Effects of cardiovascular exercise early after stroke: systematic review and meta-analysis

Abstract

BackgroundPrevious studies have shown the beneficial effects of aerobic exercise in chronic stroke. Most motor and functional recovery occurs in the first months after stroke. Improving cardiovascular capacity may have potential to precipitate recovery during early stroke rehabilitation. Currently, little is known about the effects of early cardiovascular exercise in stroke survivors. The aim of this systematic review was to evaluate the effectiveness of cardiovascular exercise early after stroke.MethodsA systematic literature search was performed. For this review, randomized and non-randomized prospective controlled cohort studies using a cardiovascular, cardiopulmonary or aerobic training intervention starting within 6 months post stroke were considered. The PEDro scale was used to detect risk of bias in individual studies. Inter-rater agreement was calculated (kappa). Meta-analysis was performed using a random-effects model.ResultsA total of 11 trials were identified for inclusion. Inter-rater agreement was considered to be “very good” (Kappa: 0.81, Standard Error: 0.06, CI95%: 0.70–0.92), and the methodological quality was “good” (7 studies) to “fair” (4 studies). Peak oxygen uptake data were available for 155 participants. Pooled analysis yielded homogenous effects favouring the intervention group (standardised mean difference (SMD) = 0.83, CI95% = 0.50–1.16, Z = 4.93, P < 0.01). Walking endurance assessed with the 6 Minute Walk Test comprised 278 participants. Pooled analysis revealed homogenous effects favouring the cardiovascular training intervention group (SMD = 0.69, CI95% = 0.45–0.94, Z = 5.58, P < 0.01). Gait speed, measured in 243 participants, did not show significant results (SMD = 0.51, CI95% = −0.25–1.26, Z = 1.31, P = 0.19) in favour of early cardiovascular exercise.ConclusionThis meta-analysis shows that stroke survivors may benefit from cardiovascular exercise during sub-acute stages to improve peak oxygen uptake and walking distance. Thus, cardiovascular exercise should be considered in sub-acute stroke rehabilitation. However, concepts to influence and evaluate aerobic capacity in severely affected individuals with sub-acute stroke, as well as in the very early period after stroke, are lacking.Further research is needed to develop appropriate methods for cardiovascular rehabilitation early after stroke and to evaluate long-term effects of cardiovascular exercise on aerobic capacity, physical functioning, and quality-of-life.

Aerobic, Resistance, and Cognitive Exercise Training Poststroke

“…9,34 The magnitude of changes in VO 2 max among stroke patients is similar to healthy sedentary adults or participants in cardiac rehabilitation (12.5% versus 10% to 30% versus 13% to 15%, respectively). 35 Even if the observed improvements are small in absolute terms (eg, ≈1 mL/kg/min), 36 considering low baseline fitness levels, the same improvements can have significant functional carryover for stroke survivors. In addition to improved cardiorespiratory capacity, one systematic review 36 supported the idea that AE improves gait velocity and capacity in randomized trials involving ≤133 mildly to moderately affected stroke patients.…”

“…35 Even if the observed improvements are small in absolute terms (eg, ≈1 mL/kg/min), 36 considering low baseline fitness levels, the same improvements can have significant functional carryover for stroke survivors. In addition to improved cardiorespiratory capacity, one systematic review 36 supported the idea that AE improves gait velocity and capacity in randomized trials involving ≤133 mildly to moderately affected stroke patients. This benefit may be even more evident with task-oriented therapy (ie, strengthening the lower extremities, enhancing walking balance and speed, or treadmill walking at higher intensity) reported in 2 randomized controlled trials with exercise sessions performed for 6 weeks (n=91; >1 year poststroke) 37 and 6 months (n=91; >6 months poststroke).…”

Forced Aerobic Exercise Enhances Motor Recovery After Stroke: A Case Report

“…Although aerobic exercise has been shown to improve cardiovascular fitness in people with stroke (Stoller, de Bruin, Knols, & Hunt, 2012), its potential role in enhancing neuroplasticity and motor recovery after stroke has not been examined.…”

Relationship between Physical Activity and Stroke: Review From Different Meta Analytical Studies

“…There is strong evidence that aerobic exercise (40-50% HRR progressing to 60-80%) conducted 20-40 min and 3-5 days per week is beneficial for enhancing aerobic fitness, walking speed and walking endurance in people who have had mild to moderate stroke and are deemed to have low cardiovascular risk with exercise after proper screening assessments (grade A recommendation). 17 observed effects of cardiovascular exercise early after stroke: systematic review and meta-analysis from 11 trials (10 RCT or randomized controlled pilot studies, 1 study prospective controlled matched design) with 423 participants. Results showed that Peak oxygen uptake (n=155) favoring the intervention group (SMD = 0.83, CI95% = 0.50-1.16, Z = 4.93, P<0.01).…”