Factors Influencing the Efficacy of Aerobic Exercise for Improving Fitness and Walking Capacity After Stroke: A Meta-Analysis With Meta-Regression.
Pierce Boyne, Jeffrey Welge, Brett Kissela and 1 others
PMID 27744025WHAT IT FOUND
After stroke, aerobic exercise improved aerobic capacity, walking speed and endurance overall.
Walking-mode and vigorous-intensity exercise were associated with larger benefits; seated exercise did not meaningfully improve walking speed or endurance.
Key findings
01Compared with control, aerobic exercise had pooled effects of 2.2 mL/kg/min for VO2peak, 0.06 m/s for walking speed and 29 m for the 6-minute walk test.
02For VO2peak, vigorous intensity had an effect of 3.8 mL/kg/min, moderate intensity 1.6 mL/kg/min, and each 1 mL/kg/min higher baseline VO2peak was associated with a 0.4 mL/kg/min larger effect.
03For walking speed, walking mode had an effect of 0.09 m/s and seated mode -0.05 m/s; for the 6-minute walk test, walking mode had 38 m and seated mode 4 m.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only people who could walk without continuous physical assistance were included, so the results may not apply to non-ambulatory patients or those needing more assistance than devices, orthotics or guarding. Meta-regression could not test several exercise factors at once, so the associations may be confounded and do not prove that one factor caused the difference in individual patients. Exercise intensity was often inferred from planned targets rather than measured achieved intensity; all 20 studies reported planned intensity, but only 5 reported mean achieved intensity, and 4 of those reported lower actual intensity than planned. Study quality varied from 3 to 8 out of 10 on the PEDro scale, and quality was not used to decide eligibility. Only immediate post-intervention change was analysed, so the summary does not show whether effects persisted later.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that any aerobic exercise will improve walking after stroke. Seated aerobic exercise did not show a clear effect on walking speed or 6-minute walk distance; walking-based exercise was associated with larger walking benefits.