Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2020; 30(02): 80-85
DOI: 10.1055/a-0979-4114
Review
© Georg Thieme Verlag KG Stuttgart · New York

Effect of Community Exercise for Patients with Stroke: A Systematic Review and Meta-analysis

Wirkung von Sport in der Gruppe bei Schlaganfallpatienten: eine systematische Literaturrecherche und Meta-Analyse
Qi-feng Peng
1   Department of Rehabilitation, Chongqing Hospital of Traditional Chinese Medicine
,
Jie Zhou
1   Department of Rehabilitation, Chongqing Hospital of Traditional Chinese Medicine
,
Heng Jiang
1   Department of Rehabilitation, Chongqing Hospital of Traditional Chinese Medicine
› Author Affiliations
Further Information

Publication History

received 15 April 2019

accepted 09 July 2019

Publication Date:
19 August 2019 (online)

Abstract

Background Community exercise might be beneficial to stroke recovery. However, the results remained controversial. We conducted a systematic review and meta-analysis to explore the effect of community exercise on stroke patients.

Methods PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of community exercise vs. usual care on stroke were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcome were 6-Minute walk test and walking speed. Metaanalysis was performed using random-effect model.

Results Four RCTs involving 497 patients were included in the metaanalysis. Overall, compared with control intervention, community exercise intervention was found to significantly improve 6-Minute walk distance (Std. mean difference=0.48; 95% CI=0.22 to 0.74; P=0.0003), and walking speed (Std. mean difference=0.40; 95% CI=0.10 to 0.70; P=0.009) in stroke patients, but resulted in no influence on Berg Balance Scale (Std. mean difference=0.39; 95% CI=−0.29 to 1.07; P=0.26), muscle strength (Std. mean difference=0.05; 95% CI=-0.34 to 0.43; P=0.82) and mental quality of life (Std. mean difference=0.04; 95% CI=−0.25 to 0.34; P=0.77).

Conclusions Compared to control intervention, community exercise was found to significantly increase 6-Minute walk test, walking speed and Berg Balance Scale, but showed no influence on Berg Balance Scale, muscle strength and mental quality of life.

Zusammenfassung

Hintergrund Sport in der Gruppe kann sich positiv auf den Heilungsverlauf nach einem Schlaganfall auswirken. Die Ergebnisse sind jedoch umstritten. Wir haben eine systematische Literaturrecherche und Meta-Analyse durchgeführt, um die Wirkung von Sport in der Gruppe bei Schlaganfallpatienten zu untersuchen.

Methoden Es wurde eine systematische Literaturrecherche in PubMed, EMbase, Web of science, EBSCO und der Cochrane library Datenbank durchgeführt. Darin eingeschlossen waren randomisierte Studien (RCTs), in der die Wirkung von Sport in der Gruppe vs. herkömmliche Maßnahmen bei Schlaganfallpatienten untersucht wurde. Zwei Untersucher recherchierten unabhängig voneinander Artikel, extrahierten Daten und bewerteten die Qualität der eingeschlossenen Studien. Primäre Zielgrößen waren der 6-Minuten-Gehtest und Gehgeschwindigkeit. Die Meta-Analyse wurde mithilfe von Datenmodellen mit zufälligen Effekten durchgeführt.

Ergebnisse In der Meta-Analyse wurden 4 RCTs untersucht, an denen 497 Patienten teilgenommen hatten. Insgesamt konnte festgestellt werden, dass Sport in der Gruppe im Vergleich zu herkömmlichen Maßnahmen die Distanz beim 6-Minuten-Gehtest bei Schlaganfallpatienten signifikant verbesserte (Standardabweichung mittlere Differenz=0,48; 95% CI=0,22– 0,74; P=0,0003), ebenso die Gehgeschwindigkeit (Standardabweichung mittlere Differenz=0,40; 95% CI=0,10–0,70; P=0,009), jedoch konnte kein Unterschied bei der Berg-Balance-Skala (Standardabweichung mittlere Differenz=0,39; 95% CI=−0,29 bis 1,07; P=0,26), der Muskelkraft (Standardabweichung mittlere Differenz=0,05; 95% CI=−0,34 bis 0,43; P=0,82) und der mentalen Lebensqualität (Standardabweichung mittlere Differenz=0,04; 95% CI=−0,25 bis 0,34; P=0,77) festgestellt werden.

