School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
Geriatric Medicine, Division of Health Sciences, Centre for Clinical Brain Sciences, The University of Edinburgh, and the Royal Infirmary, Edinburgh, UK.
Brain Behav. 2018 Jul;8(7):e01000. doi: 10.1002/brb3.1000. Epub 2018 Jun 19.
Physical fitness training after stroke is recommended in guidelines across the world, but evidence pertains mainly to ambulatory stroke survivors. Nonambulatory stroke survivors (FAC score ≤2) are at increased risk of recurrent stroke due to limited physical activity. This systematic review aimed to synthesize evidence regarding case fatality, effects, experiences, and feasibility of fitness training for nonambulatory stroke survivors.
Eight major databases were searched for any type of study design. Two independent reviewers selected studies, extracted data, and assessed study quality, using published tools. Random-effects meta-analysis was used. Following their separate analysis, qualitative and quantitative data were synthesized using a published framework.
Of 13,614 records, 33 studies involving 910 nonambulatory participants met inclusion criteria. Most studies were of moderate quality. Interventions comprised assisted walking (25 studies), cycle ergometer training (5 studies), and other training (3 studies), mainly in acute settings. Case fatality did not differ between intervention (1.75%) and control (0.88%) groups (95% CI 0.13-3.78, p = 0.67). Compared with control interventions, assisted walking significantly improved: fat mass, peak heart rate, peak oxygen uptake and walking endurance, maximum walking speed, and mobility at intervention end, and walking endurance, balance, mobility, and independent walking at follow-up. Cycle ergometry significantly improved peak heart rate, work load, peak ventilation, peak carbon dioxide production, HDL cholesterol, fasting insulin and fasting glucose, and independence at intervention end. Effectiveness of other training could not be established. There were insufficient qualitative data to draw conclusions about participants' experiences, but those reported were positive. There were few intervention-related adverse events, and dropout rate ranged from 12 to 20%.
Findings suggest safety, effectiveness, and feasibility of adapted fitness training for screened nonambulatory stroke survivors. Further research needs to investigate the clinical and cost-effectiveness as well as experiences of fitness training-especially for chronic stroke survivors in community settings.
世界范围内的指南都推荐脑卒中后进行体能训练，但现有证据主要涉及能行走的脑卒中幸存者。由于身体活动受限，无法行走的脑卒中幸存者（FAC 评分≤2）再次发生中风的风险增加。本系统综述旨在综合评估体能训练对无法行走的脑卒中幸存者的病死率、效果、体验和可行性的证据。
在 8 个主要数据库中搜索任何类型的研究设计。两名独立的审查员使用已发表的工具选择研究、提取数据和评估研究质量。使用随机效应荟萃分析。在分别进行分析后，使用已发表的框架对定性和定量数据进行综合。
在 13614 条记录中，有 33 项研究涉及 910 名无法行走的参与者，符合纳入标准。大多数研究的质量为中等。干预措施包括辅助行走（25 项研究）、脚踏车测力计训练（5 项研究）和其他训练（3 项研究），主要在急性期进行。干预组（1.75%）和对照组（0.88%）的病死率无差异（95%CI 0.13-3.78，p=0.67）。与对照组干预相比，辅助行走在干预结束时显著改善了体脂量、最大心率、最大摄氧量和步行耐力、最大步行速度和移动能力，在随访时改善了步行耐力、平衡、移动能力和独立行走。脚踏车测力计训练在干预结束时显著改善了最大心率、工作量、最大通气量、最大二氧化碳产量、高密度脂蛋白胆固醇、空腹胰岛素和空腹血糖以及独立性。其他训练的有效性无法确定。由于定性数据不足，无法得出关于参与者体验的结论，但报告的结果是积极的。干预相关不良事件很少，退出率为 12%至 20%。
研究结果表明，经过筛选的无法行走的脑卒中幸存者进行适应性体能训练是安全、有效且可行的。需要进一步研究来评估体能训练的临床和成本效益，以及特别是在社区环境中对慢性脑卒中幸存者的体能训练体验。
