Abstract
It has been shown that the autonomic nervous system can be modulated by physical exercise after stroke, but there is a lack of evidence showing rehabilitation can be effective in increasing heart rate variability (HRV). To investigate the effectiveness and safety of rehabilitation programs in modulating HRV after stroke. The search strategy was based in the PICOT (patients: stroke; interventions: rehabilitation; comparisons: any control group; outcomes: HRV; time: acute, subacute and chronic phases of stroke). We searched MEDLINE, CENTRAL, CINAHL, LILACS, and SCIELO databases without language restrictions, and included randomized controlled trials (RCTs), quasi-randomized controlled trials (quasi-RCTs), and non-randomized controlled trials (non-RCTs). Two authors independently assessed the risk of bias and we used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to rate the certainty of the evidence for each included study. Four studies (two RCTs with low certainty of the evidence and two non-RCTs with very low certainty of the evidence) were included. Three of them showed significant cardiac autonomic modulation during and after stroke rehabilitation: LF/HF ratio (low frequency/high frequency) is higher during early mobilization; better cardiac autonomic balance was observed after body-mind interaction in stroke patients; and resting SDNN (standard deviation of normal R-R intervals) was significantly lower among stroke patients indicating less adaptive cardiac autonomic control during different activities. There are no definitive conclusions about the main cardiac autonomic repercussions observed in post-stroke patients undergoing rehabilitation, although all interventions are safe for patients after stroke.
Highlights
Stroke is one of the main causes of morbidity and mortality in industrialized countries and the leading cause of chronic disability in adults[1,2,3]
heart rate variability (HRV) is defined as the changes in heart rate (HR) that occur after a stimulus, and it is a predictor of processes related to the autonomic nervous system
ND: neurological deterioration classified by the National Institutes of Health Stroke Scale (NIHSS); LF: low frequency; HF: high frequency; LF/HF: low to high frequency ratio; SDNN: standard deviation of normal R–R intervals; HRV: heart rate variability
Summary
Stroke is one of the main causes of morbidity and mortality in industrialized countries and the leading cause of chronic disability in adults[1,2,3]. HRV is the result of adaptive changes in heart rate caused by sympathetic and parasympathetic activity in response to external or internal stimuli[7]. Based on this concept, HRV is defined as the changes in heart rate (HR) that occur after a stimulus, and it is a predictor of processes related to the autonomic nervous system. It has been shown that the autonomic nervous system can be modulated by physical exercise after stroke, but there is a lack of evidence showing rehabilitation can be effective in increasing heart rate variability (HRV). Conclusions: There are no definitive conclusions about the main cardiac autonomic repercussions observed in post-stroke patients undergoing rehabilitation, all interventions are safe for patients after stroke
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