Background: Stroke has been considered the major cause of chronic disability in the world and ranks among the leading causes of death. Despite the fact that new vascular events often happen and risk factors are the same that Cardiovascular Diseases, secondary prevention through non-pharmacological measures, are not part of the routine physical rehabilitation after stroke. Objective: The aim is to answer the following clinical question: Should aerobic fitness be part of the physical rehabilitation of individuals post-stroke? Methodological Design: The methodology used in the study was an integrative literature review. Inclusion Criteria: Articles in English are published in secondary databases: systematic reviews with or without meta-analysis, which address the question PICO: patient (post-stroke), intervention (aerobic exercise), comparison (with or without aerobic conditioning) the outcome (volume of oxygen consumed peak (VO 2peak), quality of life (QoL), morbidity and mortality). Outcomes: VO 2peak, QoL, complications and mortality. Analysis of Studies: The methodological quality of included studies is assessed using the tools: PRISMA and R-AMSTAR. Results: There was “good” evidence for the inclusion of aerobic exercise on physical rehabilitation of post-stroke individuals to improve their physical capacity (VO 2peak), facilitating the completion of activities of daily living and gait. There was weak evidence on the association of aerobic fitness with positive results on QoL in stroke victims and insufficient results to evaluate the effect of aerobic fitness on the risk of stroke recurrence and mortality. Conclusion: The aerobic conditioning should be included in the rehabilitation of stroke victims.
Stroke is a clinical syndrome with a presumed vascular origin, characterized by rapidly developing clinical signs of focal or global symptoms due to changes in cerebral functions lasting for more than 24 hours or leading to death [
Recent studies have shown that individuals after stroke not only have motor and cognitive residual impairment but also poor ability to bear physical effort, where about 70% of them show some type of coexistent heart disease [
Inclusion criteria involved systematic reviews with or without meta-analysis in English, published in secondary databases (Cochrane, PEDro, Pubmed) searched were from October to November 2012 (
Cochrane e Pubmed |
---|
(Aerobic exercise OR Aerobic training OR Cardio workout OR Aerobic workout OR Aerobic conditioning OR Physical conditioning OR Cardiovascular conditioning OR Cardiovascular rehabilitation OR Physical fitness OR Resistance training OR physical exercise OR Exercise therapy OR Physical endurance OR Physical therapy OR Cardiopulmonary and metabolic rehabilitation) AND (Stroke OR Cerebral stroke OR Brain vascular accident OR Cerebrovascular apoplexy OR Cerebrovascular stroke OR CVA OR Apoplexy OR Cerebrovascular accident) |
PEDro* |
1. Aerobic exercise 2. Aerobic training 3. Cardio workout 4. Aerobic workout 5. Aerobic conditioning 6. Physical conditioning 7. Cardiovascular conditioning 8. Cardiovascular rehabilitation 9. Physical fitness 10. Resistance training 11. Physical exercise 12. Exercise therapy 13. Physical endurance 14. Physical therapy 15. Cardiopulmonary and metabolic rehabilitation 16. Stroke 17. Cerebral stroke 18. Brain vascular accident 19. Cerebrovascular apoplexy 20. Cerebrovascular stroke 21. CVA (cerebrovascular accident) 22. Apoplexy 23. Cerebrovascular accident 24. 1 and or/16 - 23 25. 2 and or/16 - 23 26. 3 and or/16 - 23 27. 4 and or/16 - 23 28. 5 and or/16 - 23 29. 6 and or/16 - 23 30. 7 and or/16 - 23 31. 8 and or/16 - 23 32. 9 and or/16 - 23 33. 10 and or/16 - 23 34. 11 and or/16 - 23 35. 12 and or/16 - 23 36. 13 and or/16 - 23 37. 14 and or/16 - 23 38. 15 and or/16 - 23 |
mortality and complications. The selected keyword was “stroke” and all equivalent terms identified in the database Medical Subject Headings-MESH, combined with the intervention “aerobic exercise” and the specific correlated words identified at MESH (
Aerobic Exercise | Stroke |
---|---|
Aerobic exercise | Stroke |
Aerobic training | Cerebral Stroke |
Cardio workout | Brain Vascular Accident |
Aerobic workout | Cerebrovascular Apoplexy |
Aerobic conditioning | Cerebrovascular Stroke |
Physical conditioning | CVA (Cerebrovascular Accident) |
Cardiovascular conditioning | Apoplexy |
Cardiovascular rehabilitation | Cerebrovascular Accident |
Physical fitness | |
Resistance training | |
Physical exercise | |
Exercise therapy | |
Physical endurance | |
Physical therapy | |
Cardiopulmonary and metabolic rehabilitation |
the articles according to the inclusion criteria and the second (Gonçalves, RL) repeated the search to improve accuracy. Any disagreement between the two reviewers was solved through a discussion.
