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

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Katz-Leurer 2003 Methods Design: randomised trial of cardiorespiratory training plus usual care versus usual care - during usual care Randomisation mechanism: unknown; method: blocks based on side of lesion Allocation concealment: sealed envelopes Blinding: investigator; efficacy unknown Intention-to-treat: unknown Measurements: end of intervention and 6-month post stroke follow-up Withdrawals: intervention: no losses at end of intervention, 5 losses at 6-month follow-up (4 not located, 1 died); control: 2 discontinued intervention (1 acute myocardial infarction, 1 deep vein thrombosis), 6 losses to follow-up (3 not located, 1 died, 2 recurrent stroke) Participants Randomised: 92 participants Intervention: 46 participants; 26 males and 20 females; age 62 years (SD 11); time since stroke unknown Control: 46 participants; 23 males and 23 females; age 65 years (SD 11); time since stroke unknown Inclusion criteria: age > 50 years; > 6 months after first ever stroke; walk 40 metres with +/ - rest, +/- assistive device; ≥ stage 3 of Chedoke-McMaster Stroke Assessment: tolerate 45 minutes of exercise with rest intervals; non-participation in other therapy programmes Exclusion criteria: comprehensive aphasia; not medically stable; musculoskeletal problems not associated with stroke Interventions Intervention: cardiorespiratory training: cycle ergometer; 8-week programme: (1) 20 minutes per day 5 days per week for 2 weeks of intermittent (10 x 1 minute) exercise progressing to 20 minutes continuous exercise by end of week 2; (2) 30 minutes per day 3 days per week for 6 weeks not exceeding 60% hear rate reserve; ACSM criteria for cardiorespiratory training met Control: usual physiotherapy, occupational therapy, speech therapy and group activity/ exercise Setting: rehabilitation centre Outcomes Included outcomes: FIM; blood pressure; maximum cycle workload (Watts); comfortable walking speed (10-metre) gait endurance; distance until fatigue; FAI; stair climbing Other outcomes: SSS Notes Risk of bias Bias Authors’ judgement Support for judgement Allocation concealment (selection bias) Low risk Sealed envelopes Physical fitness training for stroke patients (Review) Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 53
Kim 2001 Methods Design: randomised trial of resistance training versus non-exercise intervention - after usual care Randomisation mechanism: unknown; method: stratified based on gender, age (50 to 59 or 60+ years) and time since onset of stroke (6 months to 2 years/2+ years) Allocation concealment: unknown Blinding: investigator; participants blinded to purpose of interventions Intention-to-treat: unknown Measurements: end of intervention (6 weeks) Withdrawals: none Participants Randomised: 20 participants Intervention: 10 participants; 7 males and 3 females; age 60.4 years (SD 9.5); 4.9 years post-stroke (SD 3.3) Control: 10 participants; 7 males and 3 females; age 61.9 years (SD 7.5); 3.2 years poststroke (SD 1.2) All participants had hemiparesis Inclusion criteria: age > 50 years; > 6 months after first ever stroke; walk 40 metres with +/- rest, +/- assistive device; stage 3 of Chedoke-McMaster Stroke Assessment; tolerate 45 minutes of exercise with rest intervals; non-participation in other therapy programmes Exclusion criteria: comprehensive aphasia; not medically stable; musculoskeletal problems not associated with stroke Interventions Intervention: isokinetic dynamometer (Kin-Com); 45 minutes per day 3 days per week for 6 weeks; after a warm up this comprised 30 minutes of 3 x 10 resisted repetitions of maximal effort concentric hip flexion/extension, knee flexion/extension and ankle dorsiflexion/plantarflexion of the affected lower limb; progression in the resistance was achieved by increasing the preload on the Kin-Com device; ACSM criteria for resistance training met Control: exactly the same as intervention except the resisted contractions replaced with passive range of motion movements Setting: rehabilitation centre Outcomes Included outcomes: gait preferred speed (metres/minute over 8 metres); gait maximum speed (metres/minute); stair climbing speed (stairs/second); composite strength score for the affected (trained) lower limb Other outcomes: stair walking performance (4 x 18 cm steps) self selected and maximal; physical functioning and mental health components of the SF-36; composite strength score for the affected (trained) lower limb Notes Data reported as change scores Risk of bias Bias Authors’ judgement Support for judgement Allocation concealment (selection bias) Unclear risk Not reported Physical fitness training for stroke patients (Review) Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 54
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Physical fitness training for strok
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Analysis 1.19. Comparison 1 Cardior
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Analysis 5.10. Comparison 5 Mixed t
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Analysis 7.2. Comparison 7 Cardiore
Page 9 and 10: walking speed (mean difference (MD)
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Page 13 and 14: Search methods for identification o
Page 15 and 16: • type of training (cardiorespira
Page 17 and 18: Compliance with the scheduled exerc
Page 19 and 20: Case fatality Number of deaths was
Page 21 and 22: we did not include these data in th
Page 23 and 24: (Flansbjer 2008; Kim 2001; Ouellett
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Page 31 and 32: We thank the Cochrane Stroke Group
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Page 35 and 36: Dean 1997 {published data only} Dea
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Page 39 and 40: with chronic stroke. Neurorehabilit
Page 41 and 42: Askim {published data only} Askim T
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Page 45 and 46: andomized controlled trials. Clinic
Page 47 and 48: Bale 2008 Methods Design: randomise
Page 49 and 50: Cooke 2010 Methods Design: phase I
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Page 81 and 82: (Continued) Franceschini 2009 Not v
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Page 87 and 88: Eng Trial name or title The effect
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Page 97 and 98: 11.2 After usual care 3 169 Mean Di
Page 99 and 100: 7 Physical fitness - maximum cyclin
Page 101 and 102: 10.2 After usual care 1 20 Mean Dif
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Page 107 and 108: 21.2 After usual care 1 80 Mean Dif
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Analysis 3.1. Comparison 3 Resisten
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Analysis 3.11. Comparison 3 Resiste
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Analysis 5.1. Comparison 5 Mixed tr
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Table 1. Outline of the studies whi
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Table 3. Outline of the studies whi
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Table 4. Pooled walking data for ca
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#42.(physical in Abstract and (exer
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71 8 and 36 and 70 72 limit 71 to h
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S58. (MH “Random Assignment”) o
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W H A T ’ S N E W Last assessed a
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MeSH check words Humans Physical fi
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