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Maintenance of Cardiorespiratory Fitness in People With Stroke: A Systematic Review and Meta-analysis

  • Natasha Machado
    Correspondence
    Corresponding author Natasha Machado, MClinExPhys, BExSSc, 888 Toorak Rd Camberwell, Victoria, Australia 3124.
    Affiliations
    Rehabilitation, Epworth Healthcare, Victoria, Australia

    Physiotherapy Department, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Victoria, Australia
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  • Matthew Wingfield
    Affiliations
    Rehabilitation, Epworth Healthcare, Victoria, Australia

    Physiotherapy Department, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Victoria, Australia
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  • Sharon Kramer
    Affiliations
    Florey Institute of Neuroscience and Mental Health, Victoria, Australia

    Centre for Quality and Patient Safety Research, Institute for Health Transformation, Alfred-Deakin Partnership, Deakin University, Victoria, Australia
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  • John Olver
    Affiliations
    Rehabilitation, Epworth Healthcare, Victoria, Australia

    Department of Medicine, Monash University, Victoria, Australia
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  • Gavin Williams
    Affiliations
    Rehabilitation, Epworth Healthcare, Victoria, Australia

    Physiotherapy Department, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Victoria, Australia
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  • Liam Johnson
    Affiliations
    Rehabilitation, Epworth Healthcare, Victoria, Australia

    Physiotherapy Department, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Victoria, Australia

    Faculty of Exercise Science, Australian Catholic University, Victoria, Australia
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Published:February 13, 2022DOI:https://doi.org/10.1016/j.apmr.2022.01.151

      Objective

      To determine if improvements in cardiorespiratory fitness are maintained in the short-, medium- and long-term after a cardiorespiratory fitness intervention in people with stroke.

      Data Sources

      MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, (CENTRAL) Cochrane, Web of Science, Sports Discus, and Physiotherapy Evidence Database were searched from inception.

      Study Selection

      Randomized controlled trials and cohort studies including (1) people with stroke; (2) cardiorespiratory fitness interventions; (3) a direct measure of cardiorespiratory fitness; and (4) short- (0 to <3 months), medium- (3-6 months), or long-term (>6 months) follow-up data.

      Data Extraction

      Two reviewers independently screened full texts and extracted data, including study methods, participant demographic information, stroke type and severity, outcome measures, intervention information, follow-up time points, and results, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A lower limit of −1.0 mL•kg−1•min−1 was used to determine maintenance (ie, no change) of cardiorespiratory fitness.

      Data Synthesis

      Fourteen studies (N=324 participants) were included. Participants completed cardiorespiratory fitness training 2-5 days per week over 4-13 weeks at moderate to high intensity (40%-70% heart rate reserve [HRR]; n=4 studies), high intensity (60% to <90% HRR; n=7 studies), and intervals of high intensity (85%-95% peak heart rate or maximal heart rate; n=3 studies). Most people with stroke did maintain cardiorespiratory fitness in the short- (−0.19 mL•kg−1•min−1 [95% CI, −1.66 to 1.28]), medium- (−0.61 mL•kg−1•min−1 [95% CI, −3.95 to 2.74]), and long-term (0.00 mL•kg−1•min−1 [95% CI, −2.23 to 2.23]) after completion of cardiorespiratory fitness interventions.

      Conclusions

      People with stroke maintain cardiorespiratory fitness after a cardiorespiratory fitness intervention in the short-, medium-, and longer-term. However, little is known about the impact of participant and intervention characteristics on the long-term maintenance of cardiorespiratory fitness.

      Keywords

      List of abbreviations:

      HRR (heart rate reserve), NIHSS (National Institutes of Health Stroke Scale), PEDro (Physiotherapy Evidence Database), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), RCT (randomized control trial), V̇o2max (maximum oxygen consumption), Vo2peak (peak oxygen consumption)
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