The poor description of the intervention performed and lack of uniformity concerning type, intensity, frequency, duration of the exercise made the analysis of benefits of the aerobic conditioning after stroke difficult, besides the variety of outcomes used. Numerous studies that analyzed the effect of aerobic conditioning in a stroke patient used gait speed and 6-minute walking test (WT6M) as outcomes. Although there was sufficient evidence to incorporate AE involving walking within post-stroke Phys Rehab to improve speed, tolerance and independence during walking [
Two independent review authors documented the methodological quality of all studies included by using two instruments: Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA [
The data were collected according to the outcomes and scrutinized by study. The relevant features of each article were discriminated (
Physical activity is defined as any bodily movement produced by skeletal muscles that results in energy expenditure beyond resting expenditure [
Study | Patients | Intervention | Results | Clinical |
---|---|---|---|---|
Pang et al., 2006. | 480 individuals with light or moderate impairment-7 randomized clinical essays. | ―Exercise for 20 - 40 min, 3 - 5 times/week, intensity 50% - 80% of the HHR. ―Cycle ergometer training was the most used intervention (4 studies). ―Treadmill walking was used in one study. ―A combination of walking, brisk walking and sit-to stand exercise was used in one study. ―Aerobic exercises in the water used in one study. | ―Improvement in VO2 (9.0% - 34.8%) in all studies | ―There is a good evidence to support that aerobic exercise improves aerobic capacity in individuals with stroke. ―The results might be generalized in case of individuals with a light or moderate impairment caused by a stroke, showing a relative low risk of heart complications during the exercises. |
Stoller et al., 2012. | 423 individuals with light or moderate impairment-10 randomized clinical essays or randomized controlled pilot studies and 1 combined prospective controlled design. | ―Cycle ergometer training of lower limbs (5 studies) and treadmill (4 studies) were the most used interventions. ―Class circuit-based training was used in one study ―Combination of cycle ergometer training of lower limbs, treadmill, aerobic exercises with stepping and cycle ergometer of upper limbs (2 studies). ―Training for 3 - 13 weeks, 20 - 90 min, 2 - 5 times/week, intensity 40% - 80% of HR at rest. | ―VO2peak evaluated in 3 studies (173 individuals) with significant favorable results. | |
Meek et al., 2003. | 75 individuals-3 controlled trials. | ―Duncan et al. performed supervised exercises (cycle ergometer training or walking for 20 min). ―Potempa et al. performed cycle ergometer training for 30 min. ―Teixeira-Salmela et al. used aerobic and strength classes. ―Training lasted 10 weeks, was performed 3 times/week for 30 - 90 min. | ―Outcomes were quite different, making the combination and/or comparison of results difficult. ―No significant result was found when the outcomes were combined. ―Significant results were found in studies individually published. | ―Currently, the controlled clinical trials show insufficient evidence to conclude that cardiovascular exercise is beneficial for stroke patients. ―Trials to investigate the cardiovascular exercise efficacy in stroke patients is necessary |
