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.