Aerobic Exercise Training in Stroke Rehabilitation: Any Gap in Knowledge
DOI:
https://doi.org/10.34058/njmr.v18i1.111Keywords:
Aerobic, Exercise, Stroke, Review.Abstract
Background: Most stroke survivors live with residual physical impairments that may promote a sedentary lifestyle and resultant secondary complications, especially poor cardio-respiratory fitness. This systematic review was conceived to examine the extent of research on the effect of aerobic exercise on health outcomes of stroke survivors as a prelude to a clinical trial.Method: Electronic databases were searched with the last search performed in May, 2014. The methodological quality of studies was assessed using the PEDro scale. High-quality randomized controlled trials (RCTs) were considered level 1 evidence while lower-quality RCTs were considered level 2 evidence.
Result: A total of 642 articles were generated from the search strategy; 10 articles fulfilled all criteria and were selected for this review. 50% of these studies recruited stroke survivors with ischaemic type of stroke while 30% had individuals with either ischaemic or haemorrhagic types. 70% of the studies had good scores while 30% had fair scores in methodological quality. The majority of the studies used VO2max as the outcome for assessing aerobic fitness; a few studies (10% each) assessed anthropometric outcomes and biochemical profile. No study assessed a haematological profile nor compared the effects of continuous and interval aerobic exercise on stroke outcomes.
Conclusion: A gap in clinical trials on the effects of aerobic exercise on biochemical, haematological and anthropometric profiles of stroke survivors exists as well as in the comparative effects of continuous and interval training on stroke outcomes.
References
American College of Sports Medicine (2010): ACSM’s Guidelines for Exercise Testing and Prescription, ed 8. Baltimore, Wolters Kluwer,
Bhogal SK, Teasell RW, Foley NC, Speechley MR (2005): The PEDro scale provides a more comprehensive measure of methodological quality than the Jadad scale in stroke rehabilitation literature. J Clin Epidemiol; 58: 668–673.
Binder EF, Birge SJ, Spina R (1999): Peak aerobic power is an important component of physical performance in older women. J Gerontol A Biol Sci Med Sci. 1999; 54:M353–356.
Calmels P, Degache F, Courbon A, Roche F, Ramas J, Fayolle-Minon, Devillard X (2011): The faisability and the effects of cycloergometer interval training on aerobic capacity and walking performance after stroke – A preliminary study. Annals of Physical and Rehabilitation Medicine, 54, 3 – 15.
Centre for Evidence-Based Medicine. Oxford, 2014. Available from: http://www. cebm.net/.
Chu KS, Eng JJ, Dawson AS (2004): A randomized controlled trial of water-based exercise for cardiovascular fitness in individuals with chronic stroke. Arch Phys Med Rehabil. 2004; 85:870 – 874.
Cress ME, Meyer M (2003): Maximal voluntary and functional performance levels needed for independence in adults aged 65 to 97 years. Phys Ther; 83: 37–48.
Duncan P, Studenski S, Richards L, Gollub S, Lai SM, Reker D, Perera S, Yates J, Koch V, Rigler S, Johnson D (2003): Randomized clinical trial of therapeutic exercise in subacute stroke. Stroke; 34: 2173–2180.
Feigin VL, Lawes CM, Bennett DA (2003): Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurology; 2:43–53.
Globas C, Becker C, Cerny J, Lam JM, Lindemann U, Forrester LW, Macko RF, Luft AR (2012): Chronic stroke survivors benefit from highintensity aerobic treadmill exercise: a randomized controlled trial. Neurorehabil Neural Repair; 26: 85–95.
Gordon NF, Gulanick CM, Costa F, Fletcher G, Franklin BA, Roth EJ, Shephard T (2004): Physical Activity and Exercise Recommendations for Stroke Survivors - An American Heart Association Scientific Statement From the Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention; the Council on Cardiovascular Nursing; the Council on Nutrition, Physical Activity, and Metabolism; and the Stroke Council Circulation;109:2031-2041
Hardie K, Hankey GJ, Jamrozik K (2004): Ten-year risk of first recurrent stroke and disability after first-ever stroke in the Perth community stroke study. Stroke. 2004; 35:731–735.