Brazzeli et al., 2011. | 1412 individuals-32 randomized clinical studies. | ―Cardiorespiratory training in 14 studies (651 individuals), 2 studies evaluated a circuit-based training, 1 study was based on water exercises and the others on cycle ergometer training (4), treadmill (5) and electrical bicycle (2). The sessions were performed 2 - 5 times/week, for 2 - 12 weeks, from 30 - 60 min, and the intensity ranged from 50% - 85% of the participants’ maximal HH, < 60% HRR (light-vigorous intensity). | ―Adverse effects: it was not systematically reported, however in some studies the occurrence of a stroke before the end of the training is mentioned. ―Physical Skill: Cardiorespiratory Training-4 studies (120 individuals) improve in VO2peak. ―QoL: cardiorespiratory training-1 study (28 individuals) analyzed and found significant outcomes. |
Study | Primary articles included | Authors | Duplicates | Articles in which this article was included | Year |
---|---|---|---|---|---|
I―The use of aerobic exercise training in improving aerobic capacity in individuals with stroke: a meta-analysis. Pang et al., 2006. | 1. Physiological outcomes of aerobic exercise training in hemiparetic stroke patients. | Potempa K, Lopez M, Braun LT, Szidon JP, Fogg L, Tincknell T. | yes | I, III e IV | 1995 |
2. The effect of aerobic training on rehabilitation outcomes after recent severe brain injury: a randomized controlled evaluation. | Bateman A, Culpan J, Pickering AD, Powell JH, Scott OM, Greenwood RJ. | yes | I e III | 2001 | |
3. A comparison of regular rehabilitation and regular rehabilitation with supported treadmill ambulation training for acute stroke patients. | da Cunha Filho IT, Lim PAC. | yes | - | 2001 | |
4. Gait outcomes after acute stroke rehabilitation with supported treadmill ambulation training: a randomized controlled pilot study. | da Cunha IT, Lim PA, Qureshy H, Henson H, Monga T, Protas EJ. | yes | I, II e III | 2002 | |
5. Randomized clinical trial of therapeutic exercise in subacute stroke. | Duncan P, Studenski S, Richards L, et al. | yes | I, II e III | 2003 | |
6. The influence of early aerobic training on the functional capacity in patients with cerebrovascular accident at the subacute stage. | Katz-Leurer M, Shochina M, Carmeli E, Friedlander Y. | yes | I e II | 2003 | |
7. The effect of early aerobic training on independence six months post stroke. | Katz-Leurer M, Carmeli E, Shochina M. | yes | I e II | 2003 | |
8. Water-based exercise for cardiovascular fitness in people with chronic stroke: a randomized controlled trial. | Chu KS, Eng JJ, Dawson AS, Harris JE, Ozkaplan A, Gylfadottir S. | no | - | 2004 | |
9. A community-based fitness and mobility exercise (FAME) program for older adults with chronic stroke: a randomized controlled trial. | Pang MYC, Eng JJ, Dawson AS, McKay HA, Harris JE. | no | - | 2005 | |
II―Effects of cardiovascular exercise early after stroke: systematic review and metaanalysis. Stoller et al., 2012. | 1. Gait outcomes after acute stroke rehabilitation with supported treadmill ambulation training: A randomized controlled pilot study. | da Cunha IT, Lim PA, Qureshy H, Henson H, Monga T, Protas EJ. | yes | I, II e III | 2002 |
2. A randomized, controlled pilot study of a home-based exercise program for individuals with mild and moderate stroke. | Duncan P, Richards L, Wallace D, et al. | no | - | 1998 | |
3. Randomized clinical trial of therapeutic exercise in subacute stroke. | Duncan P, Studenski S, Richards L, et al. | yes | I, II e III | 2003 | |
4. Aerobic treadmill plus Bobath walking training improves walking in subacute stroke: a randomized controlled trial. | Eich HJ, Mach H, Werner C, Hesse S. | no | - | 2004 | |
5. The effect of early aerobic training on independence six months post stroke. | Katz-Leurer M, Carmeli E, Shochina M. | yes | I e II | 2003 | |
6. The influence of early aerobic training on the functional capacity in patients with cerebrovascular accident at the subacute stage. | Katz-Leurer M, Shochina M, Carmeli E, Friedlander Y. | yes | I e II | 2003 | |
