The type and dosage of exercise therapy to facilitate the recovery from stroke for balance, walking and quality of life: a systematic review and meta-analysis of randomized controlled trials

Abstract

Abstract Background Exercise therapy (aerobic or resistance therapy) could have a beneficial effect on balance, walking and quality of life (QoL). Objective This systematic review and meta-analysis aimed to quantify the effects of different modes, dosages and setting of exercise therapy on balance, walking capacity and QoL in stroke survivors. Methods We searched PubMed, CINHAL and Hinari to identify randomized controlled trials (RCT) that investigated the effects of aerobic (AT) and/or resistance therapy (RT) on balance, walking and QoL in stroke survivors. The treatment effect was computed by the standard mean differences (SMDs). Results We included 27 RCT comprising 1,549 chronic stroke survivors. Any modality was effective to improve balance. There was high-level evidence that AT interventions were most effective in improving walking capacity (SMD=0.36 [0.06, 0.66], p=0.02). Both AT, and AT combined with RT were effective to improve QoL (SMD=0.39 [0.09, 0.69], p=0.01). RT programs were not effective to improve walking and QoL. For walking capacity, a lower volume weekly (<60 minutes/session or <3 session/week) and higher intensity (>60% heart rate reserve; rate of perceived exertion (6–20) >14) of AT and RT exercises demonstrated significant higher effect. Hospital located rehabilitation settings trended to improve walking (SMD=0.23 [0.00, 0.45], p=0.05), when compared to home/community and laboratory settings. Conclusions In chronic stroke, in particular AT executed in hospital located settings, with a lower volume and high intensity seems more effective strategy to facilitate walking capacity and improve QoL and should thus be incorporated into rehabilitation programs for stroke. Funding Acknowledgement Type of funding sources: None.