中风后早期进行心血管运动的效果：系统评价和荟萃分析。
Effects of cardiovascular exercise early after stroke: systematic review and meta-analysis.
机构信息
Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland.
出版信息
BMC Neurol. 2012 Jun 22;12:45. doi: 10.1186/1471-2377-12-45.
BACKGROUND
Previous studies have shown the beneficial effects of aerobic exercise in chronic stroke. Most motor and functional recovery occurs in the first months after stroke. Improving cardiovascular capacity may have potential to precipitate recovery during early stroke rehabilitation. Currently, little is known about the effects of early cardiovascular exercise in stroke survivors. The aim of this systematic review was to evaluate the effectiveness of cardiovascular exercise early after stroke.
METHODS
A systematic literature search was performed. For this review, randomized and non-randomized prospective controlled cohort studies using a cardiovascular, cardiopulmonary or aerobic training intervention starting within 6 months post stroke were considered. The PEDro scale was used to detect risk of bias in individual studies. Inter-rater agreement was calculated (kappa). Meta-analysis was performed using a random-effects model.
RESULTS
A total of 11 trials were identified for inclusion. Inter-rater agreement was considered to be "very good" (Kappa: 0.81, Standard Error: 0.06, CI95%: 0.70-0.92), and the methodological quality was "good" (7 studies) to "fair" (4 studies). Peak oxygen uptake data were available for 155 participants. Pooled analysis yielded homogenous effects favouring the intervention group (standardised mean difference (SMD) = 0.83, CI95% = 0.50-1.16, Z = 4.93, P < 0.01). Walking endurance assessed with the 6 Minute Walk Test comprised 278 participants. Pooled analysis revealed homogenous effects favouring the cardiovascular training intervention group (SMD = 0.69, CI95% = 0.45-0.94, Z = 5.58, P < 0.01). Gait speed, measured in 243 participants, did not show significant results (SMD = 0.51, CI95% = -0.25-1.26, Z = 1.31, P = 0.19) in favour of early cardiovascular exercise.
CONCLUSION
This meta-analysis shows that stroke survivors may benefit from cardiovascular exercise during sub-acute stages to improve peak oxygen uptake and walking distance. Thus, cardiovascular exercise should be considered in sub-acute stroke rehabilitation. However, concepts to influence and evaluate aerobic capacity in severely affected individuals with sub-acute stroke, as well as in the very early period after stroke, are lacking.Further research is needed to develop appropriate methods for cardiovascular rehabilitation early after stroke and to evaluate long-term effects of cardiovascular exercise on aerobic capacity, physical functioning, and quality-of-life.
背景
先前的研究表明，有氧运动对慢性中风患者有益。大多数运动和功能恢复发生在中风后第一个月。提高心血管能力可能有助于促进中风康复早期的恢复。目前，对于中风幸存者早期心血管运动的效果知之甚少。本系统综述的目的是评估中风后早期进行心血管运动的效果。
方法
进行了系统的文献检索。对于本综述，考虑了使用心血管、心肺或有氧训练干预措施，起始时间为中风后 6 个月内的随机和非随机前瞻性对照队列研究。使用 PEDro 量表来检测个体研究中的偏倚风险。计算了观察者间一致性（kappa）。使用随机效应模型进行荟萃分析。
结果
共确定了 11 项试验纳入本研究。观察者间一致性被认为是“非常好”（kappa：0.81，标准误差：0.06，CI95%：0.70-0.92），方法学质量为“良好”（7 项研究）至“中等”（4 项研究）。有 155 名参与者的峰值摄氧量数据可用。汇总分析得出了有利于干预组的同质效应（标准化均数差（SMD）=0.83，CI95%=0.50-1.16，Z=4.93，P<0.01）。278 名参与者进行了 6 分钟步行测试来评估步行耐力。汇总分析显示，心血管训练干预组有有利于的同质效应（SMD=0.69，CI95%=0.45-0.94，Z=5.58，P<0.01）。在 243 名参与者中测量的步速没有显示出显著的结果（SMD=0.51，CI95%=0.25-1.26，Z=1.31，P=0.19），这有利于早期心血管运动。
结论
本荟萃分析表明，中风幸存者可能会受益于亚急性期的心血管运动，以提高峰值摄氧量和步行距离。因此，在亚急性中风康复中应考虑心血管运动。然而，目前缺乏影响和评估亚急性期严重中风患者以及中风后早期有氧运动能力的概念。需要进一步研究，以开发中风后早期心血管康复的适当方法，并评估心血管运动对有氧运动能力、身体功能和生活质量的长期影响。
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