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• W3134999656 abstract "HomeStrokeVol. 47, No. 9Physical Fitness Training for Patients With Stroke Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBPhysical Fitness Training for Patients With Stroke David H. Saunders, BSc, MPhil, PhD, Mark Sanderson, BSc, MSc, PhD, Sara Hayes, BSc, PG.Dip. (Stats), PhD, Maeve Kilrane, BSc, MBChB, Carolyn A. Greig, BSc, MSc, PhD, Miriam Brazzelli, BSc, PhD and Gillian E. Mead, MB, BChir, FRCP, MD, MA David H. SaundersDavid H. Saunders From the Institute for Sport, Physical Education, and Health Sciences (SPEHS), Moray House School of Education, University of Edinburgh, Midlothian, United Kingdom (D.H.S.); Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, United Kingdom (M.S.); Department of Clinical Therapies, Faculty of Education and Health Science, Health Research Institute (HRI), University of Limerick, Ireland (S.H.); Institute of Sport Exercise and Health, University College London, United Kingdom (M.K.); School of Sport, Exercise, and Rehabilitation Sciences, MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, United Kingdom (C.A.G.); Health Services Research Unit, University of Aberdeen, United Kingdom (M.B.); and Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (G.E.M.). Search for more papers by this author , Mark SandersonMark Sanderson From the Institute for Sport, Physical Education, and Health Sciences (SPEHS), Moray House School of Education, University of Edinburgh, Midlothian, United Kingdom (D.H.S.); Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, United Kingdom (M.S.); Department of Clinical Therapies, Faculty of Education and Health Science, Health Research Institute (HRI), University of Limerick, Ireland (S.H.); Institute of Sport Exercise and Health, University College London, United Kingdom (M.K.); School of Sport, Exercise, and Rehabilitation Sciences, MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, United Kingdom (C.A.G.); Health Services Research Unit, University of Aberdeen, United Kingdom (M.B.); and Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (G.E.M.). Search for more papers by this author , Sara HayesSara Hayes From the Institute for Sport, Physical Education, and Health Sciences (SPEHS), Moray House School of Education, University of Edinburgh, Midlothian, United Kingdom (D.H.S.); Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, United Kingdom (M.S.); Department of Clinical Therapies, Faculty of Education and Health Science, Health Research Institute (HRI), University of Limerick, Ireland (S.H.); Institute of Sport Exercise and Health, University College London, United Kingdom (M.K.); School of Sport, Exercise, and Rehabilitation Sciences, MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, United Kingdom (C.A.G.); Health Services Research Unit, University of Aberdeen, United Kingdom (M.B.); and Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (G.E.M.). Search for more papers by this author , Maeve KilraneMaeve Kilrane From the Institute for Sport, Physical Education, and Health Sciences (SPEHS), Moray House School of Education, University of Edinburgh, Midlothian, United Kingdom (D.H.S.); Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, United Kingdom (M.S.); Department of Clinical Therapies, Faculty of Education and Health Science, Health Research Institute (HRI), University of Limerick, Ireland (S.H.); Institute of Sport Exercise and Health, University College London, United Kingdom (M.K.); School of Sport, Exercise, and Rehabilitation Sciences, MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, United Kingdom (C.A.G.); Health Services Research Unit, University of Aberdeen, United Kingdom (M.B.); and Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (G.E.M.). Search for more papers by this author , Carolyn A. GreigCarolyn A. Greig From the Institute for Sport, Physical Education, and Health Sciences (SPEHS), Moray House School of Education, University of Edinburgh, Midlothian, United Kingdom (D.H.S.); Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, United Kingdom (M.S.); Department of Clinical Therapies, Faculty of Education and Health Science, Health Research Institute (HRI), University of Limerick, Ireland (S.H.); Institute of Sport Exercise and Health, University College London, United Kingdom (M.K.); School of Sport, Exercise, and Rehabilitation Sciences, MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, United Kingdom (C.A.G.); Health Services Research Unit, University of Aberdeen, United Kingdom (M.B.); and Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (G.E.M.). Search for more papers by this author , Miriam BrazzelliMiriam Brazzelli From the Institute for Sport, Physical Education, and Health Sciences (SPEHS), Moray House School of Education, University of Edinburgh, Midlothian, United Kingdom (D.H.S.); Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, United Kingdom (M.S.); Department of Clinical Therapies, Faculty of Education and Health Science, Health Research Institute (HRI), University of Limerick, Ireland (S.H.); Institute of Sport Exercise and Health, University College London, United Kingdom (M.K.); School of Sport, Exercise, and Rehabilitation Sciences, MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, United Kingdom (C.A.G.); Health Services Research Unit, University of Aberdeen, United Kingdom (M.B.); and Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (G.E.M.). Search for more papers by this author and Gillian E. MeadGillian E. Mead From the Institute for Sport, Physical Education, and Health Sciences (SPEHS), Moray House School of Education, University of Edinburgh, Midlothian, United Kingdom (D.H.S.); Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, United Kingdom (M.S.); Department of Clinical Therapies, Faculty of Education and Health Science, Health Research Institute (HRI), University of Limerick, Ireland (S.H.); Institute of Sport Exercise and Health, University College London, United Kingdom (M.K.); School of Sport, Exercise, and Rehabilitation Sciences, MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, United Kingdom (C.A.G.); Health Services Research Unit, University of Aberdeen, United Kingdom (M.B.); and Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (G.E.M.). Search for more papers by this author Originally published4 Aug 2016https://doi.org/10.1161/STROKEAHA.116.013640Stroke. 2016;47:e219–e220Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2016: Previous Version 1 Cardiorespiratory and musculoskeletal fitness are low after stroke. Interventions to improve physical fitness after stroke could have a range of physical, cognitive, and psychosocial benefits.ObjectivesThe primary aims of this updated review1 were to determine whether physical fitness training after stroke reduces death, dependence, and disability. The secondary aims were to assess the effects of training on adverse events, risk factors, physical fitness, mobility, physical function, quality of life, mood, and cognitive function. Cognition outcomes have become an important poststroke intervention target and are, therefore, added to this review update.MethodsSearch MethodsWe searched the Cochrane Stroke Group Trials Register (last searched February 2015), the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 1: searched February 2015), MEDLINE (1966 to February 2015), EMBASE (1980 to February 2015), CINAHL (1982 to February 2015), SPORTDiscus (1949 to February 2015), and 5 additional databases (February 2015). We also searched ongoing trials registers, hand-searched relevant journals and conference proceedings, screened reference lists, and contacted experts.Selection CriteriaRandomized trials comparing either cardiorespiratory training or resistance training, or both (mixed training), with usual care, no intervention, or a nonexercise intervention in stroke survivors.Data Collection and AnalysisTwo review authors independently selected trials, assessed quality and risk of bias, and extracted data. We analyzed data using random-effects meta-analyses. Diverse outcome measures limited the intended analyses.ResultsWe included 58 trials, involving 2797 participants, which comprised cardiorespiratory interventions (28 trials and 1408 participants), resistance interventions (13 trials and 432 participants), and mixed training interventions (17 trials and 957 participants). There were few deaths with no between-group differences at the end of intervention (n=13) or at the end of follow-up (additional n=9). No dependence data were reported. Global indices of disability showed moderate improvement after cardiorespiratory training (standardized mean difference, 0.52; 95% confidence interval, 0.19–0.84; P=0.002) and a small improvement after mixed training (standardized mean difference, 0.26; 95% confidence interval, 0.04–0.49; P=0.02); benefits at follow-up were unclear.Significant increases in the speed and tolerance of walking were observed after cardiorespiratory and mixed training, which involved walking (Table); some benefits persisted after the interventions finished. Balance