Are Aerobic Programs Similar in Design to Cardiac Rehabilitation Beneficial for Survivors of Stroke? A Systematic Review and Meta-Analysis

Abstract

Background Survivors of stroke face movement disability and increased cardiovascular disease and stroke risk. Treatment includes rehabilitation focused on functional movement with less emphasis on aerobic capacity. After rehabilitation, survivors of stroke must self-manage activity with limited appropriate community programs. Lack of structured activity contributes to sedentary behavior. The objective of this systematic review and meta-analysis is to review aerobic programs for stroke survivors similar in activity and dosage to cardiac rehabilitation programs to determine their efficacy for improving aerobic and walking capacity. Methods and Results Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to review 5 databases. Group interventions for survivors of stroke with a primary aerobic component and dosage from 18 to 36 visits over 8 to 18 weeks (matching cardiac rehabilitation requirements in the United States) were included. The 6-minute walk test, maximal oxygen consumption (VO2) peak, and walking speed were included as measures of aerobic capacity. Summary effect sizes and outcome measure mean differences were calculated for preintervention to postintervention, and summary effect sizes were calculated for preintervention to follow-up. Activity type and initial 6-minute walk test moderator analyses were performed. Nineteen studies with 23 eligible groups were selected. Survivors of stroke improved their composite aerobic capacity with an effect size of 0.38 (95% CI, 0.27-0.49). Studies including 6-minute walk test demonstrated a pooled difference in means of 53.3 m (95% CI, 36.8-69.8 m). Follow-up data were inconclusive. Conclusions Survivors of stroke benefit from aerobic programs with similar dosing to cardiac rehabilitation in the United States. The potential integration into existing programs could expand the community exercise options.

Keywords: cardiac rehabilitation; exercise; stroke; stroke rehabilitation.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) systematic review results.

Figure 2

Forest plot results for summary aerobic capacity effects from preintervention to postintervention. H.I. indicates high intensity; L.I., low intensity; M.I., moderate intensity; O.G., over ground; RS, recumbent stepper.

Figure 3

Pooled effects for aerobic capacity from preintervention to follow‐up. O.G. indicates over ground; RS, recumbent stepper.

Figure 4

Pooled effects for aerobic capacity preintervention to postintervention by activity type. H.I. indicates high intensity; L.I., low intensity; M.I., moderate intensity; OG, over ground; RS, recumbent stepper.

Figure 5

Pooled mean differences in 6‐minute walk test (6MWT) distance (in meters) grouped by initial 6MWT mean <288 and ≥288 m. H.I. indicates high intensity; L.I., low intensity; M.I., moderate intensity; OG, over ground; RS, recumbent stepper.

Figure 6

Funnel plot for pooled aerobic effects from preintervention to postintervention.