Exercise dosage to facilitate the recovery of balance, walking, and quality of life after stroke

Abstract

Background: Although aerobic training (AT) and resistance training (RT) are recommended after stroke, the optimal dosage of these interventions and their effectiveness on balance, walking capacity, and quality of life (QoL) remain conflicting.Objective: Our study aimed to quantify the effects of different modes, dosages and settings of exercise therapy on balance, walking capacity, and QoL in stroke survivors.Methods: PubMed, CINHAL, and Hinari databases were searched for randomised controlled trials (RCTs) evaluating the effects of AT and RT on balance, walking, and QoL in stroke survivors. The treatment effect was computed by the standard mean differences (SMDs).Results: Twenty-eight trials (n = 1571 participants) were included. Aerobic training and RT interventions were ineffective on balance. Aerobic training interventions were the most effective in improving walking capacity (SMD = 0.37 [0.02, 0.71], p = 0.04). For walking, capacity, a higher dosage (duration ≥ 120 min/week; intensity ≥ 60% heart rate reserve) of AT interventions demonstrated a significantly greater effect (SMD = 0.58 [0.12, 1.04], p = 0.01). Combined AT and RT improved QoL (SMD = 0.56 [0.12, 0.98], p = 0.01). Hospital located rehabilitation setting was effective for improving walking capacity (SMD = 0.57 [0.06, 1.09], p = 0.03) compared with home and/or community and laboratory settings.Conclusions: Our findings showed that neither AT nor RT have a significant effect on balance. However, AT executed in hospital-located settings with a higher dose is a more effective strategy to facilitate walking capacity in chronic stroke. In contrast, combined AT and RT is beneficial for improving QoL.Clinical implications: A high dosage of aerobic exercise, duration ≥ 120 min/week; intensity ≥ 60% heart rate reserve is beneficial for improving walking capacity.

Bilateral versus unilateral upper limb training in (sub)acute stroke: A systematic and meta-analysis

“…The dose of the training is important to reach functional recovery after stroke (Amanzonwé et al 2023 ; Kossi et al 2023 ; Nindorera et al 2023 ). Interventions favouring intensive high repetitive task-specific training in all phases post-stroke have strong evidence for better results on motor function and activities (Veerbeek et al 2014).…”

“…Our systematic review and meta-analysis aimed to compare the effectiveness of bilateral UL training with unilateral training on UL impairements and activities in Heterogeneity: τ 2 = 0.30; χ 2 = 36.52, df = 9 (p < 0.0001); i 2 = 75% Test for overall effect: Z = 2.35 (p = 0.02) Test for subgroup differences: χ 2 = 0.39, df = 1 (p = 0.53), i 2 = 0% The dose of the training is important to reach functional recovery after stroke (Amanzonwé et al 2023;Kossi et al 2023;Nindorera et al 2023)…”

Challenge Level Contributes to the Efficacy of Treadmill Interventions after Stroke: A Systematic Review and Meta-Analysis

“…The investigation of dosage as a construct is relatively new to stroke literature. Amanzonwe et al (2023) investigated how dosage influences the efficacy of aerobic training and resistance exercise after stroke [20]. Their subgroup analysis categorized studies (n = 11) according to the experimental intervention parameters as high dosage (amount ≥ 120 min/week and challenge ≥ 60% HRR or ≥14 RPE) or low dosage.…”

“…Their subgroup analysis categorized studies (n = 11) according to the experimental intervention parameters as high dosage (amount ≥ 120 min/week and challenge ≥ 60% HRR or ≥14 RPE) or low dosage. The subgroup of studies with higher-dosage experimental interventions had larger effects on walking endurance than their comparison interventions [20]. However, the dosage of the comparison intervention was not considered in the analysis [20], nor were comparisons between the subgroups clearly reported.…”

“…In this report, these different constructs are delineated and defined, where "amount" refers to the volume of therapy delivered, including the session duration, frequency per week, and length of the program [11], whereas "challenge" refers to how challenging the task is for the individual over a set period [17,19]. The combination of "amount" and "challenge" is referred to as "dosage" [20]. Across the rehabilitation literature, challenge has not been investigated to the same degree as the amount of intervention [16,21,22].…”