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

  • Sharon Kramer
    Correspondence
    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.
    Affiliations
    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
    Affiliations
    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
    Affiliations
    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
    Affiliations
    Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
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Published:December 10, 2015DOI:https://doi.org/10.1016/j.apmr.2015.11.007

      Abstract

      Objectives

      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).

      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)
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      References

        • World Health Organization
        A safer future: global public health security in the 21st century.
        World Health Organization, Geneva2007
        • Caspersen C.J.
        • Powell K.E.
        • Christenson G.M.
        Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research.
        Public Health Rep. 1985; 100: 126-131
        • Kramer S.F.
        • Churilov L.
        • Kroeders R.
        • Pang M.Y.
        • Bernhardt J.
        Changes in activity levels in the first month after stroke.
        J Phys Ther Sci. 2013; 25: 599-604
        • West T.
        • Bernhardt J.
        Physical activity in hospitalised stroke patients.
        Stroke Res Treat. 2012; 2012: 813765
        • Flansbjer U.B.
        • Downham D.
        • Lexell J.
        Knee muscle strength, gait performance, and perceived participation after stroke.
        Arch Phys Med Rehabil. 2006; 87: 974-980
        • Saunders D.H.
        • Greig C.A.
        • Young A.
        • Mead G.E.
        Association of activity limitations and lower-limb explosive extensor power in ambulatory people with stroke.
        Arch Phys Med Rehabil. 2008; 89: 677-683
        • Foley N.
        • McClure J.A.
        • Meyer M.
        • Salter K.
        • Bureau Y.
        • Teasell R.
        Inpatient rehabilitation following stroke: amount of therapy received and associations with functional recovery.
        Disabil Rehabil. 2012; 34: 2132-2138
        • Veerbeek J.M.
        • Koolstra M.
        • Ket J.C.
        • van Wegen E.E.
        • Kwakkel G.
        Effects of augmented exercise therapy on outcome of gait and gait-related activities in the first 6 months after stroke: a meta-analysis.
        Stroke. 2011; 42: 3311-3315
        • Saunders D.H.
        • Sanderson M.
        • Brazzelli M.
        • Greig C.A.
        • Mead G.E.
        Physical fitness training for stroke patients.
        Cochrane Database Syst Rev. 2013; 10: CD003316
        • American College of Sports Medicine
        ACSM’s guidelines for exercise testing and prescription.
        9th ed. Lippincott Williams & Wilkins, Baltimore2013
        • Corcoran P.J.
        • Jebsen R.H.
        • Brengelmann G.L.
        • Simons B.C.
        Effects of plastic and metal leg braces on speed and energy cost of hemiparetic ambulation.
        Arch Phys Med Rehabil. 1970; 51: 69-77
        • Macko R.F.
        • Katzel L.I.
        • Yataco A.
        • et al.
        Low-velocity graded treadmill stress testing in hemiparetic stroke patients.
        Stroke. 1997; 28: 988-992
        • Platts M.M.
        • Rafferty D.
        • Paul L.
        Metabolic cost of overground gait on younger stroke patients and healthy controls.
        Med Sci Sports Exerc. 2006; 38: 1041-1046
        • Reisman D.S.
        • Rudolph K.S.
        • Farquhar W.B.
        Influence of speed on walking economy poststroke.
        Neurorehabil Neural Repair. 2009; 23: 529-534
        • Malatesta D.
        • Simar D.
        • Dauvilliers Y.
        • et al.
        Energy cost of walking and gait instability in healthy 65- and 80-yr-olds.
        J Appl Physiol. 2003; 95: 2248-2256
        • Brouwer B.
        • Parvataneni K.
        • Olney S.J.
        A comparison of gait biomechanics and metabolic requirements of overground and treadmill walking in people with stroke.
        Clin Biomech. 2009; 24: 729-734
        • Bayat R.
        • Barbeau H.
        • Lamontagne A.
        Speed and temporal-distance adaptations during treadmill and overground walking following stroke.
        Neurorehabil Neural Repair. 2005; 19: 115-124
        • Holden M.K.
        • Gill K.M.
        • Magliozzi M.R.
        • Nathan J.
        • Piehl-Baker L.
        Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness.
        Phys Ther. 1984; 64: 35-40
        • Cowley D.E.
        Prostheses for primary total hip replacement. A critical appraisal of the literature.
        Int J Technol Assess Health Care. 1995; 11: 770-778
        • Fowkes F.G.
        • Fulton P.M.
        Critical appraisal of published research: introductory guidelines.
        BMJ. 1991; 302: 1136-1140
        • Deeks J.J.
        • Higgins J.P.T.
        • Altman D.G.
        Analysing data and undertaking meta-analyses.
        in: Higgins J.P.T. Green S. Cochrane handbook for systematic reviews of interventions. 2011 (Available at: www.cochrane-handbook.org. Accessed October 9, 2015.)
        • Bard G.
        Energy expenditure of hemiplegic subjects during walking.
        Arch Phys Med Rehabil. 1963; 44: 368-370
        • Eng J.J.
        • Dawson A.S.
        • Chu K.S.
        Submaximal exercise in persons with stroke: test-retest reliability and concurrent validity with maximal oxygen consumption.
        Arch Phys Med Rehabil. 2004; 85: 113-118
        • Teixeira da Cunha-Filho I.
        • Henson H.
        • Qureshy H.
        • Williams A.L.
        • Holmes S.A.
        • Protas E.J.
        Differential responses to measures of gait performance among healthy and neurologically impaired individuals.
        Arch Phys Med Rehabil. 2003; 84: 1774-1779
        • Bregman D.J.
        • De Groot V.
        • Van Diggele P.
        • Meulman H.
        • Houdijk H.
        • Harlaar J.
        Polypropylene ankle foot orthoses to overcome drop-foot gait in central neurological patients: a mechanical and functional evaluation.
        Prosthet Orthot Int. 2010; 34: 293-304
        • da Cunha-Filho I.T.
        • Henson H.
        • Wankadia S.
        • Protas E.J.
        Reliability of measures of gait performance and oxygen consumption with stroke survivors.
        J Rehabil Res Dev. 2003; 40: 19-25
        • Delussu A.S.
        • Morone G.
        • Iosa M.
        • Bragoni M.
        • Traballesi M.
        • Paolucci S.
        Physiological responses and energy cost of walking on the Gait Trainer with and without body weight support in subacute stroke patients.
        J Neuroeng Rehabil. 2014; 11: 54
        • Franceschini M.
        • Massucci M.
        • Ferrari L.
        • Agosti M.
        • Paroli C.
        Effects of an ankle-foot orthosis on spatiotemporal parameters and energy cost of hemiparetic gait.
        Clinical Rehabil. 2003; 17: 368-372
        • Franceschini M.
        • Rampello A.
        • Agosti M.
        • Massucci M.
        • Bovolenta F.
        • Sale P.
        Walking performance: correlation between energy cost of walking and walking participation. New statistical approach concerning outcome measurement.
        PLoS ONE. 2013; 8: e56669
        • Han S.H.
        • Kim T.
        • Jang S.H.
        • et al.
        The effect of an arm sling on energy consumption while walking in hemiplegic patients: a randomized comparison.
        Clin Rehabil. 2011; 25: 36-42
        • Maeda N.
        • Kato J.
        • Azuma Y.
        • et al.
        Energy expenditure and walking ability in stroke patients: their improvement by ankle-foot orthoses.
        Isokinet Exerc Sci. 2009; 17: 57-62
        • Manns P.J.
        • Haennel R.G.
        SenseWear Armband and stroke: validity of energy expenditure and step count measurement during walking.
        Stroke Res Treat. 2012; 2012: 247165
        • Sabut S.K.
        • Lenka P.K.
        • Kumar R.
        • Mahadevappa M.
        Effect of functional electrical stimulation on the effort and walking speed, surface electromyography activity, and metabolic responses in stroke subjects.
        J Electromyogr Kinesiol. 2010; 20: 1170-1177
        • van Nunen M.P.
        • Gerrits K.H.
        • de Haan A.
        • Janssen T.W.
        Exercise intensity of robot-assisted walking versus overground walking in nonambulatory stroke patients.
        J Rehabil Res Dev. 2012; 49: 1537-1546
        • Bleyenheuft C.
        • Caty G.
        • Lejeune T.
        • Detrembleur C.
        Assessment of the Chignon dynamic ankle-foot orthosis using instrumented gait analysis in hemiparetic adults.
        Ann Readapt Med Phys. 2008; 51: 154-160
        • Chantraine F.
        • Detrembleur C.
        • Lejeune T.M.
        Effect of the rectus femoris motor branch block on post-stroke stiff-legged gait.
        Acta Neurol Belg. 2005; 105: 171-177
        • Danielsson A.
        • Sunnerhagen K.S.
