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Table 1 Overview of included studies on cardiovascular exercise early after stroke

From: Effects of cardiovascular exercise early after stroke: systematic review and meta-analysis

Study ID Participants Inclusion criteria Exclusion criteria Exercise protocol Additional interventions/control group Outcomes (Instrument):
+ = significant between-group difference
0 = no difference between groups
da Cunha_2002 15 participants Gait deficit (gait speed <0.6 m/s), Functional Ambulation Category (FAC) 0–3, Mini-Mental State Exam >21, ability to stand and take steps, stable medical condition Comorbidity, recent myocardial infarction or bypass surgery with complications (<4wk), uncontrolled health conditions, significant lower extremity degenerative joint disease, body weight >110 kg, history of bilateral cerebrovascular accident Mode: 3 weeks of body weight supported treadmill training Usual care/Usual care 3 h/day, conventional gait training VO2consumption (5-minute walk): 0
Age: 58.4 Intensity: Starting with 30% BWS, increasing progressively each session VO2cost (5-minute walk): 0
Days since stroke (intervention group): 15.7 ± 7.7 (9–28) Duration: 20 min Gait ability (FAC Scale): 0
Moderately impaired, NIH: 4.5 Frequency: 5 x/week (15 sessions) Gait speed (5MWT): 0
       Walking distance (5 minutes walk): 0
Duncan_1998 20 participants 30–90 days after stroke, FMMS 40–90, OPS 2–5.2, ambulatory with supervision and/or assistive device, living at home, living around 50 miles of the University of Kansas Medical Centre Medical condition that interfered with outcome assessments or limited participation in submaximal exercise program, Mini-Mental State score <18, receptive aphasia that interfered with the ability to follow a 3-step command Mode: 12 weeks of strength, balance and endurance training (leg cycle ergometry) in a home based setting Usual care/Usual care, no endurance training 10MWT: + (p = 0.05 < 0.10)
Age: 67.6 Intensity: Resistance progression after 2 sets of 10 repetitions FM lower: + (p = 0.01 < 0.02)
Days since stroke (intervention group): 66.0 ± N/A Duration: 90 min 6MWT: 0
Minor impaired, OPS: 2.7 Frequency: 3 x/week (36 sessions) FMMS upper extremity: 0
Barthel Index of ADL: 0
Lawton Instrumental ADL: 0
MOS36: 0
Berg Balance Scale: 0
Hand function (Jebsen Test): 0
Duncan_2003 100 participants 30–150 days after stroke, ability to ambulate 25 ft independently, FMMS 27–90, OPS 2–5.2, Mini-Mental State Score >16, ambulatory with supervision and/or assistive device, living at home, living around 50 miles of the University of Kansas Medical Centre Serious cardiac conditions (hospitalisation for heart disease within 3 months, active angina serious cardiac arrhythmias, hypertrophic cardiomyopathy, severe aortic stenosis, pulmonary embolus, or infarction), oxygen dependence, severe weight-bearing pain, other serious organ system disease, life expectancy of <1 year Mode: 12–14 weeks of strength, balance and endurance training (leg cycle ergometry) in a home based setting Usual care/Usual care, no endurance training VO2peak (Leg cycle ergometry): + (p < 0.01, ES = 0.90)
Age: 69.4 Intensity: Resistance progression after 2 sets of 10 repetitions 10MWT: + (p = 0.05 < 0.10, ES = 0.70)
Days since stroke (intervention group): 77.5 ± 28.7 Duration: 90 min 6MWT: + (p < 0.05, ES = 0.80)
Moderate impaired, OPS: 3.4 Frequency: 3x/week (36 sessions) Duration of bike exercise: + (p < 0.001)
Berg Balance Scale: + (p < 0.01, ES = 1.07)
FMMS lower extremity: 0
FMMS upper extremity: 0
Grip strength: 0
Wolf Motor Function Test: 0
Functional Reach test: 0
Ankle isometric dorsiflexion: 0
Ankle isometric extension: 0
Eich_2004 50 participants First-time supratentorial stroke, stroke interval <6 weeks before study onset, able to walk a minimum 12 m with intermittent help or stand-by while walking, Barthel Index 50–80, Participation in a 12 week rehabilitation program, cardiovascular stable, according to 12-lead ECG, bicycle ergometry reaching >50 W and examination by a cardiologist, no other neurologic or orthopaedic disease impairing walking, able to understand the study content none Mode: 6 weeks of treadmill training, if necessary with body weight support (max 15% body weight) Usual care/Usual care 10MWT: + (p < 0.001, ES = 1.15)
Age: 63.2 Intensity: Training heart rate = (HRmax-HRrest)*0.6 + HRrest 6MWT: + (p < 0.002, ES = 1.07)
Days since stroke (intervention group): 42.7 ± 15.4 Duration: 30 min Rivermead Motor Assessment Score: 0
Moderate impaired, Barthel Index: 66.7 Frequency: 5x/week (30 sessions) Walking quality: 0
