Potential Contributions of Training Intensity on Locomotor Performance in Individuals With Chronic Stroke

Holleran, Carey L.; Rodriguez, Kelly S.; Echauz, Anthony J.; Leech, Kristan A.; Hornby, T. George

doi:10.1097/npt.0000000000000077

Cited by 57 publications

(64 citation statements)

References 31 publications

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“…For example, aerobic capacity effect sizes in previous studies (AEX group change minus control group change) have ranged from −1.5 13 to +6.3 14 mL/kg/min, walking speed effect sizes have ranged from −0.09 15 to +0.25 16 m/s and walking endurance (6-minute walk test) effect sizes have ranged from −25 17 to +89 16 m. An understanding of the factors affecting these between study differences could help inform AEX prescription and prioritize future studies.…”

Section: Main Manuscriptmentioning

confidence: 99%

Factors Influencing the Efficacy of Aerobic Exercise for Improving Fitness and Walking Capacity After Stroke

Boyne

Welge

Kissela

et al. 2017

Archives of Physical Medicine and Rehabilitation

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Objective To assess the influence of dosing parameters and patient characteristics on the efficacy of aerobic exercise (AEX) post-stroke. Data Sources A systematic review was conducted using Pubmed, MEDLINE, CINAHL, PEDro and Academic Search Complete. Study Selection Studies were selected that compared AEX to a non-aerobic control group among ambulatory persons with stroke. Data Extraction Extracted outcome data included: peak oxygen consumption during exercise testing (VO2peak), walking speed and walking endurance (6-minute walk test). Independent variables of interest were: AEX mode (seated or walking), AEX intensity (moderate or vigorous), AEX volume (total hours), stroke chronicity and baseline outcome scores. Data Synthesis Significant between-study heterogeneity was confirmed for all outcomes. Pooled AEX effect size estimates (AEX change – control change) from random effects models were: VO2peak, 2.2 mL/kg/min [95% CI: 1.3, 3.1]; walking speed, 0.06 m/s [95% CI: 0.01, 0.11]; and 6-minute walk test distance, 29 m [95% CI: 15, 42]. From meta-regression, greater VO2peak effect sizes were significantly associated with higher AEX intensity and higher baseline VO2peak. Greater effect sizes for walking speed and the 6-minute walk test were significantly associated with a walking AEX mode. In contrast, seated AEX did not have a significant effect on walking outcomes. Conclusions AEX significantly improves aerobic capacity post-stroke, but may need to be task specific to impact walking speed and endurance. Higher AEX intensity is associated with better outcomes. Future randomized studies are needed to confirm these results.

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Section: Main Manuscriptmentioning

confidence: 99%

Factors Influencing the Efficacy of Aerobic Exercise for Improving Fitness and Walking Capacity After Stroke

Boyne

Welge

Kissela

et al. 2017

Archives of Physical Medicine and Rehabilitation

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“…In clinical practice, this represents a considerable resource saving compared with provision of MTD. Therefore, the design reported here may have advantages over that reported earlier [37].…”

Section: Discussionmentioning

confidence: 46%

“…Previous studies have mainly used dose-ranging designs with pre-specified doses with parallel groups [35] or intervention crossover [36]. The authors are only aware of one previous dose-finding study of a rehabilitation intervention, but a different design was used to that reported here [37]. Unlike the present study, the starting dose was relatively high (only two cohorts before MTD was found: n=6), subsequent doses were not based on benefit as well as report of adverse consequences, each cohort received four different doses, de-escalation did not appear to have been considered and checking rules were not applied.…”

Section: Discussionmentioning

confidence: 99%

A rule-based, dose-finding design for use in stroke rehabilitation research: methodological development

et al. 2017

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Please cite this article as: Colucci E, Clark A, Lang CE, Pomeroy V.M.A rulebased, dose-finding design for use in stroke rehabilitation research: methodological development.Physiotherapy http://dx.doi.org/10.1016/j.physio. 2016.10.393 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. 2 AbstractBackground Dose-optimisation studies as precursors to clinical trials are rare in stroke rehabilitation.

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“…Aerobic exercise, such as treadmill training, is continually used in rehabilitation due to its effectiveness in improving function, mobility and cardiovascular fitness in patients with chronic stroke (37–39). Generally, this review shows that aerobic exercise is able to promote changes in central BDNF concentrations in animal models of stroke.…”

Section: Discussionmentioning

confidence: 99%

Post-stroke BDNF Concentration Changes Following Physical Exercise: A Systematic Review

et al. 2018

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Background: Research over the last two decades has highlighted the critical role of Brain-derived neurotrophic factor (BDNF) in brain neuroplasticity. Studies suggest that physical exercise may have a positive impact on the release of BDNF and therefore, brain plasticity. These results in animal and human studies have potential implications for the recovery from damage to the brain and for interventions that aim to facilitate neuroplasticity and, therefore, the rehabilitation process.Purpose: The aim of this study was to carry out a systematic review of the literature investigating how aerobic exercises and functional task training influence BDNF concentrations post-stroke in humans and animal models.Data Sources: Searches were conducted in PubMed (via National Library of Medicine), SCOPUS (Elsevier), CINAHL with Full Text (EBSCO), MEDLINE 1946—present with daily updates (Ovid) and Cochrane.Study Selection: All of the database searches were limited to the period from January, 2004 to May, 2017.Data Extraction: Two reviewers extracted study details and data. The methodological quality of the studies that used animal models was assessed using the ARRIVE Guidelines, and the study that evaluated human BDNF was assessed using the PEDro Scale.Data Synthesis: Twenty-one articles were included in this review. BDNF measurements were performed systemically (serum/plasma) or locally (central nervous system). Only one study evaluated human BDNF concentrations following physical exercise, while 20 studies were experimental studies using a stroke model in animals. A wide variation was observed in the training protocol between studies, although treadmill walking was the most common type of intervention among the studies. Studies were of variable quality: the studies that used animal models scored from 8/20 to 15/20 according to the ARRIVE Guidelines. The only study that evaluated human subjects scored 5/10 according to the PEDro scale and, which indicates a quality classified as “fair”.Conclusions: The results of the current systematic review suggest that aerobic exercise promotes changes in central BDNF concentrations post-stroke. On the other hand, BDNF responses following functional exercises, such as reaching training and Constraint Induced Movement Therapy (CIMT), seem to be still controversial. Given the lack of studies evaluating post-stroke BDNF concentration following physical exercise in humans, these conclusions are based on animal work.

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Potential Contributions of Training Intensity on Locomotor Performance in Individuals With Chronic Stroke

Cited by 57 publications

References 31 publications

Factors Influencing the Efficacy of Aerobic Exercise for Improving Fitness and Walking Capacity After Stroke

Factors Influencing the Efficacy of Aerobic Exercise for Improving Fitness and Walking Capacity After Stroke

A rule-based, dose-finding design for use in stroke rehabilitation research: methodological development

Post-stroke BDNF Concentration Changes Following Physical Exercise: A Systematic Review

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