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Factors Influencing the Efficacy of Aerobic Exercise for Improving Fitness and Walking Capacity After Stroke

A Meta-Analysis With Meta-Regression
  • Pierce Boyne
    Correspondence
    Corresponding author Pierce Boyne, PT, DPT, NCS, Department of Rehabilitation Sciences, College of Allied Health Sciences, University of Cincinnati, 3202 Eden Avenue, Cincinnati, OH 45220.
    Affiliations
    Department of Rehabilitation Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio

    Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, Ohio
    Search for articles by this author
  • Jeffrey Welge
    Affiliations
    Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, Ohio

    Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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  • Brett Kissela
    Affiliations
    Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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  • Kari Dunning
    Affiliations
    Department of Rehabilitation Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio

    Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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Published:October 13, 2016DOI:https://doi.org/10.1016/j.apmr.2016.08.484

      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

      List of abbreviations:

      AEX (aerobic exercise), CI (confidence interval), HRmax (maximal heart rate), HRR (heart rate reserve), PEDro (Physiotherapy Evidence Database), V˙o2peak (peak oxygen consumption)
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