It has been shown that patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. have been shown to have low endurance during exercise, likely due to both the event and also as a secondary reaction to forced inactivity. It is also known that there is a positive connection between aerobic capacity and functional performance (Katz-Leurer et al. 2003). This module will focus on aerobic exercise for people who are in the chronic phase (longer than 6 months post strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.) of recovery.
Click here to view the AEROBICS 2019 Update Best Practice Recommendations.
Click here to access the CPSR 2013 Clinicians’ guide.
Click here to access the CPSR 2013 Patients’ guide.
Aerobic exercise refers to physical activity that requires the body to use oxygen to generate energy. Participating in aerobic exercise is important to maintain a healthy body. A major benefit of aerobic exercise is that it conditions the heart and lungs. It does so by increasing the oxygen available to the body and enabling the heart to use oxygen more efficiently. In addition, aerobic exercise can also control body fat, increase energy, decrease tension, increase stamina, and improve mood. There are several different types of aerobic exercises that can be done at different levels of intensity for varying periods of time. Any activity that lasts longer than 3 minutes is considered aerobic (such as golf, biking, walking, and swimming). Note: While other forms of exercises (such as those focused on flexibilityThe ability to shift between different thoughts and actions so that when a problem arises, one can draw upon past mistakes and successes and use this knowledge to plan solutions (Anderson, 2008) and muscles training) are equally important, only those focusing on aerobic exercise will be addressed in this module.
Why is exercise important after I have had a stroke?
After a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., it is common to experience continued difficulties in mobility, for example in walking. It is important to continue to exercise despite these challenges to avoid a vicious cycle, where difficulty in mobility leads to lack of exercise, and lack of exercise leads to further muscle weakening and reduced fitness. Inactivity can contribute to physical complications, including osteoporosis and decreased circulation. It can also lead to loss of independence, depressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression. , and social isolation. The more inactive you are, the harder it is to maintain cardiovascular, mental, and neurological health.
Can exercise still be useful in the chronic phase?
While traditional belief was that most of an individual’s physical recovery occurred within the first several months after having a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., recent research has shown that an exercise program after this period, including in the chronic phase, can be beneficial as well. Research studies have shown that exercise during the chronic phase post strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. can lead to an improvement of one’s physical and mental well being, heart function, endurance, general quality of life, and movement. In addition, exercise can help to lower blood pressure, create a healthy balance of fats in the blood, help the body to maintain a healthy level of insulin, and minimize depressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression. .
How do I begin to exercise after a stroke?
Before beginning an exercise program, it is recommended that you undergo a comprehensive medical evaluation to assess your specific needs. Your medical or rehabilitation team can work with you to develop an appropriate exercise regime (including types of activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. , how often you should participate in activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. and for how long) based on your individual needs and abilities.
What kind of activities should I do?
You should pick an activity that you will have fun doing. Examples of aerobic exercise activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. include:
Golf
Walking
Dancing With permission of Dr. Patricia McKinley, McGill School of Physical and Occupational Therapy
Swimming
Cycling
Tennis
Bowling
Gardening and housework are also great forms of aerobic exercise. Try adding exercise to your daily routine, for example, parking your car further away from your destination. Any form of physical activity can be beneficial as long as it is done regularly and consistently. When it comes to bicycling, many people find it difficult or are afraid to fall. This problem can be solved by using a stationary bicycle. Stationary bicycles are a safe and effective means of low-impact, or light, aerobic exercise, so they are a good choice for people who have had a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. They can also be altered to fit your individual needs. Treadmills are also helpful for walking, providing that there is a bar to hold on to, and a way to modify speed and intensity. A treadmill is especially useful to retrain people who have had a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to walk again.
Can I participate in the same exercise as before?
After a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., it may be difficult to resume the same activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. that you enjoyed before. You may need to change your previous exercise regime, which may mean discovering new exercise activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. that are perhaps less physically demanding. Things that you may need to modify are:
The level of difficulty of exercise
Length of time you exercise
How often you exercise
These will depend on your needs and abilities and should be assessed by a rehabilitation team. Certain equipment can also be used to facilitate exercising, such as handrails and assistive devicesAssistive devices are any piece of equipment that you use to make your daily activities easier to perform. . For example, you may enjoy swimming but may need to find a pool that has special safety equipment and adaptations.