7. The influence of autonomic impairment on aerobic exercise outcome in stroke patients. | Katz-Leurer M, Shochina M. | no | - | 2007 | |
8. Early post-stroke physical conditioning in hemiplegic patients: A preliminary study. | Letombe A, Cornille C, Delahaye H, et al. | no | - | 2010 | |
9. Effects of a high-intensity taskoriented training on gait performance early after stroke: a pilot study. | Outermans JC, van Peppen RPS, Wittink H, Takken T, Kwakkel G. | no | - | 2010 | |
10. Effects of an Aerobic Exercise Program on Aerobic Capacity, Spatiotemporal Gait Parameters, and Functional Capacity in Subacute Stroke. | Tang A, Sibley KM, Thomas SG, et al. | no | - | 2009 | |
11. Feasibility, safety and efficacy of an early aerobic rehabilitation program for patients after minor ischemic stroke: A pilot randomized controlled trial. | Toledano-Zarhi A, Tanne D, Carmeli E, Katz-Leurer M. | no | - | 2011 |
III-Physical fitness training for stroke patients. Brazzeli et al., 2011. | 1. A study on the quality of life in ischaemic vascular accidents and its relation to physical activity. | Aidar FJ, Silva AJ, Reis VM, Carniero A, Carniero-Cotta S. | no | - | 2007 |
---|---|---|---|---|---|
2. Does functional strength training of the leg in subacute stroke improves physical performance? A pilot randomized controlled trial. | Bale M, Strand LI. | no | - | 2008 | |
3. The effect of aerobic training on rehabilitation outcomes after recent severe brain injury: a randomized controlled evaluation. | Bateman A, Culpan FJ, Pickering AD, Powell JH, Scott OM, Greenwood RJ. | yes | I e III | 2001 | |
4. Efficacy of functional strength training on restoration of lower limb motor function early after stroke: phase I randomized controlled trial. | Cooke EV, Tallis RC, Clark A, Pomeroy VM. | no | - | 2010 | |
5. Effect of the Kinetron II on gait and functional outcome in hemiplegic subjects. | Cuviello-Palmer ED. | no | - | 1988 | |
6. Gait outcomes after acute stroke rehabilitation with supported treadmill training: a randomized controlled pilot study. | da Cunha IT, Lim PA, Qureshy H, Henson H, Monga T, Protas EJ. | yes | I, II e III | 2002 | |
7. Effects of conventional physicaltherapy and functional strength training on upper limb motor recovery after stroke: a randomized phase II study. | Donaldson C, Tallis R, Miller S, Sunderland A, Lemon R, Pomeroy V. | no | - | 2009 | |
8. A randomized, controlled pilot study of a home-based exercise program for individuals with mild and moderate stroke. | Duncan P, Richards L, Wallace D, et al. | no | - | 1998 | |
9. Randomized clinical trial of therapeutic exercise in subacute stroke. | Duncan P, Studenski S, Richards L, et al. | yes | I, II e III | 2003 | |
10. Aerobic treadmill training plus physiotherapy improves walking ability in subacute stroke patients. | Eich HJ, Parchmann H, Hesse S, Mach H, Werner C. | no | - | 2004 | |
11. Progressive resistance training after stroke: effects resistance training after stroke: effects on muscle strength, muscle tone, gait performance and perceived participation. | Flansbjer UB, MillerM, Downham D, Lexell J. | ||||
12. Effects of isokinetic training on the rate of movement during ambulation in hemiparetic patients. | Glasser L. | no | - | 1986 | |
13. Effectiveness of functional training, active exercise, and resistive exercise for patients with hemiplegia. | InabaM, Edberg E, Montgomery J, GillisMK. | no | - | 1973 | |
14. Closed kinetic chain training to enhance muscle power, control and retrain dynamic balance under task specific conditions improves functional walking ability in chronic stroke survivors. | James JEP. | no | - | 2002 | |
