Physical Fitness Training for Patients With Stroke
2014; Lippincott Williams & Wilkins; Volume: 45; Issue: 4 Linguagem: Inglês
10.1161/strokeaha.113.003935
ISSN1524-4628
AutoresDavid H. Saunders, Mark Sanderson, Miriam Brazzelli, Carolyn Greig, Gillian Mead,
Tópico(s)Stroke Rehabilitation and Recovery
ResumoHomeStrokeVol. 45, No. 4Physical Fitness Training for Patients With Stroke Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBPhysical Fitness Training for Patients With StrokeAn Updated Review David H. Saunders, BSc, MPhil, PhD, Mark Sanderson, BSc, MSc, PhD, Miriam Brazzelli, BSc, PhD, Carolyn A. Greig, BSc, MSc, PhD and Gillian E. Mead, MB, BChir, FRCP, MD, MA David H. SaundersDavid H. Saunders From the Institute for Sport, Physical Education and Health Sciences (SPEHS), Moray House School of Education (D.H.S.) and Centre for Clinical Brain Sciences (G.E.M.), University of Edinburgh, Edinburgh, Midlothian, United Kingdom; Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, United Kingdom (M.S.); Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom (M.B.); and School of Sport, Exercise and Rehabilitation Sciences, MRC-ARUK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom (C.A.G.). , Mark SandersonMark Sanderson From the Institute for Sport, Physical Education and Health Sciences (SPEHS), Moray House School of Education (D.H.S.) and Centre for Clinical Brain Sciences (G.E.M.), University of Edinburgh, Edinburgh, Midlothian, United Kingdom; Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, United Kingdom (M.S.); Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom (M.B.); and School of Sport, Exercise and Rehabilitation Sciences, MRC-ARUK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom (C.A.G.). , Miriam BrazzelliMiriam Brazzelli From the Institute for Sport, Physical Education and Health Sciences (SPEHS), Moray House School of Education (D.H.S.) and Centre for Clinical Brain Sciences (G.E.M.), University of Edinburgh, Edinburgh, Midlothian, United Kingdom; Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, United Kingdom (M.S.); Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom (M.B.); and School of Sport, Exercise and Rehabilitation Sciences, MRC-ARUK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom (C.A.G.). , Carolyn A. GreigCarolyn A. Greig From the Institute for Sport, Physical Education and Health Sciences (SPEHS), Moray House School of Education (D.H.S.) and Centre for Clinical Brain Sciences (G.E.M.), University of Edinburgh, Edinburgh, Midlothian, United Kingdom; Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, United Kingdom (M.S.); Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom (M.B.); and School of Sport, Exercise and Rehabilitation Sciences, MRC-ARUK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom (C.A.G.). and Gillian E. MeadGillian E. Mead From the Institute for Sport, Physical Education and Health Sciences (SPEHS), Moray House School of Education (D.H.S.) and Centre for Clinical Brain Sciences (G.E.M.), University of Edinburgh, Edinburgh, Midlothian, United Kingdom; Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, United Kingdom (M.S.); Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom (M.B.); and School of Sport, Exercise and Rehabilitation Sciences, MRC-ARUK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom (C.A.G.). Originally published23 Jan 2014https://doi.org/10.1161/STROKEAHA.113.003935Stroke. 2014;45:e54–e55Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2014: Previous Version 1 IntroductionPhysical fitness is low after stroke and this may cause or exacerbate some common poststroke problems, including disability. It is not known whether physical fitness training after stroke reduces death, disability, or dependency.ObjectivesThe primary aims of this review1 were to determine whether physical fitness training (cardiorespiratory training and resistance training) after stroke reduces death, dependence, and disability at the end of intervention or end of follow-up. The secondary aims were to determine the effects of fitness training on physical fitness, mobility, physical function, health status and quality of life, mood, and the incidence of adverse events.MethodsSearch StrategyWe searched the Cochrane Stroke Group Trials Register (last searched January 2013), the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2012, Issue 12, searched January 2013), MEDLINE (1966 to January 2013), EMBASE (1980 to January 2013), CINAHL (1982 to January 2013), SPORTDiscus (1949 to January 2013), and 5 additional databases (January 2013). We also searched registers of ongoing trials, hand-searched relevant journals and conference proceedings, screened reference lists, and contacted experts in the field.Selection CriteriaWe selected randomized trials comparing cardiorespiratory training, resistance training, or a combination of both (mixed training), with no intervention, a nonexercise intervention, or usual care in stroke survivors.Data Collection and AnalysisTwo review authors independently selected trials, assessed quality, and extracted data. We analyzed data with random-effects meta-analyses using Cochrane Review Manager software (RevMan version 5.2).ResultsWe included 45 trials, involving 2188 participants, that comprised cardiorespiratory (22 trials and 995 participants), resistance (8 trials and 275 participants), and mixed training interventions (15 trials and 918 participants). There were no differences in mortality at the end of intervention (n=9) or end of follow-up (additional n=7). No dependence data were reported. Global indices of disability significantly improved after cardiorespiratory training (standardized mean difference, 0.37; 95% confidence interval, 0.10–0.64; P=0.007); marginal improvements observed after mixed training were unsafe because of study design issues. There were insufficient data to assess the effects