Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil.
École de réadaptation, Université de Montréal (UdeM), Montréal, Canada.
Disabil Rehabil. 2020 Apr;42(7):902-917. doi: 10.1080/09638288.2018.1511755. Epub 2018 Nov 19.
To identify interventions employed to increase post-stroke physical activity, evaluate their efficacy, and identify the gaps in literature. Randomized controlled trials published until March 2018 were searched in MEDLINE, PEDro, EMBASE, LILACS, and SCIELO databases. The quality of each study and overall quality of evidence were assessed using the PEDro and the GRADE scales. Eighteen studies were included (good PEDro and very low GRADE-scores). In seven, the experimental groups showed significant increases in physical activity (aerobics, resistance, and home-based training; counseling, aerobics, resistance, and home-based training; electrical stimulation during walking; functional-task training; robot-assisted arm therapy; accelerometer-based feedback, and physical activity encouragement). In seven, there were no significant between-group differences (physical activity plan; stretching, use of toe-spreaders, standard treatment; counseling; circuit video-game; functional-task; counseling and cognitive training). The combined experimental and control groups showed significant declines in physical activity in one study (aerobic training or stretching) and increases in three others (aerobic, resistance or sham resistance training; stroke-with advice or only stroke-counseling; aerobic training, educational sessions, standard treatment, and coaching, or mobilization and standard treatment). A meta-analysis could not be performed, due to heterogeneity. Some interventions improved physical activity after stroke. However, the interpretability is limited.Implications for rehabilitationIndividuals with stroke show low physical activity, which may compromise function and health.The use of interventions aimed at improving and maintaining physical activity of individuals with stroke are recommended.Some interventions, such as aerobic, resistance, and combined home-based training, electrical stimulation during walking, functional task training, and arm robot-assisted therapy, could improve the physical activity after stroke.
为了确定增加卒中后体力活动的干预措施，评估其疗效，并确定文献中的差距。在 MEDLINE、PEDro、EMBASE、LILACS 和 SCIELO 数据库中搜索了截至 2018 年 3 月发表的随机对照试验。使用 PEDro 和 GRADE 量表评估每项研究的质量和总体证据质量。纳入了 18 项研究（PEDro 评分良好，GRADE 评分极低）。在其中 7 项研究中，实验组的体力活动明显增加（有氧运动、抗阻运动和家庭训练；咨询、有氧运动、抗阻运动和家庭训练；步行时电刺激；功能任务训练；机器人辅助手臂治疗；基于加速度计的反馈和体力活动鼓励）。在其中 7 项研究中，实验组和对照组之间没有显著差异（体力活动计划；伸展运动、使用脚趾伸展器、标准治疗；咨询；电路视频游戏；功能任务；咨询和认知训练）。在一项研究中（有氧运动或伸展运动），实验组和对照组的体力活动都显著下降，而在另外三项研究中（有氧运动、抗阻或假抗阻训练；带建议或仅卒中咨询的卒中；有氧运动、教育课程、标准治疗和辅导，或动员和标准治疗），体力活动都有所增加。由于异质性，无法进行荟萃分析。一些干预措施改善了卒中后的体力活动。然而，解释性有限。
康复的意义
卒中患者的体力活动水平较低，这可能会影响其功能和健康。
建议使用旨在提高和维持卒中患者体力活动的干预措施。
一些干预措施，如有氧运动、抗阻运动和联合家庭训练、步行时电刺激、功能任务训练和手臂机器人辅助治疗，可能会改善卒中后的体力活动。
