What Is the Dose-Response Relationship Between Exercise and Cardiorespiratory Fitness After Stroke? A Systematic Review.

Margaret Galloway, Dianne L Marsden, Robin Callister, Kirk I Erickson, Michael Nilsson, Coralie English

Journal: Physical therapy 2019;99(7):821-832

PMID: 30834439

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Abstract

BACKGROUND

Exercise after stroke improves cardiorespiratory fitness and walking capacity; however, the effect of altering exercise dose (via frequency, intensity, time, and type) on fitness or walking capacity is unclear.

PURPOSE

The purpose of this study was to synthesize the current evidence for the effects of different doses of exercise on cardiorespiratory fitness and walking capacity in people after stroke.

DATA SOURCES

Seven relevant electronic databases were searched using keywords relating to stroke and cardiorespiratory fitness.

STUDY SELECTION

Trials that compared more than 1 dose of exercise for people (≥ 18 years old) after stroke and measured peak oxygen consumption or 6-minute walk test distance as an outcome were included. Two reviewers independently appraised all trials.

DATA EXTRACTION

Two reviewers independently extracted data from included articles. Intervention variables were extracted in accordance with the Template for Intervention Description and Replication checklist.

DATA SYNTHESIS

Data were synthesized narratively. Nine trials involving 279 participants were included. Three of 5 trials comparing exercise intensity showed that higher-intensity training was associated with greater improvements in cardiorespiratory fitness. The effects of other exercise dose components (frequency, time, and type) on fitness were not determined. Overall, walking capacity improved as program length increased.

LIMITATIONS

All trials had a high risk of bias, and most had a high rate of attrition. Most trials included people more than 6 months after stroke and who walked independently, limiting the generalizability of the findings.

CONCLUSIONS

Exercising at an intensity greater than 70% of heart rate reserve can be more effective in increasing cardiorespiratory fitness after stroke than exercising at lower intensities. More trials that compare exercise doses by manipulating only 1 dose parameter at a time for people after stroke are needed.

Address: School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, University Drive, Callaghan, New South Wales 2305, Australia; and Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Hunter Medical Research Institute, Newcastle, New South Wales, Australia.; School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle; Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Hunter Medical Research Institute; and Hunter Stroke Service, Hunter New England Local Health District, Newcastle, New South Wales, Australia.; Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Hunter Medical Research Institute; and School of Biomedical Sciences and Pharmacy and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle.; Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania.; Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Hunter Medical Research Institute; and Faculty of Health and Medicine, University of Newcastle.; School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle; and Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Hunter Medical Research Institute.

DOI: 10.1093/ptj/pzz038

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MeSH Terms: Cardiorespiratory Fitness, Exercise Therapy, Humans, Stroke Rehabilitation