Physical fitness training for stroke patients

 

Abstract

Background

Levels of physical fitness are low after stroke. It is unknown whether improving physical fitness after stroke reduces disability.

Objectives

To determine whether fitness training after stroke reduces death, dependence, and disability. The secondary aims were to determine the effects of training on physical fitness, mobility, physical function, quality of life, mood, and incidence of adverse events.

Search methods

We searched the 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 five additional databases (March 2010). We also searched ongoing trials registers, handsearched relevant journals and conference proceedings, screened reference lists, and contacted experts in the field.

Selection criteria

Randomised trials comparing either cardiorespiratory training or resistance training, or both, with no intervention, a non-exercise intervention, or usual care in stroke survivors.

Data collection and analysis

Two review authors independently selected trials, assessed quality, and extracted data. We analysed data using random-effects meta-analyses. Diverse outcome measures limited the intended analyses.

Main results

We included 32 trials, involving 1414 participants, which comprised cardiorespiratory (14 trials, 651 participants), resistance (seven trials, 246 participants), and mixed training interventions (11 trials, 517 participants). Five deaths were reported at the end of the intervention and nine at the end of follow-up. No dependence data were reported. Diverse outcome measures made data pooling difficult. The majority of the estimates of effect were not significant. Cardiorespiratory training involving walking improved maximum walking speed (mean difference (MD) 8.66 metres per minute, 95% confidence interval (CI) 2.98 to 14.34), preferred gait speed (MD 4.68 metres per minute, 95% CI 1.40 to 7.96) and walking capacity (MD 47.13 metres per six minutes, 95% CI 19.39 to 74.88) at the end of the intervention. These training effects were retained at the end of follow-up. Mixed training, involving walking, increased preferred walking speed (MD 2.93 metres per minute, 95% CI 0.02 to 5.84) and walking capacity (MD 30.59 metres per six minutes, 95% CI 8.90 to 52.28) but effects were smaller and there was heterogeneity amongst the trial results. There were insufficient data to assess the effects of resistance training. The variability in the quality of included trials hampered the reliability and generalizability of the observed results.

Authors' conclusions

The effects of training on death, dependence, and disability after stroke are unclear. There is sufficient evidence to incorporate cardiorespiratory training involving walking within post-stroke rehabilitation programmes to improve speed, tolerance, and independence during walking. Further well-designed trials are needed to determine the optimal exercise prescription and identify long-term benefits.

 

Plain language summary

Physical fitness training for stroke patients

Fitness training is considered beneficial for stroke patients. Physical fitness is important for the performance of everyday activities. The physical fitness of stroke patients is impaired after their stroke and this may reduce their ability to perform everyday activities and also exacerbate any stroke-related disability. This review of 32 trials involving 1414 participants found that cardiorespiratory fitness training after stroke can improve walking performance. There are too few data for other reliable conclusions to be drawn.

 

摘要

背景

給予中風病人的體適能訓練

中風後病人的體適能較差。我們不曉得在中風之後改善體適能是否可以減少失能。

目標

評定中風後的體適能訓練(心肺訓練、力量訓練或兩者)是否可以減少死亡，依賴以及失能。回顧的次級目標是評定體適能訓練對體適能，活動性，身體功能，健康與生活品質，情緒以及不良事件的發生率的效果。

搜尋策略

我們搜尋了Cochrane Stroke Group Trials Register(搜尋至2009年3月)，Cochrane Central Register of Controlled Trials Trials (The Cochrane Library2007年第1期)，MEDLINE(1966年至2007年3月)，EMBASE(1980年至2007年3月)，CINAHL(1982年至2007年3月)和另外6個資料庫直到2007年3月。我們搜尋相關期刊及研討會手冊並且篩選參考索引。此外我們搜尋試驗資料庫並且聯絡該領域專家。

選擇標準

如果隨機對照試驗(randomised controlled trial)的治療方式旨在改善肌肉力量或心肺耐力(或兩者皆有)，且其對照組包括了無治療、日常照護或者是非運動性的治療，則被我們納入此篇回顧。

資料收集與分析

2位文獻回顧作者評定試驗的合適性及品質。1位回顧作者於治療末了時時擷取資料並追蹤分數，或相當於較基礎分數的改變。評估結果的方法不同限制了意向分析(intended analysis)。

主要結論

我們收納了24個試驗，涵蓋1147參與者。包括心肺訓練(11試驗，692名參與者)、力量訓練(4項試驗，158名參與者)以及混合訓練治療(9個試驗，360名參與者)。，在治療終止時(1/1147)與後續追蹤時(8/627)的死亡情形是少見的。並沒有依賴照顧這部分的資料被報告。因評估失能的方法不同，造成進行統合分析(metaanalysis)上的困難，而大多數的效果規模(effect size)並不顯著。心肺訓練包含走路訓練，提高最大步行速度(平均差異每分鐘6.47公尺，95％CI 2.37至10.57)，行走耐力(平均差異38.9公尺/每6分鐘，95％CI為14.3至63.5)，並減少行走依賴(能性步行功能分級MD 0.72，95％CI為0.46～0.98)目前的數據包括少數力量訓練的試驗，並且缺乏非運動專注控制、長期的培訓和後續追蹤。

作者結論

中風後訓練對於死亡、依賴情形和失能情形的影響仍不清楚。有足夠的證據顯示可納入心肺訓練(包括走路)於中風後復健當中，以提升速度，容忍程度和行走時獨立性。未來需要進一步的試驗，以確定最佳的運動處方，並找出長期的效益。

翻譯人

本摘要由奇美醫院陳軾正翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

給予中風病人的體適能訓練。關於體適能訓練對於中風病人是否有益所知甚少。體適能對於執行日常的活動是重要的。中風病人的體適能在他們中風之後會變差，而這可能會減低他們執行日常活動的能力並加劇任何中風導致的失能。這篇回顧24個試驗及1147位病人的文獻，發現中風後的體適能訓練可以改善行走的表現。但資料太少以至於無法作出其他可靠的結論。