Who can help me resume my exercise activities?
While rehabilitation staff, such as occupational therapists, physiotherapists, social workers, recreation therapists, and psychologists will start you on your new exercise program, your family and friends are an excellent source of support to help you continue with success. Exercising with a friend or family member is motivating, encouraging, and of course more fun.
How much exercise should I do?
According to the American Heart Association, the recommended frequency of training is 3 to 7 days a week, with a duration of 20 to 60 minutes per day, depending on the patient’s level of fitness. ** Once again, however, it is very important that you seek medical advice before beginning an exercise program and get advice on how often and for how long you should be doing the activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. . Where can I participate in exercise? While in the hospital or rehabilitation centre, you will participate in exercise programs developed and assisted by your rehabilitation team. When you are ready to go home, the team may show you how to continue with this exercise on your own, may recommend that you join an exercise program, or a combination of the two. Day centers, local community centers, and gyms in your area may be able to provide appropriate programs and support that you need.
Researchers have studied how aerobic exercise can help with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. in the sub-acute phase and found the following:
Aerobic Capacity: this is the highest amount of oxygen consumed during maximal exercise. Studies showed that aerobic exercise improved aerobic capacity.
Heart rate: with aerobic exercise, heart rate did not increase in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This is a positive outcome.
Walking: in some studies, aerobic exercise was shown to improve walking distance and speed.
Endurance: strong evidence has shown aerobic exercise improves endurance in people with sub-acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression. : studies have shown that aerobic exercise can improve depressive symptoms in individuals with sub-acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., but only in the short term.
Quality of Life: performing aerobic exercise also seemed to improve the quality of life of people with sub-acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Balance: aerobic exercise was shown to improve some aspects of balance in people with sub-acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Are there any side effects or risks?
While exercise is mostly risk-free, it is important to stay within your own personal threshold. As mentioned before, it is best to consult with your doctor or therapist before beginning an exercise program. They will assist you in determining how often you should exercise, what activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. you should participate in, and how intense they should be. If you were physically active before the strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., you may or may not be able to continue with the same activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. . You may simply need to modify those activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. so they are easier for you. If you feel dizzy, have pain (especially in your chest) or have difficulty breathing, stop exercising immediately and tell your healthcare provider.
Clinician Information
Note: When reviewing the findings, it is important to note that they are always made according to randomized clinical trial (RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.) criteria – specifically as compared to a control group. To clarify, if a treatment is “effective” it implies that it is more effective than the control treatment to which it was compared. Non-randomized studies are no longer included when there is sufficient research to indicate strong evidence (level 1a) for an outcome.
Note: Only studies that included at least one outcome measure for aerobic capacity (VO2, heart rate and/or workload during either a maximal stress test on a treadmill or a cycle ergometer) are included in this report. The only exception is when there is a follow-up of the study groups at a later date using other outcome measures such as depression, quality of life etc. All studies to date that have examined the effect of aerobic exercise on chronic stroke featured a “cocktail” of different types of treatment (e.g. strength training, flexibilityThe ability to shift between different thoughts and actions so that when a problem arises, one can draw upon past mistakes and successes and use this knowledge to plan solutions (Anderson, 2008) training as well as a strong aerobic training component) so it is important to note that the effects of these interventions may be due in part to the combination of different treatments and not the aerobic component specifically. As well it should be noted that some of the studies contain small sample sizes, which can lead to inconclusive results. More studies with larger sample size are needed before conclusive result can be found.
The studies that meet the inclusion criteria (4 high quality RCTs, 5 fair quality RCTs, 2 quasi-experimental studies, 1 pre-post design study, 1 repeated measures study and 1 non-controlled intervention study) suggest that a sustained exercise program containing an aerobic component provided over a period of at least 8 weeks, 3 x per week, may improve aspects of physiological function, physical function, and emotional well-being in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Outcomes
Activity and participation
Not effective
1b
One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Pang et al., 2005) and one quasi-experimental non-randomized trial (Sunnerghagen, 2007) examined the effects of aerobic exercise on activity and participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Pang et al., 2005) investigated the effect of aerobic exercise on activity and participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. No significant difference in scores on the Physical Activity Scale for Individuals with Physical Disabilities was found between the intervention group who received 19 weeks of cardiorespiratory fitness, mobility, balance and leg muscle strength exercise (the FAME program), and the control group who received a 19-week seated upper extremity exercise program.
