Cost-Effectiveness of Physical Fitness Training for Stroke Survivors

Collins, Marissa; Clifton, E.; Wijck, Frederike van; Mead, Gillian

doi:10.4997/jrcpe.2018.115

Cited by 14 publications

(11 citation statements)

References 19 publications

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“…The AEX + TST also improved their cardiorespiratory fitness more than the TST group, which is an important risk factor in the prevention of stroke (Hussain et al, ; Pandey et al, ). These findings support the merit of including aerobic exercise as part of a comprehensive stroke rehabilitation intervention (Collins, Clifton, Wijck, & Mead, ; Gezer, Karaahmet, Gurcay, Dulgeroglu, & Cakci, ).…”

Section: Discussionsupporting

confidence: 71%

Aerobic exercise and consecutive task‐specific training (AExaCTT) for upper limb recovery after stroke: A randomized controlled pilot study

Valkenborghs

Vliet

Nilsson

et al. 2019

Physiotherapy Res Intl

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Objective This study examined the feasibility of a parallel‐group assessor‐blinded randomized controlled trial investigating whether task‐specific training preceded by aerobic exercise (AEX + TST) improves upper limb function more than task‐specific training (TST) alone. Methods People with upper limb motor dysfunction after stroke were allocated to TST or AEX + TST. Both groups were prescribed 60 hr of TST over 10 weeks (3 × 1‐hr sessions with a therapist per week and 3 × 1 hr of home‐based self‐practice per week). The AEX + TST group performed 30 minutes of aerobic exercise immediately prior to the 1 hr of TST with the therapist. Recruitment, adherence, retention, participant acceptability, and adverse events were recorded. Clinical measures were performed prerandomization at baseline, on completion of the intervention, and at 1‐ and 6‐month follow‐up. Results Fifty‐nine persons after stroke were screened, 42 met the eligibility criteria, and 20 (11 male; mean [SD] age: 55.4 [16.0] years; time since stroke: 71.7 [91.2] months) were recruited over 17 months. The mean Wolf Motor Function Test Functional Ability Score at baseline was 27.4 (max = 75) and the mean Action Research Arm Test score was 11.2 (max = 57). Nine were randomized to AEX + TST and 11 to TST. There were no adverse events, but there was one drop out. Retention at 1‐ and 6‐month follow‐up was 80% and 85%, respectively. Attendance was 93% (6) for the AEX + TST group, and 89% (9) for the TST group. AEX + TST was perceived as acceptable (100%) and beneficial (87.5%). Exertional fatigue (visual analogue scale) prior to TST was worse in the AEX + TST group (3.5 [0.7] out of 10) than the TST group (1.7 [1.4] out of 10). The TST group performed 31% more repetitions per session than the AEX + TST group. Conclusion A subsequent Phase III study is feasible, but modifications to eligibility criteria, outcome measures, and intervention delivery are recommended.

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Section: Discussionsupporting

confidence: 71%

Aerobic exercise and consecutive task‐specific training (AExaCTT) for upper limb recovery after stroke: A randomized controlled pilot study

Valkenborghs

Vliet

Nilsson

et al. 2019

Physiotherapy Res Intl

View full text Add to dashboard Cite

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“…Nonetheless, we seek to advocate for patients and challenge payers by presenting scientific evidence that exercise is not only good for one's health but can facilitate brain function and potentially reduce disability. 18,55 Figure 2. Line plot depicting means and SDs of Fugl-Meyer scores at baseline, EOT, and EOT+4.…”

Section: Considerations For Clinical Translationmentioning

confidence: 99%

Forced, Not Voluntary, Aerobic Exercise Enhances Motor Recovery in Persons With Chronic Stroke