        Oxygen consumption during treadmill walking with and without body weight support in patients with hemiparesis after stroke and in healthy subjects.
        Arch Phys Med Rehabil. 2000; 81: 953-957
        • Danielsson A.
        • Sunnerhagen K.S.
        Energy expenditure in stroke subjects walking with a carbon composite ankle foot orthosis.
        J Rehabil Med. 2004; 36: 165-168
        • Danielsson A.
        • Willen C.
        • Sunnerhagen K.S.
        Measurement of energy cost by the physiological cost index in walking after stroke.
        Arch Phys Med Rehabil. 2007; 88: 1298-1303
        • Dobrovolny C.L.
        • Ivey F.M.
        • Rogers M.A.
        • Sorkin J.D.
        • Macko R.F.
        Reliability of treadmill exercise testing in older patients with chronic hemiparetic stroke.
        Arch Phys Med Rehabil. 2003; 84: 1308-1312
        • Fredrickson E.
        • Ruff R.L.
        • Daly J.J.
        Physiological Cost Index as a proxy measure for the oxygen cost of gait in stroke patients.
        Neurorehabil Neural Repair. 2007; 21: 429-434
        • Jung T.
        • Ozaki Y.
        • Lai B.
        • Vrongistinos K.
        Comparison of energy expenditure between aquatic and overground treadmill walking in people post-stroke.
        Physiother Res Int. 2014; 19: 55-64
        • Macko R.F.
        • Smith G.V.
        • Dobrovolny C.L.
        • Sorkin J.D.
        • Goldberg A.P.
        • Silver K.H.
        Treadmill training improves fitness reserve in chronic stroke patients.
        Arch Phys Med Rehabil. 2001; 82: 879-884
        • Massaad F.
        • Lejeune T.M.
        • Detrembleur C.
        Reducing the energy cost of hemiparetic gait using center of mass feedback: a pilot study.
        Neurorehabil Neural Repair. 2010; 24: 338-347
        • Michael K.M.
        • Allen J.K.
        • Macko R.F.
        Reduced ambulatory activity after stroke: the role of balance, gait, and cardiovascular fitness.
        Arch Phys Med Rehabil. 2005; 86: 1552-1556
        • Stoquart G.G.
        • Detrembleur C.
        • Palumbo S.
        • Deltombe T.
        • Lejeune T.M.
        Effect of botulinum toxin injection in the rectus femoris on stiff-knee gait in people with stroke: a prospective observational study.
        Arch Phys Med Rehabil. 2008; 89: 56-61
        • Thijssen D.H.
        • Paulus R.
        • van Uden C.J.
        • Kooloos J.G.
        • Hopman M.T.
        Decreased energy cost and improved gait pattern using a new orthosis in persons with long-term stroke.
        Arch Phys Med Rehabil. 2007; 88: 181-186
        • Ijmker T.
        • Houdijk H.
        • Lamoth C.J.
        • et al.
        Effect of balance support on the energy cost of walking after stroke.
        Arch Phys Med Rehabil. 2013; 94: 2255-2261
        • Martin P.E.
        • Rothstein D.E.
        • Larish D.D.
        Effects of age and physical activity status on the speed-aerobic demand relationship of walking.
        J Appl Physiol. 1992; 73: 200-206
        • Tyson S.F.
        • Sadeghi-Demneh E.
        • Nester C.J.
        A systematic review and meta-analysis of the effect of an ankle-foot orthosis on gait biomechanics after stroke.
        Clin Rehabil. 2013; 27: 879-891
        • Ryan A.S.
        • Dobrovolny C.L.
        • Smith G.V.
        • Silver K.H.
        • Macko R.F.
        Hemiparetic muscle atrophy and increased intramuscular fat in stroke patients.
        Arch Phys Med Rehabil. 2002; 83: 1703-1707
        • De Deyne P.G.
        • Hafer-Macko C.E.
        • Ivey F.M.
        • Ryan A.S.
        • Macko R.F.
        Muscle molecular phenotype after stroke is associated with gait speed.
        Muscle Nerve. 2004; 30: 209-215
        • Mackay-Lyons M.J.
        • Makrides L.
        Exercise capacity early after stroke.
        Arch Phys Med Rehabil. 2002; 83: 1697-1702
        • O'Brien I.A.
        • O'Hare P.
        • Corrall R.J.
        Heart rate variability in healthy subjects: effect of age and the derivation of normal ranges for tests of autonomic function.
        Br Heart J. 1986; 55: 348-354
        • Grassi B.
        Skeletal muscle VO2 on-kinetics: set by O2 delivery or by O2 utilization? New insights into an old issue.
        Med Sci Sports Exerc. 2000; 32: 108-116
        • Zhang Y.
        • Chapman A.M.
        • Plested M.
        • Jackson D.
        • Purroy F.
        The incidence, prevalence, and mortality of stroke in France, Germany, Italy, Spain, the UK, and the US: a literature review.
        Stroke Res Treat. 2012; 2012: 436125