Abstract
Objectives
To systematically review the evidence to determine energy expenditure (EE) in volume
of oxygen uptake (o2) (mL/kg/min) and energy cost in oxygen uptake per meter walked (o2/walking speed; mL/kg/m) during walking poststroke and how it compares with healthy
controls; and to determine how applicable current exercise prescription guidelines
are to stroke survivors.
Data Sources
Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and CINAHL were searched
on October 9, 2014, using search terms related to stroke and EE. Additionally, we
screened reference lists of eligible studies.
Study Selection
Two independent reviewers screened titles and abstracts of 2115 identified references.
After screening the full text of 144 potentially eligible studies, we included 29
studies (stroke survivors: n=501, healthy controls: n=123), including participants
with confirmed stroke and a measure of o2 during walking using breath-by-breath analysis. Studies with (9 studies) and without
(20 studies) a healthy control group were included.
Data Extraction
Two reviewers independently extracted data using a standard template, including patient
characteristics, outcome data, and study methods.
Data Synthesis
Mean age of stroke survivors was 57 years (range, 40–67y). Poststroke EE was highly
variable across studies and could not be pooled because of high heterogeneity. EE
during steady-state overground walking at matched speeds was significantly higher
in stroke survivors than healthy controls (mean difference in o2, 4.06 mL/kg/min; 95% confidence interval [CI], 2.21–5.91; 1 study; n=26); there was
no significant group difference at self-selected speeds. Energy cost during steady-state
overground walking was higher in stroke survivors at both self-selected (mean difference,
.47 mL/kg/m; 95% CI, .29–.66; 2 studies; n=38) and matched speeds compared with healthy
controls (mean difference, .27 mL/kg/m; 95% CI, .03–.51; 1 study; n=26).
Conclusions
Stroke survivors expend more energy during walking than healthy controls. Low-intensity
exercise as described in guidelines might be at a moderate intensity level for stroke
survivors; there is a need for stroke-specific exercise guidelines.
Keywords
List of abbreviations:
AFO (ankle-foot orthosis), CI (confidence interval), EE (energy expenditure), FAC (Functional Ambulation Category), V˙o2 (volume of oxygen uptake)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 10, 2015
Footnotes
Disclosures: none.
Identification
Copyright
© 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
