2007 Asia Pacific Evidence-Based Medicine Network Conference
November 16-18, 2007 Taipei, Taiwan
Ref. No. C-12
THE EFFECT OF AEROBIC EXERCISE TRAINING ON
CARDIORESPIRATORY FITNESS, AMBULATION PERFORMANCE
AND FUNCTIONAL MOBILITY IN INDIVIDUALS WITH STROKE: A
Lai, Chung-Chun, Wu, Ying-Tai
School and Graduate Institute of Physical Therapy, College of Medicine,
National Taiwan University, Taiwan
Stroke is a leading cause of chronic disability. Survivors lived with residual physical impairment resulted in
decreased cardiorespiratory fitness, secondary complication, recurrent stroke and increased mortality.
Issues of cardiorespiratory fitness in stroke patients was noticed in the past decade, however, there were
insufficient evidence to support the effects of aerobic training on cardiorespiratory fitness, ambulation
performance and functional performance in stroke patients. The purpose of this meta-analysis was to
evaluate the effect of aerobic training in individuals with stroke.
MEDLINE, CINAHL, PubMed, PEDro and CEPS electronic databases were searched for randomized
controlled trials (RCTs) or randomized pre-post control followed single pre-post design studies in
comparing any type of aerobic training with usual care or functional training in stroke patients. The
outcome measures included peak oxygen consumption, peak workload, gait speed, walking distance, and
functional performance (gross motor function, balance performance, physical activity level). Weight mean
difference (WMD) or standard mean difference (SMD) and 95% confidence interval (CI) were calculated.
Fixed or randomized effect model were determined by the heterogeneity test of each outcome.
Seven RCTs and one randomized pre-post control followed single pre-post design were identified with
data from 363 participants with stroke. The poststroke duration ranged from 48 hours to average 7 years,
and training period from 6 weeks to 6 months with treadmill exercise training, leg cycle ergometer or
water-based exercise with moderate to high intensity. Meta-analysis showed a significant effect on
aerobic exercise improving peak oxygen consumption (WMD 1.23 mL/Kg/min with 95%CI 0.63 to 1.83),
and peak workload (WMD 13.46 W, 95% CI 7.96 to 18.97). There was also a significant effect in
improving walking distance (WMD 34.37 m, 95% CI 15.67 to 53.06), but a borderline effect in selected
gait speed (WMD 0.06, p=0.06). In addition, the aerobic exercise has significant positive effects on
balance performance (Berg balance scale, WMD 2.19 with 95% CI 0.62 to 3.77) due to combined balance
training. There were no effects on gross motor function and physical activity level. No studies reported
adverse events occurred during training period as an outcome, except one study recorded dropout
reason due to fatigue.
Aerobic training improves cardiorespiratory fitness and ambulation performance in individuals with stroke.
Aerobic exercise has substantial implications for future plan of rehabilitation. Only eight RCTs were found,
no subgroup analyses were performed for patients in acute, subacute, or chronic stage. Further trials are
needed to investigate the effects in different stages or dose response relationship.