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 |