Physical fitness interventions for nonambulatory stroke survivors: A mixed-methods systematic review and meta-analysis

Lloyd, Megan; Skelton, Dawn A.; Mead, Gillian E.; Williams, Brian; van Wijck, Frederike

Abstract

Introduction
Physical fitness training after stroke is recommended in guidelines across the world, but evidence pertains mainly to ambulatory stroke
survivors. Non-ambulatory stroke survivors (FAC score ≤2) are at
increased risk of recurrent stroke due to limited physical activity. This systematic review aimed to synthesise evidence regarding case fatality, effects, experiences and feasibility of fitness training for non-ambulatory stroke survivors.
Methods
Eight major databases were searched for any type of study design. Two independent reviewers selected studies, extracted data and assessed study quality, using published tools. Random-effects meta-analysis was used. Following their separate analysis, qualitative and quantitative data were synthesised using a published framework.
Results
Of 13,614 records, 33 studies involving 910 non-ambulatory participants met inclusion criteria. Most studies were of moderate
quality. Interventions comprised assisted walking (25 studies), cycle
ergometer training (5 studies) and other training (3 studies), mainly in acute settings. Case fatality did not differ between intervention (1.75%) and control (0.88%) groups (95% CI 0.13-3.78, P=0.67). Compared with control interventions, assisted walking significantly improved: fat mass, peak heart rate, peak oxygen uptake and walking endurance, maximum walking speed and mobility at intervention end, and walking endurance, balance, mobility and independent walking at follow-up. Cycle ergometry significantly improved peak heart rate, work load, peak ventilation, peak
carbon dioxide production, HDL cholesterol, fasting insulin and fasting glucose and independence at intervention end. Effectiveness of other training could not be established. There were insufficient qualitative data to draw conclusions about participants’ experiences, but those reported were positive. There were few intervention-related adverse events and drop-out rate ranged from 12-20%.
Conclusions
Findings suggest safety, effectiveness and feasibility of adapted fitness training for screened non-ambulatory stroke survivors. Further research needs to investigate the clinical and cost-effectiveness as well as experiences of fitness training - especially for chronic stroke survivors in community settings.

Citation

Lloyd, M., Skelton, D. A., Mead, G. E., Williams, B., & van Wijck, F. (2018). Physical fitness interventions for nonambulatory stroke survivors: A mixed-methods systematic review and meta-analysis. Brain and Behavior, 8(7), Article e01000. https://doi.org/10.1002/brb3.1000

• Journal Article Type: Article
• Acceptance Date: Apr 15, 2018
• Online Publication Date: Jun 19, 2018
• Publication Date: 2018-07
• Deposit Date: May 7, 2018
• Publicly Available Date: Jun 26, 2018
• Journal: Brain and Behavior
• Print ISSN: 2162-3279
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 8
• Issue: 7
• Article Number: e01000
• DOI: https://doi.org/10.1002/brb3.1000
• Keywords: exercise; fitness; nonambulatory; rehabilitation; stroke; systematic review
• Public URL: http://researchrepository.napier.ac.uk/Output/1154077