Schlussfolgerung Im Vergleich zu herkömmlichen Maßnahmen konnte mit Sport in der Gruppe eine signifikante Verbesserung des 6-Minuten-Gehtests und der Gehgeschwindigkeit erzielt werden, es zeigte sich jedoch keine Wirkung auf der Berg-Balance-Skala, der Muskelkraft und mentalen Lebensqualität.

 
  • References

  • 1 Mandliya A, Das A, Unnikrishnan J. et al. Post-stroke fatigue is an independent predictor of post-stroke disability and burden of care: a path analysis study. Topics in stroke rehabilitation 2016; 23: 1-7
  • 2 Simonetto M, Gardener H, Wang K. et al. Race/Ethnic Disparities for In-Hospital Mortality and Disability at Discharge after Acute Ischemic Stroke: Florida Puerto Rico Collaboration to Reduce Stroke Disparities (P5. 287). Neurology 2017; 88 P5 287
  • 3 Burn J, Dennis M, Bamford J. et al. Long-term risk of recurrent stroke after a first-ever stroke. The Oxfordshire Community Stroke Project. Stroke 1994; 25: 333-337
  • 4 Park JH, Ovbiagele B. Relationship of functional disability after a recent stroke with recurrent stroke risk. European journal of neurology 2016; 23: 361-367
  • 5 Han B, Haley WE. Family caregiving for patients with stroke. Review and analysis. Stroke 1999; 30: 1478-1485
  • 6 Zhang D, Wang W, Li F. Association between resting heart rate and coronary artery disease, stroke, sudden death and noncardiovascular diseases: a meta-analysis. Canadian Medical Association Journal 2016; 188: E384-E392
  • 7 Kuo C-L, Shiao A-S, Wang S-J. et al. Risk of sudden sensorineural hearing loss in stroke patients: A 5-year nationwide investigation of 44,460 patients. Medicine 2016; Sep; 95 (36) e4841
  • 8 Pennlert J, Asplund K, Glader E-L. et al. Socioeconomic Status and the Risk of Stroke Recurrence. Stroke 2017; 48: 1518-1523
  • 9 Furie KL, Kasner SE, Adams RJ. et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the american heart association/american stroke association. Stroke 2011; 42: 227-276
  • 10 Creager MA, Luscher TF, Cosentino F. et al. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: Part I. Circulation 2003; 108: 1527-1532
  • 11 Versari D, Daghini E, Virdis A. et al. Endothelial Dysfunction as a Target for Prevention of Cardiovascular Disease. Diabetes Care 2009; 32: S314-S321
  • 12 Feigin VL, Roth GA, Naghavi M. et al. Global burden of stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet Neurology 2016; 15: 913-924
  • 13 Blair SN, Kampert JB, Kohl 3rd HW. et al. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. Jama 1996; 276: 205-210
  • 14 de Oliveira Otto MC, Afshin A, Micha R. et al. The impact of dietary and metabolic risk factors on cardiovascular diseases and type 2 diabetes mortality in Brazil. PloS one 2016; 11: e0151503
  • 15 Brazzelli M, Saunders DH, Greig CA. et al. Physical fitness training for stroke patients. The Cochrane database of systematic reviews 2011; Nov 9; (11) CD003316
  • 16 Moore SA, Hallsworth K, Jakovljevic DG. et al. Effects of Community Exercise Therapy on Metabolic, Brain, Physical, and Cognitive Function Following Stroke: A Randomized Controlled Pilot Trial. Neurorehabilitation and neural repair 2015; 29: 623-635
  • 17 Dean CM, Rissel C, Sherrington C. et al. Exercise to enhance mobility and prevent falls after stroke: the community stroke club randomized trial. Neurorehabilitation and neural repair 2012; 26: 1046-1057
  • 18 Pang MYC, Eng JJ, Dawson AS. et al. A Community-Based Fitness and Mobility Exercise Program for Older Adults with Chronic Stroke: A Randomized, Controlled Trial. Journal of the American Geriatrics Society 2005; 53: 1667-1674
  • 19 Moher D, Liberati A, Tetzlaff J. et al. Group P Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Bmj 2009; 339: b2535
  • 20 Higgins JPTGS. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration. 2011; www.cochrane-handbook.org
  • 21 Eng JJ, Chu KS, Dawson AS. et al. Functional walk tests in individuals with stroke: relation to perceived exertion and myocardial exertion. Stroke 2002; 33: 756-761
  • 22 Berg KO, Maki BE, Williams JI. et al. Clinical and laboratory measures of postural balance in an elderly population. Archives of physical medicine and rehabilitation 1992; 73: 1073-1080