Katz-Leurer_2003A 92 participants 48 after stroke, clinical signs of first stroke Brainstem lesions or bilateral signs, no lower-limb paralysis, >30 days after first event, pathological ECG during stress testing, significant change in blood pressure upon exertion, resting systolic blood pressure >200 mmHg, resting diastolic blood pressure > 100 mmHg, arrhythmia, heart failure, beta-blockers, suffering from inflammatory or degenerative joint diseases Mode: 8 weeks of leg cycle ergometry Usual care/Usual care WRpeak: + (p < 0.01, ES = 2.54)
Katz-Leurer_2003B Age: 63.5 Intensity: 60% of heart rate reserve Resting heart rate: + (p = < 0.02)
Katz-Leurer_2007 Days since stroke (intervention group): >30 ± N/A Duration: 30 min Number of stairs climbed until fatigue: + (p < 0.01)
Moderate impaired, SSS: 31.0 Frequency: 3x/week (24 sessions) 10MWT: 0
Walking distance until fatigue: 0
FIM: 0
FAI at 6 month follow-up: 0
Heart rate variability: 0
Letombe_2010 18 participants Right or left hemiplegia following ischaemic or haemorrhagic hemispheric stroke, a full set of aetiological data (CT and/or MRI scans, Holter ECG, Doppler, cardiac ultrasound), a stable clinical state, well-balanced treatment (particular in terms of antihypertensives and anticoagulants) Existence of disorders associated with hemiplegic motor damage, such as cognitive and memory disorders, hemisensory neglect, the existence of an intercurrent affection or unstable brain lesions Mode: 4 weeks of leg cycle ergometry or treadmill or stepper Usual care/ADL focussed usual care VO2peak (Leg cycle ergometry): + (p < 0.05, ES = 1.43)
Age: 60 Intensity: 70–80% of maximum power (W) WRpeak (Leg cycle ergometry): + (p < 0.05)
Days since stroke (intervention group): 21.0 ± 3.0 Duration: 40–60 min Test duration (Leg cycle ergometry): + (p < 0.05)
Moderate impaired, Barthel Index: 41 Frequency: 4x/week (16 sessions) Barthel Index: + (p < 0.05)
Katz-ADL Scale Score: + (p < 0.05)
Outermans_2010 43 participants Clinical diagnosis of hemiplegia following first or recurrent stroke, time since most recent stroke and time of recruitment between 2–8 weeks, ability to walk 10 meters without assistance; FAC >3 Case of cardiovascular instability, acute impairments of the lower extremities influencing walking ability, sensory communicative disorders Mode: 4 weeks of task-oriented circuit class training Usual care/Usual care and low intensity PT 6MWT: + (p < 0.02, ES = 0.75)
Age: 57 Intensity: 40–80% of maximum heart rate reserve 10MWT: + (p < 0.03, ES = 3.00)
Days since stroke (intervention group): 22.5 ± 8.2 Duration: 45 min Berg Balance Scale: 0
Moderate impaired, FAC >3 Frequency: 3x/week (12 sessions) Functional Reach Test: 0
Tang_2009 57 participants Walk at least 5 meters independently, Chedoke-McMaster Stroke Assessment leg impairment score of 3–7 (where spasticity and weakness are marked) Contraindications to maximal exercise testing, musculoskeletal impairments or pain that would limit pedalling ability Mode: 2–4 weeks of leg cycle ergometry Usual care/Usual care VO2peak (Leg cycle ergometry): + (p = 0.004, ES = 1.05)
Age: 65.2 Intensity: 50–75% of maximum heart rate reserve WRpeak (Leg cycle ergometry): + (p < 0.001, ES = 0.93)
Days since stroke (intervention group): 17.8 ± 3.1 (6–62) Duration: 30 min 6MWT: + (p < 0.001, ES = 0.67)
Moderately impaired, NIH: 4.7 Frequency: 3x/week (9 sessions) Peak heart rate (Leg cycle ergometry): + (p = 0.002)
Gait speed preferred: + (p < 0.001)
Gait speed fast: + (p < 0.001)
Stroke Impact Scale (SIS): + (p < 0.001)
Toledano-Zarhi_2011 28 participants Minor ischemic stroke, 1–3 weeks post stroke Blood pressure >200/110, unstable angina pectoris, arrhythmia, congestive heart failure, ST depression >2 mm during rest ECG, 3rd degree atrioventricular block with no pacemaker, severe peripheral vascular disease, orthopaedic or neurological disability, dementia or major depression, age >80 years Mode: 6 weeks of leg cycle ergometry or treadmill or handbike None/Home based exercise program for strength and flexibility 6MWT: + (p < 0.001, ES = 1.89)
Age: 65.0 Intensity: 50–70% of maximum heart rate reserve) 4 Square Step test: + (p = 0.03)
Days since stroke (intervention group): 11.0 ± 5.0 Duration: 35–55 min Test duration (treadmill exercise): + (p < 0.001)
Minor impaired, Modified Ranking Scale: <2 Frequency: 2x/week (12 sessions) 13 Stairs descending: 0
13 Stairs ascending: 0
Heart rate rest: 0
Heart rate work: 0
Blood pressure rest: 0
       Blood pressure work: 0
  1. Abbreviations: NIH = National Institute of Health, CVA = Cerebrovascular accident, OPS = Orpington Prognostic Scale, FMM = Fugl-Meyer Motor Score, 10MWT = 10 Meter Walk Test, 6MWT = 6 Minute Walk Test, MOS36 = 36 Item Short Form Health Survey, SSS = Scandinavian Stroke Scale, FIM = Functional Independence Measure, FAI = Frenchay Activities Index, FAC = Functional Ambulatory Classification.