Optimizing physical fitness in chronic stroke patients: the impact of exercise training modality and dosage on maximal and sub-maximal fitness – a systematic review and meta-analysis
DOI:
https://doi.org/10.2340/jrm.v57.43359Keywords:
VO2peak, VO2max, 6MWT, stroke rehabilitation, aerobic training., Resistance Training, Physical activity, Physical exerciseAbstract
Objective: To evaluate the effects of different exercise training modalities on maximal and sub-maximal physical fitness in chronic stroke patients and determine the optimal training dosage.
Design: Systematic review and meta-analysis of 38 randomized controlled trials.
Methods: A comprehensive search was conducted across seven databases (MedLine, Embase, ScienceDirect, Cochrane Library, CINAHL, and SPORTSDiscus) up to March 31, 2024. Maximal fitness was measured by VO2 max/peak, and sub-maximal fitness by the 6- or 12-minute walk test (6MWT)
Results: Aerobic and mixed training significantly improved VO2 max/peak (MD = 3.16 [2.83, 3.49], p < 0.00001; I² = 22%). Only aerobic training significantly enhanced 6MWT performance (MD = 34.30 [25.08, 43.53], p < 0.00001; I² = 25%). Sensitivity analysis revealed that VO2 max/peak gains were greater with moderate-to-high intensity, while moderate intensity sufficed for 6MWT improvement. The optimal regimen was 45-minute sessions of moderate-to-high intensity aerobic training, at least three times weekly for a minimum of eight weeks.
Conclusion: Moderate-to-vigorous aerobic training enhances physical fitness in chronic stroke. High-intensity and mixed training programs yield greater maximal fitness improvements, while moderate intensity benefits sub-maximal capacity. Targeted, intensity-monitored exercise programs of ≥45 minutes, three times weekly over ≥8 weeks, are recommended for significant fitness gains.
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References
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