  • 23 Jadad AR, Moore RA, Carroll D. et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary?. Controlled Clinical Trials 1996; 17: 1-12
  • 24 Kjaergard LL, Villumsen J, Gluud C. Reported Methodologic Quality and Discrepancies between Large and Small Randomized Trials in Meta-Analyses. Annals of Internal Medicine 2001; 135: 982-989
  • 25 Harrington R, Taylor G, Hollinghurst S. et al. A community-based exercise and education scheme for stroke survivors: a randomized controlled trial and economic evaluation. Clinical rehabilitation 2010; 24: 3-15
  • 26 Aidar FJ, Silva AJ, Reis VM. et al. A study on the quality of life in ischaemic vascular accidents and its relation to physical activity. Revista de neurologia 2007; 45: 518-522
  • 27 Mead GE, Greig CA, Cunningham I. et al. Stroke: a randomized trial of exercise or relaxation. J Am Geriatr Soc 2007; 55: 892-899
  • 28 Angevaren M, Aufdemkampe G, Verhaar HJ. et al. Physical activity and enhanced fitness to improve cognitive function in older people without known cognitive impairment. The Cochrane database of systematic reviews 2008; 3: CD005381
  • 29 Ryan AS, Li G, Hafer-Macko C. et al. Resistive Training and Molecular Regulators of Vascular-Metabolic Risk in Chronic Stroke. Journal of Stroke and Cerebrovascular Diseases 2017; 26: 962-968
  • 30 O'Donnell MJ, Chin SL, Rangarajan S. et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. The Lancet 2016; 388: 761-775
  • 31 Gordon DJ, Knoke J, Probstfield JL. et al. High-density lipoprotein cholesterol and coronary heart disease in hypercholesterolemic men: the Lipid Research Clinics Coronary Primary Prevention Trial. Circulation 1986; 74: 1217-1225
  • 32 Watkins LO, Neaton JD, Kuller LH. Racial differences in high-density lipoprotein cholesterol and coronary heart disease incidence in the usual-care group of the Multiple Risk Factor Intervention Trial. The American journal of cardiology 1986; 57: 538-545
  • 33 Roth EJ. Heart disease in patients with stroke: incidence, impact, and implications for rehabilitation. Part 1: Classification and prevalence. Archives of physical medicine and rehabilitation 1993; 74: 752-760
  • 34 Micha R, Peñalvo JL, Cudhea F. et al. Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States. Jama 2017; 317: 912-924
  • 35 Rimmer JH, Rauworth AE, Wang EC. et al. A preliminary study to examine the effects of aerobic and therapeutic (nonaerobic) exercise on cardiorespiratory fitness and coronary risk reduction in stroke survivors. Archives of physical medicine and rehabilitation 2009; 90: 407-412
  • 36 Ivey FM, Ryan AS, Hafer-Macko CE. et al. Treadmill aerobic training improves glucose tolerance and indices of insulin sensitivity in disabled stroke survivors: a preliminary report. Stroke 2007; 38: 2752-2758
  • 37 Stradecki-Cohan HM, Youbi M, Cohan CH. et al. Physical Exercise Improves Cognitive Outcomes in 2 Models of Transient Cerebral Ischemia. Stroke 2017; Aug; 48 (8) 2306-2309
  • 38 Hasan SM, Rancourt SN, Austin MW. et al. Defining Optimal Aerobic Exercise Parameters to Affect Complex Motor and Cognitive Outcomes after Stroke: A Systematic Review and Synthesis. Neural plasticity 2016; 2016: 2961573
  • 39 Ivey FM, Macko RF, Ryan AS. et al. Cardiovascular health and fitness after stroke. Topics in stroke rehabilitation 2005; 12: 1-16
  • 40 Langhammer B, Sunnerhagen KS, Lundgren-Nilsson A et al. Factors enhancing activities of daily living after stroke in specialized rehabilitation. An observational multicenter study within the Sunnaas International Network. European journal of physical and rehabilitation medicine 2017
  • 41 Rezaiefar P, Pottie K. Blood pressure and secondary prevention of strokes. How low should we go? Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Canadian family physician Medecin de famille canadien 2002; 48: 1625-1629
  • 42 Lennon O, Galvin R, Smith K. et al. Lifestyle interventions for secondary disease prevention in stroke and transient ischaemic attack: A systematic review. European journal of preventive cardiology 2014; 21: 1026-1039