Application of principles of exercise training in sub-acute and chronic stroke survivors: a systematic review

Abstract

BackgroundThere is increasing evidence for the beneficial effects of exercise training in stroke survivors. In order to reach the desired training effects, exercise training principles must be considered as this ensures the prescription of adequate exercises at an adequate dose. Moreover, exercise training interventions must be designed in a way that maximizes patients’ adherence to the prescribed exercise regimen. The objectives of this systematic review were (1) to investigate whether training principles for physical exercise interventions are reported in RCTs for sub-acute and chronic stroke survivors, (2) to evaluate whether the RCTs reported the prescription of the FITT components of the exercise interventions as well as (3) patients’ adherence to this prescription, and (4) to assess the risk of bias of the included studies.MethodsWe performed a systematic review of RCTs with exercise training as the primary intervention and muscular strength and/or endurance as primary outcomes. The Cochrane library’s risk of bias (ROB) tool was used to judge the methodological quality of RCTs.ResultsThirty-seven RCTs were included in this systematic review. Eighteen studies (48.7%) focused on aerobic, 8 (21.6%) on resistance and 11 (29.7%) on combined interventions of aerobic and resistive strength exercise. Twenty-nine studies (78.4%) included only chronic stroke survivors, 5 studies (13.5%) only sub-acute stroke survivors whilst 3 studies (8.1%) included both. In terms of principle of exercise training, 89% reported specificity, 75.7% progression, 48.7% overload, 37.8% initial values, 32.4% reversibility and 13.5% diminishing returns. One RCT described all principles of physical exercise training and 19 (51.4%) all FITT components. Patients’ adherence to exercise prescription was accounted for in 3 studies (8.1%). Failure to report blinding in patients and participants and failure to report allocation concealment were the most prevalent methodological shortcomings.ConclusionsIncomplete and inconsistent reporting of (1) training components, (2) underlying exercise training principles and (3) patient adherence together with (4) a broad variation in the methodological quality of the included RCTs limit both the utility and reproducibility of physical exercise programs in stroke patients.

The Completeness Of Intervention Descriptions In Randomised Trials Of Supervised Exercise Training In Peripheral Arterial Disease

“…Poor reporting of adherence to exercise interventions is also a common problem in other areas of exercise medicine. For example, in a review of exercise interventions for stroke survivors, a target for the frequency, intensity, time and type of exercise was described for 95%, 60%, 92% and 95% of interventions, respectively, whereas adherence to these components was reported in only 57%, 14%, 19% and 24% of them [32]. Similar findings have been reported in the cancer literature [33,34].…”

“…The intensity of exercise was the most frequently missing component (24%), and this was also the case for the three other reviews: stroke, 40% [32]; breast cancer, 21% [33]; other cancer, 30% [34]. Sufficient detail regarding the mode of exercise was also missing for 17% of the PAD interventions, which is exactly the same proportion as for the breast cancer review [33], but worse than that reported in the stroke and other-cancer reviews (5% and 6%, respectively) [32,34]. Mode and intensity of exercise are key determinants of training response, and a clear understanding of these components (and others) is critical for interpreting study findings, the investigation of dose-response effects, and the replication of protocols in future studies and clinical practice.…”

“…Three previous reviews, one in the area of stroke rehabilitation [32], and two in cancer survivorship [33,34], have evaluated the reporting of exercise programmes according to the FITT principle, which is a well-established core methodology in exercise prescription that stands for the Frequency, Intensity, Time and Type of exercise. Using the TIDieR checklist, the type of exercise is captured in Item 4 (Procedures), whereas frequency, intensity and time are captured in our adapted version of Item 8 (When and How Much).…”

Neurofeedback as a Form of Cognitive Rehabilitation Therapy Following Stroke: A Systematic Review

“…One source identified the sub-acute phase ranging from 1 week to 3 months post-stroke, defining chronic as greater than 3 months [48]. Other sources defined the acute phase from time of stroke until 14 days, sub-acute from 15 days to 6 months, and chronic as greater than 6 months [49][50][51]. Based on this consensus, sub-acute and chronic recovery were defined using this precedence.…”

Effects of laryngeal restriction on pharyngeal peristalsis and biomechanics: Clinical implications

“…There are six principles commonly followed in exercise training to ascertain function improvement. These include specificity, overload, progression, initial values, reversibility, and diminishing returns (1). In this study we addressed two of the six exercise training principles, namely specificity and overload.…”