Effects of Augmented Exercise Therapy on Outcome of Gait and Gait-Related Activities in the First 6 Months After Stroke

Abstract

Background and Purpose-The purpose of this study was to determine the effects of augmented exercise therapy on gait, gait-related activities, and (basic and extended) activities of daily living within the first 6 months poststroke. Methods-A systematic literature search in electronic databases from 1990 until October 2010 was performed. Randomized controlled trials were included in which the experimental group spent augmented time in lower-limb exercise therapy compared with the control group. Outcomes were gait, gait-related activities, and (extended) activities of daily living.Results from individual studies were pooled by calculating the summary effect sizes. Subgroup analyses were applied for a treatment contrast of Ն16 hours, timing poststroke, type of control intervention, and methodological quality. Results-Fourteen (Nϭ725) of 4966 identified studies were included. Pooling resulted in small to moderate significant summary effect sizes in favor of augmented exercise therapy for walking ability, comfortable and maximum walking speed, and extended activities of daily living. No significant effects were found for basic activities of daily living. Subgroup analysis did not show a significant effect modification. Conclusions-Dose-response trials in stroke rehabilitation are heterogeneous. The present meta-analysis suggests that increased time spent on exercise of gait and gait-related activities in the first 6 months poststroke results in significant small to moderate effects in terms of walking ability, walking speed, and extended activities of daily living. High-quality dose-response exercise therapy trials are needed with identical treatment goals but incremental levels of intensity. (Stroke. 2011;42:3311-3315.)Key Words: dose-response Ⅲ exercise therapy Ⅲ intensity Ⅲ meta-analysis Ⅲ stroke S troke rehabilitation is characterized by early initiated, intensive, and ongoing training, in which task and context specificity play an important role. 1,2 There is indirect evidence that complex rehabilitation interventions may prevent inactivity-related complications and enhance functional recovery after stroke. [3][4][5][6][7] However, the underlying mechanisms that drive these benefits are still poorly understood. 5 To optimize rehabilitation services for patients with stroke, a better understanding of the dose-response relationship between exercise therapy and functional outcome is needed. 1,2 A number of systematic reviews have demonstrated that augmented task-specific training defined as either additional time spent in exercise therapy 1,8 or increased number of repetitions 8,9 enhance outcome of gait-related activities, activities of daily living (ADL), and health-related quality of life. 10 French and colleagues' review showed that repetitive task-oriented training resulted in modest improvements of lower-limb function but not of upper-limb function. 9 Another meta-analysis suggested that augmented practice of at least 16 hours in the first 6 months poststroke was needed to gain a mean improvement in ADL o...

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