Maintenance of Cardiorespiratory Fitness in People With Stroke: A Systematic Review and Meta-analysis

Abstract

Objective: To determine if improvements in cardiorespiratory fitness are maintained in the short-, medium- and long-term after a cardiorespiratory fitness intervention in people with stroke.

Data sources: MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, (CENTRAL) Cochrane, Web of Science, Sports Discus, and Physiotherapy Evidence Database were searched from inception.

Study selection: Randomized controlled trials and cohort studies including (1) people with stroke; (2) cardiorespiratory fitness interventions; (3) a direct measure of cardiorespiratory fitness; and (4) short- (0 to <3 months), medium- (3-6 months), or long-term (>6 months) follow-up data.

Data extraction: Two reviewers independently screened full texts and extracted data, including study methods, participant demographic information, stroke type and severity, outcome measures, intervention information, follow-up time points, and results, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A lower limit of -1.0 mL•kg^-1•min^-1 was used to determine maintenance (ie, no change) of cardiorespiratory fitness.

Data synthesis: Fourteen studies (N=324 participants) were included. Participants completed cardiorespiratory fitness training 2-5 days per week over 4-13 weeks at moderate to high intensity (40%-70% heart rate reserve [HRR]; n=4 studies), high intensity (60% to <90% HRR; n=7 studies), and intervals of high intensity (85%-95% peak heart rate or maximal heart rate; n=3 studies). Most people with stroke did maintain cardiorespiratory fitness in the short- (-0.19 mL•kg^-1•min^-1 [95% CI, -1.66 to 1.28]), medium- (-0.61 mL•kg^-1•min^-1 [95% CI, -3.95 to 2.74]), and long-term (0.00 mL•kg^-1•min^-1 [95% CI, -2.23 to 2.23]) after completion of cardiorespiratory fitness interventions.

Conclusions: People with stroke maintain cardiorespiratory fitness after a cardiorespiratory fitness intervention in the short-, medium-, and longer-term. However, little is known about the impact of participant and intervention characteristics on the long-term maintenance of cardiorespiratory fitness.

Keywords: Cardiorespiratory fitness; Cerebrovascular disorders; Follow-up studies; Rehabilitation; Stroke; Systematic review.