Linder

Rosenfeldt

Davidson

et al. 2019

Neurorehabil Neural Repair

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Background. The recovery of motor function following stroke is largely dependent on motor learning–related neuroplasticity. It has been hypothesized that intensive aerobic exercise (AE) training as an antecedent to motor task practice may prime the central nervous system to optimize motor recovery poststroke. Objective. The objective of this study was to determine the differential effects of forced or voluntary AE combined with upper-extremity repetitive task practice (RTP) on the recovery of motor function in adults with stroke. Methods. A combined analysis of 2 preliminary randomized clinical trials was conducted in which participants (n = 40) were randomized into 1 of 3 groups: (1) forced exercise and RTP (FE+RTP), (2) voluntary exercise and RTP (VE+RTP), or (3) time-matched stroke-related education and RTP (Edu+RTP). Participants completed 24 training sessions over 8 weeks. Results. A significant interaction effect was found indicating that improvements in the Fugl-Meyer Assessment (FMA) were greatest for the FE+RTP group ( P = .001). All 3 groups improved significantly on the FMA by a mean of 11, 6, and 9 points for the FE+RTP, VE+RTP, and Edu+RTP groups, respectively. No evidence of a treatment-by-time interaction was observed for Wolf Motor Function Test outcomes; however, those in the FE+RTP group did exhibit significant improvement on the total, gross motor, and fine-motor performance times ( P ≤ .01 for all observations). Conclusions. Results indicate that FE administered prior to RTP enhanced motor skill acquisition greater than VE or stroke-related education. AE, FE in particular, should be considered as an effective antecedent to enhance motor recovery poststroke.

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“…Importantly, none of the studies included any measure of costs. A recent study demonstrated the cost‐effectiveness (Collins, Clifton, van Wijck, & Mead, ) of a clinically effective community‐based fitness training program for ambulatory stroke survivors (Mead et al., ), but more health‐economic evidence is required for service development.…”

Section: Discussionmentioning

confidence: 99%

Physical fitness interventions for nonambulatory stroke survivors: A mixed‐methods systematic review and meta‐analysis

et al. 2018

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IntroductionPhysical fitness training after stroke is recommended in guidelines across the world, but evidence pertains mainly to ambulatory stroke survivors. Nonambulatory stroke survivors (FAC score ≤2) are at increased risk of recurrent stroke due to limited physical activity. This systematic review aimed to synthesize evidence regarding case fatality, effects, experiences, and feasibility of fitness training for nonambulatory stroke survivors.MethodsEight major databases were searched for any type of study design. Two independent reviewers selected studies, extracted data, and assessed study quality, using published tools. Random‐effects meta‐analysis was used. Following their separate analysis, qualitative and quantitative data were synthesized using a published framework.ResultsOf 13,614 records, 33 studies involving 910 nonambulatory participants met inclusion criteria. Most studies were of moderate quality. Interventions comprised assisted walking (25 studies), cycle ergometer training (5 studies), and other training (3 studies), mainly in acute settings. Case fatality did not differ between intervention (1.75%) and control (0.88%) groups (95% CI 0.13–3.78, p = 0.67). Compared with control interventions, assisted walking significantly improved: fat mass, peak heart rate, peak oxygen uptake and walking endurance, maximum walking speed, and mobility at intervention end, and walking endurance, balance, mobility, and independent walking at follow‐up. Cycle ergometry significantly improved peak heart rate, work load, peak ventilation, peak carbon dioxide production, HDL cholesterol, fasting insulin and fasting glucose, and independence at intervention end. Effectiveness of other training could not be established. There were insufficient qualitative data to draw conclusions about participants' experiences, but those reported were positive. There were few intervention‐related adverse events, and dropout rate ranged from 12 to 20%.ConclusionsFindings suggest safety, effectiveness, and feasibility of adapted fitness training for screened nonambulatory stroke survivors. Further research needs to investigate the clinical and cost‐effectiveness as well as experiences of fitness training—especially for chronic stroke survivors in community settings.

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Cost-Effectiveness of Physical Fitness Training for Stroke Survivors

Cited by 14 publications

References 19 publications

Aerobic exercise and consecutive task‐specific training (AExaCTT) for upper limb recovery after stroke: A randomized controlled pilot study

Aerobic exercise and consecutive task‐specific training (AExaCTT) for upper limb recovery after stroke: A randomized controlled pilot study

Forced, Not Voluntary, Aerobic Exercise Enhances Motor Recovery in Persons With Chronic Stroke

Physical fitness interventions for nonambulatory stroke survivors: A mixed‐methods systematic review and meta‐analysis

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