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Meta-Analysis
. 2017 Mar;98(3):581-595.
doi: 10.1016/j.apmr.2016.08.484. Epub 2016 Oct 12.

Factors Influencing the Efficacy of Aerobic Exercise for Improving Fitness and Walking Capacity After Stroke: A Meta-Analysis With Meta-Regression

Pierce Boyne  1 , Jeffrey Welge  2 , Brett Kissela  3 , Kari Dunning  4
Affiliations
Meta-Analysis

Factors Influencing the Efficacy of Aerobic Exercise for Improving Fitness and Walking Capacity After Stroke: A Meta-Analysis With Meta-Regression

Pierce Boyne et al. Arch Phys Med Rehabil. 2017 Mar.

Abstract

Objective: To assess the influence of dosing parameters and patient characteristics on the efficacy of aerobic exercise (AEX) poststroke.

Data sources: A systematic review was conducted using PubMed, MEDLINE, Cumulative Index of Nursing and Allied Health Literature, Physiotherapy Evidence Database, and Academic Search Complete.

Study selection: Studies were selected that compared an AEX group with a nonaerobic control group among ambulatory persons with stroke.

Data extraction: Extracted outcome data included peak oxygen consumption (V˙o2peak) during exercise testing, walking speed, and walking endurance (6-min walk test). Independent variables of interest were AEX mode (seated or walking), AEX intensity (moderate or vigorous), AEX volume (total hours), stroke chronicity, and baseline outcome scores.

Data synthesis: Significant between-study heterogeneity was confirmed for all outcomes. Pooled AEX effect size estimates (AEX group change minus control group change) from random effects models were V˙o2peak, 2.2mL⋅kg-1⋅min-1 (95% confidence interval [CI], 1.3-3.1mL⋅kg-1⋅min-1); walking speed, .06m/s (95% CI, .01-.11m/s); and 6-minute walk test distance, 29m (95% CI, 15-42m). In meta-regression, larger V˙o2peak effect sizes were significantly associated with higher AEX intensity and higher baseline V˙o2peak. Larger effect sizes for walking speed and the 6-minute walk test were significantly associated with a walking AEX mode. In contrast, seated AEX did not have a significant effect on walking outcomes.

Conclusions: AEX significantly improves aerobic capacity poststroke, but may need to be task specific to affect walking speed and endurance. Higher AEX intensity is associated with better outcomes. Future randomized studies are needed to confirm these results.

Keywords: Cardiovascular deconditioning; Exercise; Locomotion; Rehabilitation; Stroke.

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Conflict of interest statement

Conflict of Interest: The authors declare no conflicts of interest

Figures

Figure 1
Figure 1
PRISMA Flow Diagram
Figure 2
Figure 2. Forest plot of VO2peak mean differences by AEX intensity
AEX, aerobic exercise; VO2peak, peak oxygen uptake during graded exercise test; SD, standard deviation; RE, random effects; CI, confidence interval
Figure 3
Figure 3. Forest plot of walking speed mean differences by AEX mode
AEX, aerobic exercise; SD, standard deviation; RE, random effects; CI, confidence interval; CWS, comfortable walking speed; FWS, fast walking speed
Figure 4
Figure 4. Forest plot of 6-minute walk test mean differences by AEX mode
AEX, aerobic exercise; SD, standard deviation; RE, random effects; CI, confidence interval
Figure 5
Figure 5. Funnel plots of mean differences (AEX-control) by study sample size
AEX, aerobic exercise. Dotted lines indicate random effects model estimate for population mean difference
See this image and copyright information in PMC

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