Training for Patients with Stroke

Stroke is one of the most common cause of adult death and a primary cause of adult disability worldwide. Physical fitness levels in the stroke survivors  are degraded because of the neurologic effects of stroke, tendency for physical inactivity, and predisposing poor baseline fitness. Exercise interventions may improve disability and decrease stroke recurrence, but evidence regarding the effect is limited to small trials with diverse functional measures.

There is moderate-quality evidence that physical fitness training improves disability after stroke. One Cochrane review from  Saunders (Saunders DH, 2016) analysed 58 randomized trials and 2,797 patients. Training sessions were diverse in mode, intensity, duration, and proximity to stroke, limiting comparability of results. Some trials included nonambulatory participants, whereas others included only ambulatory patients. Meta-analysis showed no effect on mortality, independence, or stroke recurrence after physical fitness training.

The best evidence of benefit was found for cardiovascular training. Eight trials showed that cardiovascular training reduced disability at the end of the intervention. Measures of mobility were significantly improved, including maximal walking speed (mean difference [MD] = 6.71 meters per minute), preferred gait speed (MD = 4.28 meters per minute), and walking distance (MD = 30.29 meters in six minutes). These mobility effects may have contributed to the disability improvement.

Neither resistance training nor mixed resistance and cardiovascular training conferred the benefits of cardiovascular training alone. There was insufficient evidence to show that resistance training resulted in a sustained effect on disability. Mixed training reduced disability at the end of the intervention. However, it is unclear whether this represents a clinically important outcome. Mixed training, which included walking, showed some of the same mobility benefits as cardiovascular training alone, including preferred gait speed (MD = 4.54 meters per minute) and walking distance (MD = 41.60 meters in six minutes). The actual effect on mobility was uncertain because benefit was demonstrated only if exercise was initiated after usual care.