Effects of Exercise on Quality of Life in Stroke Survivors: A Meta-Analysis

Background and Purpose— One of the major consequences after stroke is the deterioration in health-related quality of life (HRQOL). Three previous systematic reviews indicated that exercise has limited to no effect in improving HRQOL in stroke survivors. The objective of this meta-analysis was to update the evidence on exercise and HRQOL in stroke survivors with additional new information on randomized controlled trials that have been published since these 3 previous reviews. Methods— MEDLINE, Cumulated Index to Nursing and Allied Health Literature, EMBASE, and SportsDiscus databases were searched for randomized controlled trials reporting the effects of exercise on HRQOL in stroke survivors from 1950 to March 2010. The methodological quality of each study was appraised using the Physiotherapy Evidence Database scale. Standardized mean difference was used to compute effect size and subgroup analysis was conducted to test the consistency of results across the subgroups with different characteristics. Results— A total of 1101 citations was identified and 9 studies met all criteria for a total sample of 426 stroke survivors. Eight studies were rated as good quality (ie, Physiotherapy Evidence Database scale ≥5). This meta-analysis provided evidence that exercise can have a small to medium effect on HRQOL outcomes (standardized mean difference, 0.32, P<0.01) at postintervention but not at follow-up after exercise was terminated (standardized mean difference, 0.17, P=0.12). No adverse events related to exercise were reported. Conclusions— The results provide moderate support for the use of exercise to improve HRQOL in stroke survivors. However, the challenge for researchers is identifying effective strategies for sustaining these effects postintervention.

[1]  Gwyn McClelland.  Survivors , 1891, The Hospital.

[2]  Ingram Olkin,et al.  Estimation of a Single Effect Size: Parametric and Nonparametric Methods , 1985 .

[3]  L. Hedges,et al.  Statistical Methods for Meta-Analysis , 1987 .

[4]  S Studenski,et al.  A randomized, controlled pilot study of a home-based exercise program for individuals with mild and moderate stroke. , 1998, Stroke.

[5]  S. Olney,et al.  Muscle strengthening and physical conditioning to reduce impairment and disability in chronic stroke survivors. , 1999, Archives of physical medicine and rehabilitation.

[6]  Mark W. Lipsey,et al.  Practical Meta-Analysis , 2000 .

[7]  J. Hobart,et al.  Quality of Life Measurement After Stroke: Uses and Abuses of the SF-36 , 2002, Stroke.

[8]  S. Thompson,et al.  Quantifying heterogeneity in a meta‐analysis , 2002, Statistics in medicine.

[9]  P. Langhorne,et al.  A systematic review of exercise trials post stroke , 2003, Clinical rehabilitation.

[10]  L. Ada,et al.  A treadmill and overground walking program improves walking in persons residing in the community after stroke: a placebo-controlled, randomized trial. , 2003, Archives of physical medicine and rehabilitation.

[11]  Catherine Sherrington,et al.  Reliability of the PEDro scale for rating quality of randomized controlled trials. , 2003, Physical therapy.

[12]  Ian D Cameron,et al.  Treadmill training and body weight support for walking after stroke. , 2005, The Cochrane database of systematic reviews.

[13]  D. Altman,et al.  Measuring inconsistency in meta-analyses , 2003, BMJ : British Medical Journal.

[14]  Geoffrey A. Donnan,et al.  Quality of Life After Stroke: The North East Melbourne Stroke Incidence Study (NEMESIS) , 2004, Stroke.

[15]  Fernando Costa,et al.  Physical activity and exercise recommendations for stroke survivors: an American Heart Association scientific statement from the Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention; the Council on Cardiovascular Nursing; the Council on Nutrition, Physical , 2004, Stroke.

[16]  C. Granger,et al.  Trends in length of stay, living setting, functional outcome, and mortality following medical rehabilitation. , 2004, JAMA.

