking capacity) and reduces dependence during usual care.
These training effects are retained at follow-up.
• There are insufficient data to assess reliably the effects of
resistance training.
• There is a suggestion that mixed training may improve
measures of walking performance.
• There is an indication that the training effect may be
greater when fitness training is specific or ’task-related’.
• There are few data relating to physical function, quality of
life, and mood outcomes.
• There are insufficient data to conduct meaningful subgroup
analyses to explore the effects of the type, ’dose’, and timing of
training on outcome measures.
• Limited methodological quality of included trials and
relatively small sample sizes hamper the generalizability of
findings.
Issues for research
Control groups
Physical fitness training for stroke patients (Review)
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
In terms of trial design, there should be a concerted effort to balance
total contact time across all arms in order to avoid confounded
results. Preferably, the control intervention should contain minimal
or no physical activity since even performing activities of daily
living may be sufficient to cause training effects in elderly people
(Young 2001). One robust way of clarifying whether the content
of the training itself is beneficial would be, for example, to compare
and assess two doses of training.
22