Stroke

Physical Fitness Training for Patients With Stroke : Updated Review Miriam Brazzelli, David H. Saunders, Carolyn A. Greig and Gillian E. Mead Stroke. 2012;43:e39-e40; originally published online March 15, 2012; doi: 10.1161/STROKEAHA.111.647008
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Physical Fitness Training for Patients With Stroke
Updated Review
Miriam Brazzelli, BSc, PhD; David H. Saunders, BSc, MPhil, PhD; Carolyn A. Greig, BSc, MSc, PhD;Gillian E. Mead, MB, BChir, FRCP, MD, MA
hysical fitness is low after stroke and this may cause or exacerbate some common poststroke problems, including disability. It is not known whether improving physical fitness or participating in physical fitness training after stroke reduces death, disability, or dependency.

P

Results
We included 32 trials, involving 1414 participants, which comprisedcardiorespiratory (14 trials, n 651), resistance (7 trials, n 246), and mixed training interventions (11 trials, n 517). Five deaths were reported at the end of the intervention and 9 at the end of follow-up. No dependence data were reported. Diverse outcome measures limited the intended meta-analyses and most estimates of effect were not significant. However, a clear pattern of benefits emergedfor walking outcomes (Table). Cardiorespiratory training improved cardiorespiratory fitness and when it also involved walking as a mode of exercise, it caused a significant increase in walking speed (maximum and preferred speeds) and tolerance (6-minute walking test) at the end of intervention. Some of these benefits persisted 3 months after the intervention had stopped. Mixed training showedweaker, heterogeneous effects on walking, which were confounded by lack of attention control. Resistance training improved muscle strength but showed no significant effects on walking. The variability in the quality of included trials hampered the reliability and generalizability of the observed results.

Objectives
The primary aim of the review was to determine whether physical fitness training(cardiorespiratory training and/or resistance training) after stroke reduces death, dependence, and disability at the end of intervention or at the end of follow-up. The secondary aim was 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.

Methods
Search Strategy
We searchedthe Cochrane Stroke Group Trials Register (last searched April 2010), the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library, July 2010), MEDLINE (1966 to March 2010), EMBASE (1980 to March 2010), CINAHL (1982 to March 2010), SPORTDiscus (1949 to March 2010), and 5 additional databases (March 2010). We also searched registers of ongoing trials, hand-searched relevant...