Review article (meta-analysis)| Volume 97, ISSUE 4, P619-632.e1, April 2016

Energy Expenditure and Cost During Walking After Stroke: A Systematic Review

  • Sharon Kramer
    Corresponding author Sharon Kramer, MSc, The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Austin Campus, 245 Burgundy St, Heidelberg, VIC 3084, Australia.
    Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia

    The Florey Department of Neuroscience and Mental Health, University of Melbourne, VIC, Australia
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  • Liam Johnson
    Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia

    Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, VIC, Australia
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  • Julie Bernhardt
    Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia

    School of Health Science, Latrobe University, Melbourne, VIC, Australia
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  • Toby Cumming
    Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
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Published:December 10, 2015DOI:



      To systematically review the evidence to determine energy expenditure (EE) in volume of oxygen uptake ( V ˙ o2) (mL/kg/min) and energy cost in oxygen uptake per meter walked ( V ˙ 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 V ˙ 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 V ˙ 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).


      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.


      List of abbreviations:

      AFO (ankle-foot orthosis), CI (confidence interval), EE (energy expenditure), FAC (Functional Ambulation Category), V˙o2 (volume of oxygen uptake)
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