15. The effect of early aerobic training on independence six months post stroke. | Katz-Leurer M, Carmeli E, Shochina M. | no | - | 2003 | |
16. Effects of isokinetic strength training on walking in persons with stroke: a double-blind controlled pilot study. | Kim CM, Eng JJ, MacIntyre DL, Dawson AS. | no | - | 2001 | |
17. Stroke patients and long-term training: is it worthwhile? A randomized comparison of two different training strategies after rehabilitation. | Langhammer B, Lindmark B, Stanghelle JK. | no | - | 2007 | |
18. A pilot randomized controlled trial to evaluate the benefit of the cardiac rehabilitation paradigm for the nonacute ischaemic stroke population. | Lennon O, Carey A, Gaffney N, Stephenson J, Blake C. | no | - | 2008 | |
19. Stroke: a randomized trial of exercise or relaxation. | Mead GE, Greig CA, Cunningham I, et al. | no | - | 2007 | |
20. Locomotor training improves daily stepping activity and gait efficiency in individuals post stroke who have reached a “plateau” in recovery. | Moore JL, Roth EJ, Killian C, Hornby TG. | no | - | 2010 |
21. Circuit-based rehabilitation improves gait endurance but not usual walking activity in chronic stroke: a randomized controlled trial. | Mudge S, Barber PA, Stott NS. | no | - | 2009 | |
---|---|---|---|---|---|
22. High-intensity resistance training improves muscle strength, selfreported function, and disability in long-term stroke survivors. | Ouellette MM, LeBrasseur NK, Bean JF, et al. | no | - | 2004 | |
23. Speeddependent treadmill training in ambulatory hemiparetic stroke patients: a randomized controlled trial. | Pohl M, Mehrholz J, Ritschel C, Ruckriem S. | no | - | 2002 | |
24. Physiological outcomes of aerobic exercise training in hemi paretic stroke patients. | Potempa K, Lopez M, Braun LT, Szidon JP, Fogg L, Tincknell T. | yes | I, III e IV | 1995 | |
25. Task-specific physical therapy for optimization of gait recovery in acute stroke patients. | Richards CL, Malouin F, Wood-Dauphinee S, Williams JI, Bouchard JP, Brunet D. | no | - | 1993 | |
26. The role of technology in task oriented training in persons with subacute stroke: a randomized controlled trial. | Richards CL, Malouin F, Bravo G, Dumas F, Wood-Dauphinee S. | no | - | 2004 | |
27. A task-orientated intervention enhances walking distance and speed in the first year post stroke: a randomized controlled trial. | Salbach NM, Mayo NE, Wood-Dauphinee S, Hanley JA, Richards CL, Côté R. | no | - | 2004 | |
28. Regenerate: assessing the feasibility of a strength training program to enhance the physical and mental health of chronic post stroke patients with depression. | Sims J, Galea M, Taylor N, et al. | no | - | 2009 | |
29. Treadmill training post stroke: are there any secondary benefits? A pilot study. | Smith PS, Thompson M. | no | - | 2008 | |
30. Muscle strengthening and physical conditioning to reduce impairment and disability in chronic stroke survivors. | Teixeira-Salmela LF, Olney SJ, Nadeau S, Brouwer B. | yes | III e IV | 1999 | |
31. A randomized controlled comparison of upper-extremity rehabilitation strategies in acute stroke: a pilot study of immediate and long-term outcomes. | Winstein CJ, Rose DK, Tan SM, Lewthwaite R, Chui HC, Azen SP. | no | - | 2004 | |
32. Taskoriented progressive resistance strength training improves muscle strength and functional performance in individuals with stroke. | Yang YR, Wang RY, Lin KH, Chu MY, Chan RC. | no | - | 2006 | |
IV―A systematic review of exercise trials post stroke. Meek et al., 2003. | 1. Muscle strengthening and physical conditioning to reduce impairment and disability in chronic stroke survivors. | Teixeira-Salmela LF, Olney SJ, Nadeau S, Brouwer B. | yes | III e IV | 1999 |