scores improved slightly after mixed training (standardized mean difference, 0.27; 95% confidence interval, 0.07–0.47; P=0.008). The variability, quality of the included trials, and lack of data prevent conclusions about other outcomes and limit the generalisability of the observed results.Table. Random-Effects Meta-Analyses of Cardiorespiratory Training, Resistance Training, and Mixed Training Interventions on Walking Performance Outcomes at the End of Intervention and at the End of Follow-UpFitness Training InterventionWalking OutcomeEnd of InterventionEnd of Follow-UpN (n)Mean Difference (95% Confidence Interval)Significance LevelN (n)Mean Difference (95% Confidence Interval)Significance LevelCardiorespiratory trainingMaximum walking speed14 (631)6.71 m/min (2.73 to 10.69)P<0.00065 (312)6.71 m/min (2.40 to 11.02)P=0.002Preferred walking speed10 (505)4.28 m/min (1.71 to 6.84)P=0.0013 (176)1.67 m/min (-3.27 to 6.62)NS6 minute walking test15 (826)30.29 m (16.19 to 44.39)P<0.00015 (283)38.29 m (7.19 to 69.39)P=0.02Resistance trainingMaximum walking speed4 (104)1.92 m/min (−3.50 to 7.35)NS1 (24)−19.8 m/min (−95.77 to 56.17)NSPreferred walking speed3 (80)2.34 m/min (−6.77 to 11.45)NS………6 minute walking test2 (66)3.78 m (−68.56 to 76.11)NS1 (24)11.0 m/min (−105.95 to 127.95)NSMixed trainingMaximum walking speed………………Preferred walking speed9 (639)4.54 m/min (0.95 to 8.14)P=0.014 (443)1.60 m/min (-5.62 to 8.82)NS6 minute walking test7 (561)41.60 m (25.25 to 57.95)P<0.000013 (365)51.62 m (25.20 to 78.03)P=0.0001N indicates trial number; n, participant number; and NS, nonsignificant.Reviewer ConclusionsCardiorespiratory training and, to a lesser extent, mixed training reduce disability during or after usual stroke care; perhaps mediated by improved mobility and balance. There is sufficient evidence to incorporate cardiorespiratory and mixed training, involving walking, within poststroke rehabilitation programs to improve the speed and tolerance of walking; improvement in balance may also occur. There is insufficient evidence to support the use of resistance training. The effects of training on death and dependence after stroke are unclear, but these outcomes are rarely observed in physical fitness training trials. Cognitive function is underinvestigated despite being an important outcome for people with stroke. Further well-designed randomized trials are needed to determine the optimal exercise prescription and identify long-term benefits.AcknowledgmentsThis article is based on a Cochrane Review published in The Cochrane Library 2016, Issue 10 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and The Cochrane Library should be consulted for the most recent version of the review.DisclosuresDrs Saunders and Greig were coauthors of one included study (Mead 2007). Dr Mead has received research funding for exercise after stroke. She has received honoraria from Later Life Training to develop an educational course of exercise after stroke for exercise professionals. She has also received honoraria and expenses to present work on exercise after stroke at conferences. She has led a trial of exercise after stroke that is included in the review (Mead 2007). The other authors report no conflicts.FootnotesCorrespondence to David H. Saunders, BSc, MPhil, PhD, The Moray House School of Education, Institute for Sport, Physical Education and Health Sciences (SPEHS), University of Edinburgh, St. Leonards Land, Holyrood Rd, Edinburgh, Midlothian EH8 8AQ, United Kingdom. E-mail [email protected]References1. Saunders DH, Sanderson M, Hayes S, Kilrane M, Greig CA, Brazzelli M, Mead GE. Physical fitness training for stroke patients.Cochrane Database Syst Rev. 2016;(3): CD003316. doi: 10.1002/14651858.CD003316.pub6.MedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Gambassi B, Coelho-Junior H, Schwingel P, Almeida F, Gaspar Novais T, Lauande Oliveira P, Sauaia B, Melo C, Uchida M and Rodrigues B (2017) Resistance Training and Stroke: A Critical Analysis of Different Training Programs, Stroke Research and Treatment, 10.1155/2017/4830265, 2017, (1-11), . September 2016Vol 47, Issue 9 Advertisement Article InformationMetrics © 2016 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.116.013640 Manuscript receivedJune 13, 2016Manuscript acceptedJuly 5, 2016Originally publishedAugust 4, 2016Manuscript revisedJune 13, 2016 Keywordsphysical fitnessstrokeexerciserisk factorssystematic reviewPDF download Advertisement SubjectsCerebrovascular Disease/Stroke" @default.
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