[17]  Peter Langhorne,et al.  Effects of Augmented Exercise Therapy Time After Stroke: A Meta-Analysis , 2004, Stroke.

[18]  M. Morris,et al.  Outcomes of progressive resistance strength training following stroke: a systematic review , 2004, Clinical rehabilitation.

[19]  E. Roth,et al.  Physical activity and exercise recommendations for stroke survivors: an American Heart Association scientific statement from the Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention; the Council on Cardiovascular Nursing; the Council on Nutrition, Physical , 2004, Circulation.

[20]  A. Thrift,et al.  Long-Term Outcome in the North East Melbourne Stroke Incidence Study: Predictors of Quality of Life at 5 Years After Stroke , 2005, Stroke.

[21]  S. Studenski,et al.  Daily Functioning and Quality of Life in a Randomized Controlled Trial of Therapeutic Exercise for Subacute Stroke Survivors , 2005, Stroke.

[22]  L. Ada,et al.  Strengthening interventions increase strength and improve activity after stroke: a systematic review. , 2006, The Australian journal of physiotherapy.

[23]  V. Mok,et al.  Quality of life of stroke survivors: a 1-year follow-up study. , 2006, Archives of physical medicine and rehabilitation.

[24]  S. Studenski,et al.  Therapeutic Exercise and Depressive Symptoms After Stroke , 2006, Journal of the American Geriatrics Society.

[25]  J. Eng,et al.  The use of aerobic exercise training in improving aerobic capacity in individuals with stroke: a meta-analysis , 2006, Clinical rehabilitation.

[26]  G. Kwakkel,et al.  Effects of Exercise Training Programs on Walking Competency After Stroke: A Systematic Review , 2007, American journal of physical medicine & rehabilitation.

[27]  Tamilyn Bakas,et al.  Barriers and Facilitators to Exercise Among Stroke Survivors , 2007, Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses.

[28]  Richard W. Bohannon.  Muscle strength and muscle training after stroke. , 2007, Journal of rehabilitation medicine.

[29]  Janice J Eng,et al.  Gait training strategies to optimize walking ability in people with stroke: a synthesis of the evidence , 2007, Expert review of neurotherapeutics.

[30]  G. Mead,et al.  Stroke: A Randomized Trial of Exercise or Relaxation , 2007, Journal of the American Geriatrics Society.

[31]  Carolynn Patten,et al.  Strengthening to Promote Functional Recovery Poststroke: An Evidence-Based Review , 2008, Topics in stroke rehabilitation.

[32]  J. Rimmer,et al.  Barriers associated with exercise and community access for individuals with stroke. , 2008, Journal of rehabilitation research and development.

[33]  G. Davis,et al.  Comparison of Effect of Aerobic Cycle Training and Progressive Resistance Training on Walking Ability After Stroke: A Randomized Sham Exercise–Controlled Study , 2008, Journal of the American Geriatrics Society.

[34]  D. Downham,et al.  Progressive resistance training after stroke: effects on muscle strength, muscle tone, gait performance and perceived participation. , 2008, Journal of rehabilitation medicine.

[35]  M. Galea,et al.  Regenerate: assessing the feasibility of a strength‐training program to enhance the physical and mental health of chronic post stroke patients with depression , 2009, International journal of geriatric psychiatry.

[36]  F. J. Carod-Artal,et al.  Quality of Life after Stroke: The Importance of a Good Recovery , 2009, Cerebrovascular Diseases.

[37]  G. Mead,et al.  Effects of Task-Oriented Circuit Class Training on Walking Competency After Stroke: A Systematic Review , 2009, Stroke.

[38]  Yasser Salem,et al.  Overground physical therapy gait training for chronic stroke patients with mobility deficits. , 2009, The Cochrane database of systematic reviews.

[39]  F. Aichner,et al.  Reversibility of Basilar Artery Stenosis following Timely Treatment of Temporal Arteritis , 2009, Cerebrovascular Diseases.