2. A randomised controlled pilot study of a home-based exercise program for individuals with mild and moderate stroke. | Duncan P, Richards L, Wallace D et al. | no | - | 1998 | |
3-Physiological outcomes of aerobic exercise training in hemiparetic stroke patients. | Potempa K, Lopez M, Braun L, Szidon P, Fogg L, Tincknell T. | yes | I, III e IV | 1995 |
with a light-moderate intensity [
The initial search resulted in 860 articles, where 23 [
The relevant characteristics of included studies for this analysis are shown in
The AE intensity ranged from 50% - 80% heart rate reserve (HRR), 40% - 70% VO2peak, from 50% - 80% maximum heart rate (MHR), a perceived exertion of 11 - 14 on the Borg scale (Scale 6 - 20), for 20 - 60 min, 3 - 7
Study | Reason for exclusion |
---|---|
Cooke et al., 2010. | Study did not address physical conditioning |
Chen MD, Rimmer JH, 2011. | Study did not address physical conditioning |
Wendel-Vos et al., 2004. | Study excluded aerobic exercise and address leisure activities |
Lopopolo et al., 2006. | Study did not address physical conditioning |
Kwakkel et al., 2004. | Study did not address physical conditioning |
French et al., 2010. | Study did not address physical conditioning |
Harris JE, Eng JJ, 2010. | Study did not address physical conditioning |
Verbeek et al., 2011. | Study did not address physical conditioning |
Reimers et al., 2009. | Study did not specify physical activities, includes more than aerobic exercise |
Wevers et al., 2009. | Study did not address physical conditioning |
van de Port et al., 2007. | Outcome was gait |
States et al., 2009. | Outcome was gait |
McGeough et al., 2009. | Study addressed fatigue and drug treatment |
English C, Hillier SL, 2010. | Study did not address physical conditioning |
States et al., 2009. | Study addressed gait training |
Moseley et al., 2005. | Study addressed gait training |
An M, Shaughnessy M, 2011. | Study did not address physical conditioning |
Ovando et al., 2010. | Study did not follow the criteria inclusion and it is in Portuguese |
Chong et al., 2003. | Study approached several types of physical activity, including leisure activities |
Study | Score | Max Score | |
---|---|---|---|
Pang et al., 2006. | 21 | 27 | |
Stoller et al., 2012. | 23 | 27 | |
Meek et al., 2003. | 16 | 27 | |
Brazzeli et al., 2011. | 21 | 27 | |
Study | Score | Maximum score | Classification |
---|---|---|---|
Pang et al., 2006. | 34 | 44 | C |
Stoller et al., 2012. | 30 | 44 | D |
Meek et al., 2003. | 29 | 44 | D |
Brazzeli et al., 2011. | 39 | 44 | B |
Subtitle: the item was scored according to the questionnaire (annex). The score followed the criteria proposed by R-AMSTAR: A Quality―100% - 90% (score 44 - 40); B Quality―89% - 80% (score 39 - 36); C Quality―79% - 70% (score 35 - 31); D Quality < 69% (score < 31).
times/week and intensity ranging, according to the ACSM, from very light to vigorous.
Outcomes
・ VO2peak: All studies included evaluated the VO2peak. Pang et al. found out there was an improvement in VO2peak in all studies analyzed, ranging from 9-34.8%. Stoller et al. carried out three studies evaluating the VO2peak which demonstrated homogenous effects in favor of the intervention group. Meek et al. have concluded that due to the limited number of participants in the few primary studies included in their review, insufficient evidence was identified to establish if aerobic conditioning post-stroke has a positive effect, although Potempa et al. have individually demonstrated an improvement in VO2peak. Brazzeli et al. have shown also in improvement in VO2peak in four studies.
