Saunders D H, Greig C A, Young A, Mead G E
Department of Physical Education Sport and Leisure Studies, University of Edinburgh, St Leonards Land, Holyrood Road, Edinburgh, Midlothian, UK, EH8 2AZ.
Cochrane Database Syst Rev. 2004(1):CD003316. doi: 10.1002/14651858.CD003316.pub2.
Stroke patients have impaired physical fitness and this may exacerbate their disability. It is not known whether improving physical fitness after stroke reduces disability.
The primary aims of the review were to establish whether physical fitness training reduces death, dependence and disability after stroke. The secondary aims of the review included an investigation of the effects of fitness training on secondary outcome measures (including, physical fitness, mobility, physical function, health and quality of life, mood and the incidence of adverse events).
We searched the Cochrane Stroke Group Trials Register (June 2003). In addition, the following electronic databases were searched: Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2002 Issue 4), MEDLINE (1966 to December 2002), EMBASE (1980 to December 2002), CINAHL (1982 to December 2002), SPORTDiscus (1949 to December 2002), Science Citation Index Expanded (1981 to December 2002), Web of Science Proceedings (1982 to December 2002), Physiotherapy Evidence Database (December 2002), REHABDATA (1956 to December 2002) and Index to UK Theses (1970 to December 2002). We hand searched relevant journals and conference proceedings and screened reference lists. To identify unpublished and ongoing trials we searched trials directories and contacted experts in the field.
Randomised controlled trials were included when an intervention represented a clear attempt to improve either muscle strength and/or cardiorespiratory fitness, and whose control groups comprised either usual care or a non-exercise intervention.
Data from eligible studies were independently extracted by two reviewers. The primary outcome measures were death, disability and dependence. The lack of common outcome measures prevented some of the intended analysis.
A total of twelve trials were included in the review. No trials reported death and dependence data. Two small trials reporting disability showed no evidence of benefit. The remaining available secondary outcome data suggest that cardiorespiratory training improves walking ability (mobility). Observed benefits appear to be associated with specific or 'task-related' training.
REVIEWER'S CONCLUSIONS: There are few data available to guide clinical practice at present with regard to fitness training interventions after stroke. More general research is needed to explore the efficacy and feasibility of training, particularly soon after stroke. In addition more specific studies are required to explore the effect of content and type of training. Further research will require careful planning to address a number of issues peculiar to this type of intervention.
中风患者的身体素质受损，这可能会加重他们的残疾程度。目前尚不清楚中风后改善身体素质是否能减轻残疾。
本综述的主要目的是确定体能训练是否能降低中风后的死亡率、依赖性和残疾程度。综述的次要目的包括调查体能训练对次要结局指标（包括身体素质、活动能力、身体功能、健康和生活质量、情绪以及不良事件发生率）的影响。
我们检索了Cochrane中风小组试验注册库（2003年6月）。此外，还检索了以下电子数据库：Cochrane对照试验中心注册库（CENTRAL）（《Cochrane图书馆》，2002年第4期）、MEDLINE（1966年至2002年12月）、EMBASE（1980年至2002年12月）、CINAHL（1982年至2002年12月）、SPORTDiscus（1949年至2002年12月）、科学引文索引扩展版（1981年至2002年12月）、科学网会议录（1982年至2002年12月）、物理治疗证据数据库（2002年12月）、康复数据库（1956年至2002年12月）以及英国论文索引（1970年至2002年12月）。我们手工检索了相关期刊和会议论文集，并筛选了参考文献列表。为了识别未发表和正在进行的试验，我们检索了试验目录并联系了该领域的专家。
当一项干预措施明显旨在提高肌肉力量和/或心肺适能，且其对照组包括常规护理或非运动干预时，纳入随机对照试验。
两名评审员独立提取符合条件的研究的数据。主要结局指标是死亡、残疾和依赖性。缺乏共同的结局指标妨碍了一些预期的分析。
本综述共纳入12项试验。没有试验报告死亡和依赖性数据。两项报告残疾情况的小型试验未显示出有益效果的证据。其余可用的次要结局数据表明，心肺训练可提高步行能力（活动能力）。观察到的益处似乎与特定的或“与任务相关的”训练有关。
目前几乎没有数据可指导中风后体能训练干预的临床实践。需要进行更广泛的研究来探索训练的有效性和可行性，尤其是在中风后不久。此外，还需要更具体的研究来探索训练内容和类型的效果。进一步的研究需要精心规划，以解决这类干预措施特有的一些问题。
