Effects of exercise on cardiovascular risk factors following stroke or transient ischemic attack: a systematic review and meta-analysis

D'Isabella, Natalie; Shkredova, Daria A.; Richardson, Julie; Tang, Ada

doi:10.1177/0269215517709051

Cited by 78 publications

(68 citation statements)

References 64 publications

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“…In contrast to other studies which reported an increase in HDL cholesterol with lifestyle modification in diabetic [47] or stroke [48] populations, our review did not find any effect on HDL cholesterol. Other studies have reported that HDL cholesterol is correlated with physical fitness [49].…”

Section: Discussioncontrasting

confidence: 99%

Supervised lifestyle intervention for people with metabolic syndrome improves outcomes and reduces individual risk factors of metabolic syndrome: A systematic review and meta-analysis

2019

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Background: Metabolic syndrome is characterised by a clustering of metabolic risk factors including abdominal obesity, raised triglycerides, lowered HDL cholesterol, hypertension and impaired glucose tolerance. Multifaceted lifestyle interventions including diet and exercise are recommended as the first-line treatment for the metabolic syndrome. Objective: To investigate the effects of lifestyle interventions that include both diet interventions and supervised exercise on outcomes for people with metabolic syndrome. Methods: A systematic review and meta-regression was conducted. PubMed, EMBASE, MEDLINE and CINAHL were searched from the earliest date possible until November 2018 to identify randomised controlled trials examining the effects of lifestyle interventions compared to usual care on patient health outcomes and components of metabolic syndrome. Post-intervention means and standard deviations were pooled using inverse variance methods and random-effects models to calculate mean differences (MD), standardised mean differences (SMD) and 95% confidence intervals (CI). Results: Searching identified 2598 articles, of which 15 articles reporting data from 10 trials, with 1160 participants were included in this review. Compared to usual care, supervised lifestyle intervention demonstrated significant improvements in all but one of the components of metabolic syndrome. Reductions were seen in waist circumference (−4.9 cm, 95%CI −8.0 to −1.7), systolic blood pressure (−6.5 mmHg, 95%CI −10.7 to −2.3), diastolic blood pressure (−1.9 mmHg, 95%CI −3.6 to −0.2), triglycerides (SMD −0.46, 95%CI −0.88 to −0.04) and fasting glucose (SMD-0.68, 95%CI −1.20 to −0.15). Prevalence of metabolic syndrome was reduced by 39% in intervention group participants compared to control group participants (Risk Ratio 0.61, 95%CI 0.38 to 0.96). Improvements in quality of life were not statistically significant. Conclusion: There is low to moderate quality evidence that supervised multifaceted lifestyle intervention improves multiple risk factors of metabolic syndrome, as well as reducing prevalence of the disease. Health services should consider implementing lifestyle intervention programs for people with metabolic syndrome to improve health outcomes and prevent progression to chronic disease.

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Section: Discussioncontrasting

confidence: 99%

Supervised lifestyle intervention for people with metabolic syndrome improves outcomes and reduces individual risk factors of metabolic syndrome: A systematic review and meta-analysis

2019

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“…Multiple clinical stroke practice guidelines recommend an early initiation of individually tailored CRF training . CRF training can improve fitness, mobility, balance, and cognitive function and moderates cardiovascular risk profile . It has beneficial effects on metabolic adaptations both in subacute (>3 months) and chronic (>6 months) stroke populations.…”

Section: Introductionmentioning

confidence: 99%

Safety of Performing a Graded Exercise Test Early after Stroke and Transient Ischemic Attack