In the quasi-experimental non-randomized trial, Sunnerghagen (2007) investigated the effect of circuit training on strength, aerobic capacity, and activity and participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. in community-living “young” males with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The experimental group trained for 45 minutes 3x/week for 8 weeks on strength, endurance and aerobic capacity whereas the controls received no treatments. At post treatment non-significant differences were found within the experimental group for activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. of daily living (ADLs) as measured by the Functional Independence Measure and Instrumental Activity Measure and for physical activity level as assessed with the Physical Activity Scale for the Elderly.
Note: The quasi-experimental non randomized trial did not report between group differences and is therefore not included in determining level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines).
Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that aerobic exercise does not improve activity and participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Ambulation and transfers
Effective
1b
One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Quaney et al., 2009) found a significant improvement in ambulation and transfers (as measured by the Get Up and Go test) in favour of the intervention group immediately following an 8-week progressive, resistive stationary bicycle exercise program, compared to the control group that completed an 8-week upper and lower extremity stretching program. Note: This difference between groups was not seen on follow-up assessment 8 weeks later.
Conclusion: There is moderate evidence (level 1b) from one high quality study that aerobic exercise improves ambulation and transfer skills in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. versus a stretching program, in the short term.
Attention
Insufficient evidence
5
One pre-post design study (Kluding et al., 2011) investigated the effect of aerobic exercise on attention in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and found no significant improvement in attention (measured by the Flanker Test – recognition of congruent and incongruent stimuli), from baseline to post-intervention following a 12-week aerobic and strengthening exercise program. Note: This study did not compare aerobic training to a non-aerobic control, therefore it was not used to determine the level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) for the effectiveness of aerobic training.
Conclusion: There is insufficient evidence (level 5) regarding the efficacy of aerobic exercise on attention. However, one non-controlled study reported no improvement in attention following an aerobic exercise program.
Balance
Not effective
1a
Three high quality RCTs (Chu et al., 2004, Pang et al., 2005, Quaney et al., 2009) and one fair quality RCTs (Janssen et al., (2008) investigated the effect of aerobic exercise on balance in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
In the first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness., Chu et al., (2004) found no significant post-intervention difference for balance (measured by the Berg Balance Scale) between the intervention group who received an 8-week chest-deep water-aerobic program compared to the control group who received arm and hand exercises while sitting. Note: The authors pointed out that the lack of significant improvements for balance may have been due to the buoyancy of the water during the training aiding the participants too much. As well pre-test scores on the Berg Balance Scale were quite high which may have led to a ceiling effectA ceiling effect occurs when test items aren’t challenging enough for a group of individuals. Thus, the test score will not increase for a subsample of people who may have clinically improved because they have already reached the highest score that can be achieved on that test. In other words, because the test has a limited number of difficult items, the most highly functioning individuals will score at the highest possible score. This becomes a measurement problem when you are trying to identify changes – the person may continue to improve but the test does not capture that improvement. Example: A memory test that assesses how many words a participant can recall has a total of five words that each participant is asked to remember. Because most individuals can remember all five words, this measure has a ceiling effect. See also “floor effect.” (inability to detect further improvement in those already scoring at the top of the Scale initially).
In the second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness., Pang et al., (2005) found no significant difference in balance (as measured by the Berg Balance Scale) between the intervention group who followed the FAME program (19 weeks of cardiorespiratory fitness, mobility, balance and leg muscle strength exercises), and the control group who followed a 19-week seated upper extremity exercise program. Note: Pre-test scores on the Berg Balance Scale were quite high which may have led to a ceiling effectA ceiling effect occurs when test items aren’t challenging enough for a group of individuals. Thus, the test score will not increase for a subsample of people who may have clinically improved because they have already reached the highest score that can be achieved on that test. In other words, because the test has a limited number of difficult items, the most highly functioning individuals will score at the highest possible score. This becomes a measurement problem when you are trying to identify changes – the person may continue to improve but the test does not capture that improvement. Example: A memory test that assesses how many words a participant can recall has a total of five words that each participant is asked to remember. Because most individuals can remember all five words, this measure has a ceiling effect. See also “floor effect.” (inability to detect further improvement in those already scoring at the top of the Scale initially).
