The use of aerobic exercise training in improving aerobic capacity in individuals with stroke: a meta-analysis.

OBJECTIVE To determine whether aerobic exercise improves aerobic capacity in individuals with stroke. DESIGN A systematic review of randomized controlled trials. DATABASES SEARCHED: MEDLINE, CINAHL, EMBASE, Cochrane Database of Systematic Reviews and Physiotherapy Evidence Database were searched. INCLUSION CRITERIA Design: randomized controlled trials (RCTs). PARTICIPANTS individuals with stroke. INTERVENTIONS aerobic exercise training aimed at improving aerobic capacity. OUTCOMES PRIMARY OUTCOMES aerobic capacity (peak oxygen consumption (VO2), peak workload). SECONDARY OUTCOMES walking velocity, walking endurance. DATA ANALYSIS The methodological quality was assessed by the PEDro scale. Meta-analyses were performed for all primary and secondary outcomes. RESULTS Nine articles (seven RCTs) were identified. The exercise intensity ranged from 50% to 80% heart rate reserve. Exercise duration was 20-40 min for 3-5 days a week. The total number of subjects included in the studies was 480. All studies reported positive effects on aerobic capacity, regardless of the stage of stroke recovery. Meta-analysis revealed a significant homogeneous standardized effect size (SES) in favour of aerobic exercise to improve peak VO2 (SES 0.42; 95% confidence interval (CI) 0.15-0.69; P=0.001) and peak workload (SES 0.50; 95% CI 0.26-0.73; P<0.001). There was also a significant homogeneous SES in favour of aerobic training to improve walking velocity (SES 0.26; 95% CI 0.05-0.48; P= 0.008) and walking endurance (SES 0.30; 95% CI 0.06-0.55; P= 0.008). CONCLUSIONS There is good evidence that aerobic exercise is beneficial for improving aerobic capacity in people with mild and moderate stroke. Aerobic exercise should be an important component of stroke rehabilitation.