Complication
・ Recurrent stroke: Stroke recurrence was addressed in three of the studies included. Pang et al. found that one (Duncan et al.) of the seven studies reported stroke recurrence. In this study, 6% of the subjects had a recurrent stroke during the exercise trial. Two of the strokes occurred in the beginning of the intervention and one occurred at seven weeks. That is, the incidence rate of recurrent stroke reported was comparable to the recurrent stroke risk reported in the general stroke population (8% between 1 - 6 months after stroke). Stoller et al. reported that in one study two individuals in the control group during the follow-up had stroke recurrence and the same was demonstrated by Pang et al. since they used the same primary study. Brazelli et al. reported that in 15 trials including post-intervention follow-up, seven participants (three in the intervention group and four in the control group) had a recurrent stroke between the end of the intervention and the follow-up. Another study informed that three participants (one in the intervention group and two in the control group) also had another stroke between the beginning and end of the intervention. Besides that, four participants (three in the intervention group and one in the control group) had a stroke between the beginning and end of the intervention.
・ Mortality: One study included in this review evaluated mortality. Brazzelli et al. reported there were insufficient data to determine the influence of fitness training on mortality.
・ QoL: Three of the studies included in the review discussed the QoL. Stoller et al. have shown favorable results in one study. On the other hand, Meek et al. concluded that although two primary studies included in a review have demonstrated an improvement in the QoL after aerobic fitness (Duncan et al. and Teixeira-Salmela et al.), not enough evidences were found to confirm this information. Brazzelli et al. analyzed the QoL and concluded there was a significant improvement (Aidar et al.). However there was no significant result in another study (Kim et al.) and two others showed good results concerning the function [
There was “good” evidence for the inclusion of AE on Phys Rehab of post-stroke individuals to improve their physical capacity (VO2peak), facilitating the completion of its ADL and gait. However, we could not assess if this outcome was kept after the Phys Rehab. The results related to the QoL in response to physical conditioning suggest it might be beneficial in stroke victims. Although there were insufficient evidences for a strong recommendation, based on the results the inclusion of AE to improve the QoL post-stroke with a “weak” level of evidence. There were insufficient results to evaluate the effect of AE on the risk of falls in stroke recurrence, occurrence of a cardiovascular event post-stroke and mortality.
Stroke is a preventable and treatable disease. Physiopathologically, stroke is the result of hypoxic brain cells damage or death due to the interruption of blood flow in part of the brain. As a consequence, depending on the affected brain area there will be damage, dysfunction and/or disability being the reason that most of these individuals will be included in a Phys Rehab [
Currently, stroke has been considered as a global public health problem in elderly people [
Stroke victims are at heightened risk of having new vascular events and the most of the victims will have a recurrent stroke or AMI, especially in the first year after the initial event [
It has been shown that the low aerobic capacity is a risk factor for CVD and stroke [
There is good evidence that the QoL might be improved by physical exercise [
There is a vast literature approaching falls in the elderly [
According to the ACSM, the risk of sudden death or AMI is very low in healthy adults during activities of moderate intensity [
Aerobic exercise should be included in the Phys Rehab of stroke survivors which main purpose is to improve the physical capacity, favoring the skill to perform DLA and gait. It is possible that AE improves the QoL in patients with stroke. No conclusions can be drawn stating that AE is able to decrease the recurrence of stroke, number of falls or mortality.
The Phys Rehab of stroke patients might include not only the functional aspects but also measurements to prevent secondary complications, changes in their life style and decrease the risk factors in order to change the natural history of disease.
Roberta Lins Gonçalves,Ingrid de Fátima Aquino Suzuki,Fernanda Figueiroa Sanchez,Elisa Brosina De Leon,Peterson Marco de Oliveira Andrade,1 1, (2016) Effects of Aerobic Conditioning on Individuals Post-Stroke: What Is the Evidence?. International Journal of Clinical Medicine,07,245-260. doi: 10.4236/ijcm.2016.73026