Ivey FM, Ryan AS, Hafer-Macko CE, Goldberg AP, Macko RF (2007): Treadmill Aerobic Training Improves Glucose Tolerance and Indices of Insulin Sensitivity in Disabled Stroke Survivors A Preliminary Report Stroke; 38:2752-2758
Jamnik VJ, Warburton DER, Makarski J, McKenzie DC, Shephard RJ, Stone J, Charlesworth S, Gledhill N (2011): Enhancing the effectiveness of clearance for physical activity participation: background and overall process. Appl Physiol Nutr Metab; 36:S3–S13.
Jorgensen HS, Nakayama H, Raaschou HO (1999): Stroke: Neurologic and functional recovery. The Copenhagen Study. Phys Med Rehabil Clin N Am; 10:887–906.
Katz-Leurer M, Carmeli E, Shochina M (2003a): The effect of early aerobic training on independence six months post stroke. Clin Rehabil; 17: 735–741.
Katz-Leurer M, Sender I, Ofer K, Zeevi D (2006): The influence of early cycling training on balance in stroke patients at the subacute stage. Clin Rehabil; 20: 398–405.
Katz-Leurer M, Shochina M, Carmeli E, Friedlander Y (2003b): The influence of early aerobic training on the functional capacity in patients with cerebrovascular accident at the subacute stage. Arch Phys Med Rehabil; 84: 1609–1614.
Kleindorfer DO, Khoury J, Moomaw CJ, Alwell K, Woo D, Flaherty ML, Khatri P, Adeoye O, Ferioli S, Broderick JP, Kissela BM (2010): Stroke incidence is decreasing in whites but not in blacks: a population-based estimate of temporal trends in stroke incidence from the Greater Cincinnati/ Northern Kentucky Stroke Study. Stroke; 41:1326–1331.
Kurl S, Laukanen JA, Rauramaa R (2003): Cardiorespiratory fitness and the risk for stroke in men. Arch Intern Med; 163:1682–1688.
MacKay-Lyons MJ, Makrides L (2004): Longitudinal changes in exercise capacity after stroke. Arch Phys Med Rehabil; 85: 1608–1612.
Macko RF, Ivey FM, Forrester LW, Hanley D, Sorkin JD, Katzel LI, Silver KH, Goldberg AP (2005): Treadmill exercise rehabilitation improves ambulatory function and cardiovascular fitness in patients with chronic stroke: a randomized, controlled trial. Stroke; 36: 2206–2211.
Outermans JC, van Peppen R, Wittink H, Takken T, Kwakkel G (2010): Effects of a high-intensity task-oriented training on gait performance early after stroke: a pilot study. Clin Rehabil; 24: 979–987.
Palm F, Urbanek C, Rose S, Buggle F, Bode B, Hennerici MG, Schmieder K, Inselmann G, Reiter R, Fleischer R, Piplack KO, Safer A, Becher H, Grau AJ (2010): Stroke incidence and survival in Ludwigshafen am Rhein, Germany: the Ludwigshafen Stroke Study (LuSSt). Stroke. 2010; 41:1865–1870.
Pang MYC, Eng JJ, Dawson AS (2005): Relationship between ambulatory capacity and cardiorespiratory fitness in chronic stroke: influence of stroke-specific impairments. Chest; 127: 495–501
Potempa K, Lopez M, Braun LT, Szidon JP, Fogg L, Tincknell T (1995): Physiological outcomes of aerobic exercise training in hemiparetic stroke patients. Stroke; 26: 101–105.
Rogers MA, Yamamoto C, Hagberg JM (1987): The effects of 7 years of intense exercise training on patients with coronary artery disease. J Am Coll Cardiol. 1987; 10:32–326.
Roth EJ. Heart disease in patients with stroke (1993): incidence, impact, and implications for rehabilitation. Part I: classification and prevalence. Arch Phys Med Rehabil; 74:752–760.
Toledano-Zarhi A, Tanne D, Carmeli E, Katz-Leurer M (2011): Feasibility, safety and efficacy of an early aerobic rehabilitation program for patients after minor ischemic stroke: a pilot randomized controlled trial. NeuroRehabilitation; 28: 85–90.
Warburton DER, Gledhill N, Jamnik VK, Bredin SSD, McKenzie DC, Stone J, Charlesworth S, Shephard RJ (2011): Evidence-based risk assessment and recommendations for physical activity clearance: Consensus Document 2011. Appl Physiol Nutr Metab; 36: 266– 298.