of resistance training on primary outcomes.A significant increase in walking speed (maximum and preferred speeds) and tolerance (6-minute walking test) was observed at the end of cardiorespiratory and mixed training interventions; some improvements persisted after the intervention had been completed (Table). Cardiorespiratory training also significantly improved balance at the end of intervention (Berg Balance Scores: mean difference, 3.14; 95% confidence interval, 0.56–5.73; P=0.02). There was no evidence of any serious adverse events.Table. Random-Effects Meta-analyses of Cardiorespiratory Training, Resistance Training, and Mixed Training Interventions on Walking Performance Outcomes at the End of Intervention and at the End of Follow-UpFitness Training InterventionWalking OutcomeEnd of InterventionEnd of Follow-UpN (n)Mean Difference (95% Confidence Interval)Significance LevelN (n)Mean Difference (95% Confidence Interval)Significance LevelCardiorespiratory trainingMaximum walking speed13 (609)7.37 m/min (3.70, 11.03)P<0.00015 (312)6.71 m/min (2.40, 11.02)P=0.002Preferred walking speed8 (425)4.63 m/min (1.84, 7.43)P=0.0012 (126)0.72 m/min (−6.78, 8.22)NS6-minute walking test10 (468)26.99 m (9.13, 44.84)P=0.0034 (233)33.37 m (−8.25, 74.99)NSResistance trainingMaximum walking speed4 (104)1.92 m/min (−3.50, 7.35)NS1 (24)−19.8 m/min (−95.77, 56.17)NSPreferred walking speed3 (80)2.34 m/min (−6.77, 11.45)NS………6-minute walking test2 (66)3.78 m (−68.56, 76.11)NS1 (24)11.0 m (−105.9, 127.95)NSMixed trainingMaximum walking speed………………Preferred walking speed9 (639)4.54 m/min (0.95, 8.14)P=0.014 (443)1.60 m/min (−5.62, 8.82)NS6-minute walking test7 (561)41.60 m (25.2, 57.95)P<0.000013 (365)51.62 m (25.20, 78.03)P=0.00013…indicates no data; N, trial number; n, participant number; and NS, nonsignificant.Reviewer ConclusionsThe effects of training on death and dependence after stroke are unclear. Cardiorespiratory training reduces disability after stroke. There is sufficient evidence to incorporate cardiorespiratory and mixed training, involving walking, within poststroke rehabilitation programs to improve the speed and tolerance of walking; improvement in balance may also occur. Our findings reinforce the importance of task-related training when functional benefits are sought. There is insufficient evidence to support the use of resistance training on its own. Further well-designed trials are needed to determine the optimal content of the exercise prescription and identify long-term benefits.AcknowledgmentsThis article is based on a Cochrane Review published in The Cochrane Library 2013, Issue 10. Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and The Cochrane Library should be consulted for the most recent version of the review.Sources of FundingThis study was supported by National Institute for Health Research, United Kingdom. Cochrane Review Incentive Scheme 2012.DisclosuresDrs Saunders and Greig were coauthors of one included study (Mead 2007). Drs Sanderson and Saunders received National Institute for Health Research funding to complete this update. Dr Mead has received research funding for exercise after stroke. She has received honoraria from Later Life Training to develop an educational course of exercise after stroke for exercise professionals. She has also received honoraria and expenses to present work on exercise after stroke at conferences. She has led a trial of exercise after stroke that is included in the review (Mead 2007). Dr Brazzelli reports no conflicts.FootnotesCorrespondence to David H. Saunders, BSc, MPhil, PhD, Institute for Sport, Physical Education and Health Sciences (SPEHS), The Moray House School of Education, University of Edinburgh, St Leonards Land, Holyrood Rd, Edinburgh, Midlothian EH8 8AQ, United Kingdom. E-mail [email protected].Reference1. Saunders DH, Sanderson M, Brazzelli M, Greig CA, Mead GE. Physical fitness training for stroke patients.Cochrane Database Syst Rev. 2013; (10): CD003316. doi: 10.1002/14651858.CD003316.pub5. http://dx.doi.org/10.1002/14651858.CD003316.MedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Sammut M, Fini N, Haracz K, Nilsson M, English C and Janssen H (2020) Increasing time spent engaging in moderate-to-vigorous physical activity by community-dwelling adults following a transient ischemic attack or non-disabling stroke: a systematic review, Disability and Rehabilitation, 10.1080/09638288.2020.1768599, 44:3, (337-352), Online publication date: 30-Jan-2022. Ng M, Hill K, Batchelor F and Burton E (2017) Factors Predicting Falls and Mobility Outcomes in Patients With Stroke Returning Home After Rehabilitation Who Are at Risk of Falling, Archives of Physical Medicine and Rehabilitation, 10.1016/j.apmr.2017.05.018, 98:12, (2433-2441), Online publication date: 1-Dec-2017. Saunders D, Sanderson M, Hayes S, Kilrane M, Greig C, Brazzelli M and Mead G (2016) Physical fitness training for stroke patients, Cochrane Database of Systematic Reviews, 10.1002/14651858.CD003316.pub6 Assumpção F, Fortini I, Magalhães L, Basílio M, Carvalho A and Salmela L (2015) Propriedades de medida do LIFE-H 3.1 Brasil para avaliação da participação social de hemiparéticos, Revista Neurociências, 10.34024/rnc.2015.v23.7985, 23:4, (506-515) Saunders D, Sanderson M, Hayes S, Johnson L, Kramer S, Carter D, Jarvis H, Brazzelli M and Mead G (2020) Physical fitness training for stroke patients, Cochrane Database of Systematic Reviews, 10.1002/14651858.CD003316.pub7, 2020:3 April 2014Vol 45, Issue 4 Advertisement Article InformationMetrics © 2014 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.113.003935 Manuscript receivedNovember 26, 2013Manuscript acceptedDecember 13, 2013Originally publishedJanuary 23, 2014 Keywordssystematicstrokedisability evaluationexercisephysical fitnessreviewPDF download Advertisement SubjectsRehabilitation
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