Johnson

Kramer

Catanzariti

et al. 2019

PM&R

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Background: Low cardiorespiratory fitness (CRF) is a predictor of stroke risk and poor outcome poststroke. Fitness levels are rarely assessed in the acute phase and it is unclear if it is safe for stroke survivors and people with transient ischemic attack (TIA) to perform a graded exercise test to assess fitness. Objective: To determine if people within 14 days post stroke can safely perform a graded exercise test. Design: Observational study. Setting: Research institute. Participants: People with stroke or TIA admitted to an acute stroke unit. Intervention: Not applicable. Main Outcome Measures: Safety of performing a graded exercise test early post stroke. Safety outcomes were (1) occurrence of an adverse event or (2) <85% blood oxygen saturation (SpO 2 ). Participants performed a graded exercise test on a recumbent stepper at a research institute <2 weeks postevent. CRF was determined by measuring peak volume of oxygen uptake (VO 2peak ) using a metabolic cart. Results: Twenty-nine participants were enrolled in the study (median age 69 years; interquartile range 58-75). Sixteen were diagnosed with TIA and 13 with a mild stroke. Twenty-eight participants completed the test; one participant was unable to perform the test due to back pain. The test was terminated due to standardized stopping criteria in 26 cases (5 = volitional fatigue, 6 = unable to keep required cadence, 15 = reaching 85% HR max ), one due to safety (ie, SpO 2 < 85%), and one was inadvertently terminated before stopping criteria were reached. Average CRF determined by the exercise test was low; mean VO 2peak of 16.2 AE 4.5 mL/kg/min for men (n = 20) and 12.4 AE 3.6 mL/kg/min for women (n = 8). Conclusions: Determining exercise capacity early post stroke and TIA using a graded exercise test appears to be safe in patients with mild deficits. This information should be useful to plan tailored exercise programs. Further research should focus on determining safety of exercise testing in more severely affected stroke survivors.

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“…Tang et al conducted a systematic review and meta-analysis on RCTs (18 trials with 930 subjects overall) evaluating the efficacy of exercise training in subjects at any time post-TIA or stroke, and demonstrated significant improvements of blood pressure, fasting blood glucose, fasting insulin and HDL-C; however, changes in exercise capacity were not reported 19. In another recent meta-analysis comprising 22 RCTs evaluating lifestyle interventions in over 2500 patients post-TIA, no significant effect was found on cardiovascular morbidity or mortality or lipids profile; however, from subgroup analyses focused on trials with exercise training that lasted longer than 4 months, interventions that used at least three behaviour change techniques (BCTs) showed significant reductions in systolic blood pressure 20.…”

Section: Secondary Prevention: Evidence Of Exercise Benefits In Patiementioning

confidence: 99%

Exercise for stroke prevention

Prior

Suskin

2018

Stroke Vasc Neurol

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We review evidence concerning exercise for stroke prevention. Plausible biological reasons suggest that exercise would be important in preventing stroke. While definitive randomised controlled trials evaluating the impact of physical activity (PA) and exercise on preventing stroke and mortality are lacking, observational studies, small randomised controlled trials and meta-analyses have provided evidence that PA and exercise favourably modify stroke risk factors, including hypertension, dyslipidaemia, diabetes, sedentary lifestyle, obesity, excessive alcohol consumption and tobacco use. It is, therefore, important to understand the factors associated with poststroke PA/exercise and cardiorespiratory fitness. Positively associated factors include self-efficacy, social support and quality of patients’ relationships with health professionals. Negatively associated factors include logistical barriers, medical comorbidities, stroke-related deficits, negative exercise beliefs, fear of falling, poststroke fatigue, arthropathy/pain and depression. Definitive research is needed to specify efficacious behavioural approaches to increase poststroke exercise. Effective techniques probably include physician endorsement of exercise programmesto patients, enhancement of patient–professional relationships, providing patients an exercise rationale, motivational interviewing, collaborative goal-setting with patients, addressing logistical concerns, social support in programsmes, structured exercise programming, individualised behavioural instruction, behavioural diary recording, reviewing behavioural consequences of exercise efforts, reinforcing successful exercise performance. Exercise programming without counselling may increase short-term activity; simple advice or information-giving is probably ineffective. Older patients or those with cognitive impairment may need increased structure, with emphasis on behaviour per se, versus self-regulation skills. We support the latest American Heart Association/American Stroke Association guidelines (2014) recommending PA and exercise for stroke prevention, and referral to behaviourally oriented programmes to improve PA and exercise.

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Effects of exercise on cardiovascular risk factors following stroke or transient ischemic attack: a systematic review and meta-analysis

Cited by 78 publications

References 64 publications

Supervised lifestyle intervention for people with metabolic syndrome improves outcomes and reduces individual risk factors of metabolic syndrome: A systematic review and meta-analysis

Supervised lifestyle intervention for people with metabolic syndrome improves outcomes and reduces individual risk factors of metabolic syndrome: A systematic review and meta-analysis

Safety of Performing a Graded Exercise Test Early after Stroke and Transient Ischemic Attack

Exercise for stroke prevention

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