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

walking speed (mean difference (MD) 8.66 metres per minute, 95% confidence interval (CI) 2.98 to 14.34), preferred gait speed (MD
4.68 metres per minute, 95% CI 1.40 to 7.96) and walking capacity (MD 47.13 metres per six minutes, 95% CI 19.39 to 74.88) at
the end of the intervention. These training effects were retained at the end of follow-up. Mixed training, involving walking, increased
preferred walking speed (MD 2.93 metres per minute, 95% CI 0.02 to 5.84) and walking capacity (MD 30.59 metres per six minutes,
95% CI 8.90 to 52.28) but effects were smaller and there was heterogeneity amongst the trial results. There were insufficient data to
assess the effects of resistance training. The variability in the quality of included trials hampered the reliability and generalizability of
the observed results.
Authors’ conclusions
The effects of training on death, dependence, and disability after stroke are unclear. There is sufficient evidence to incorporate cardiorespiratory
training involving walking within post-stroke rehabilitation programmes to improve speed, tolerance, and independence
during walking. Further well-designed trials are needed to determine the optimal exercise prescription and identify long-term benefits.
P L A I N L A N G U A G E S U M M A R Y
Physical fitness training for stroke patients
Fitness training is considered beneficial for stroke patients. Physical fitness is important for the performance of everyday activities. The
physical fitness of stroke patients is impaired after their stroke and this may reduce their ability to perform everyday activities and also
exacerbate any stroke-related disability. This review of 32 trials involving 1414 participants found that cardiorespiratory fitness training
after stroke can improve walking performance. There are too few data for other reliable conclusions to be drawn.
B A C K G R O U N D
Physical activity and exercise recommendations exist for a wide
range of healthy, older, and patient populations (Nelson 2007;
O’Donovan 2010) including those with specific health problems
such as stroke (Gordon 2004). Although exercise and physical
activity are promoted positively the evidence is still incomplete.
What is physical fitness training?
Exercise refers to a subset of physical activity which is planned,
structured, repetitive, and deliberately performed to train (improve)
one or more components of physical fitness (USDHHS
2008). Since the term ’exercise’ is used more generically within
stroke care we will refer to exercise as ’physical fitness training’.
What is physical fitness?
Physical fitness describes a set of physiological attributes that a
person has or achieves, which confer the ability to perform physical
activities without undue fatigue. Activities can range from dayto-day
tasks to leisure activities (USDHHS 2008). The most important
components of physical fitness are those responsible for
muscular work, as follows.
Physical fitness training for stroke patients (Review)
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
1. Cardiorespiratory fitness is the ability to transport and use
oxygen and is usually expressed as maximal oxygen uptake (VO2
max). Cardiorespiratory fitness confers ’endurance’, that is the
ability to perform physical activity for an extended period.
2. Muscle strength refers to the ability of a specific muscle or
muscle group to exert force. Strength is associated with the
ability to perform forceful movements such as pushing or lifting.
3. Muscle power refers to the rate at which muscular work can
be performed during a single explosive contraction. Power is
associated with the ability to carry out forceful movements, in
particular those that are dynamic.
In addition, other components of fitness can influence the ability to
perform physical activities, including flexibility (range of motion
about a specific joint), balance (ability to maintain stability and
posture), and body composition (for example relative amounts of
fat and fat-free mass).
Determinants of fitness
Physical fitness is lower in women compared to men and it deteriorates
due to increasing age (1% to 4% in one year) (Young
2001), physical inactivity (12% to 14% in 10 days) (Kortebein
2008), and other secondary consequences of chronic disease such
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