The third high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness., Quaney et al., 2009 investigated the effects of aerobic exercise on balance (as measured by the Berg Balance Scale). Patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. were randomized to an intervention group that completed an 8-week progressive resistive stationary bicycle exercise program, or a control group that completed an 8-week upper and lower extremity stretching program. A trend towards a significant difference in balance scores was seen immediately following completion of the program (8 weeks) that reached significance at follow-up assessment (16 weeks), in favour of the intervention group.
In the fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness., Janssen et al., (2008) investigated the effectiveness of functional electrical stimulation FES- assisted leg cycling training on improving aerobic capacity, maximal power output, muscle strength and functional performance in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Both groups received cycling training in conjunction with FES twice a week for 6 weeks. However, the treatment group received FES evoking muscle contractions while the control group received sensible FES which could be felt but did not evoke muscle contractions. At post treatment there was no statistically significant difference between groups in balance as measured by the Berg Balance Scale.
Conclusion: There is strong evidence (level 1a) from three high quality RCTs and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that aerobic exercise does not improve balance in individuals with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Note: Pretest scores on the Berg Balance Scale were quite high which may have led to a ceiling effectA ceiling effect occurs when test items aren’t challenging enough for a group of individuals. Thus, the test score will not increase for a subsample of people who may have clinically improved because they have already reached the highest score that can be achieved on that test. In other words, because the test has a limited number of difficult items, the most highly functioning individuals will score at the highest possible score. This becomes a measurement problem when you are trying to identify changes – the person may continue to improve but the test does not capture that improvement. Example: A memory test that assesses how many words a participant can recall has a total of five words that each participant is asked to remember. Because most individuals can remember all five words, this measure has a ceiling effect. See also “floor effect.” (inability to detect further improvement in those already scoring at the top of the Scale initially). Note: One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found differences approaching significance on completion of the aerobic exercise program, which then became significant 8 weeks after completion of the program. Two high quality studies note that high pretest scores on the Berg Balance Scale may have led to a ceiling effectA ceiling effect occurs when test items aren’t challenging enough for a group of individuals. Thus, the test score will not increase for a subsample of people who may have clinically improved because they have already reached the highest score that can be achieved on that test. In other words, because the test has a limited number of difficult items, the most highly functioning individuals will score at the highest possible score. This becomes a measurement problem when you are trying to identify changes – the person may continue to improve but the test does not capture that improvement. Example: A memory test that assesses how many words a participant can recall has a total of five words that each participant is asked to remember. Because most individuals can remember all five words, this measure has a ceiling effect. See also “floor effect.”, influencing the results of the studies.
Blood lipid profile
Effective
2b
One quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints. (Rimmer et al., 2009) found an improvement in triglycerides (lowered) and low-density lipoprotein cholesterol (lowered) in favour of both moderate intensity shorter duration (MISD) exercise or low-intensity longer duration exercise (LILD) compared to conventional therapeutic exercise (TE) following 14 weeks of intervention.
Conclusion: There is limited evidence (level 2b) from one quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints. that aerobic exercise can improve the blood lipid profile of those with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Blood pressure
Effective
2a
One fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Potempa et al., 1995) and one quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints. (Rimmer et al., 2009) investigated the effect of aerobic exercise on blood pressure in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
One fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Potempa et al., 1995) investigated the effect of aerobic exercise on blood pressure in an intervention group that received a 10-week progressive aerobic training program on a bicycle ergometer, and a control group that received a 10-week range of motion training program. While no overall significant between group differences were found for resting and sub-maximal blood pressure, a significant between group differences in sub-maximal systolic blood pressure was found in favour of a subgroup of patients in the intervention group who were able to work at a peak workload of at least 40 watts.
One quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints. (Rimmer et al., 2009) found an improvement in diastolic blood pressure following moderate intensity shorter duration exercise compared to conventional therapeutic exercise (TE), but no difference between low-intensity longer duration exercise (LILD) and TE, following 14 weeks of intervention.
Conclusion: There is limited evidence (level 2a) from one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. demonstrating that aerobic exercise at a peak workload of at least 40 watts improves sub-maximal systolic blood pressure in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. However, no effect was found for resting blood pressure or sub-maximal blood pressure. Furthermore, one quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints. found that aerobic exercise (moderate intensity and short duration) can improve the blood pressure of patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Body composition
Effective
2a
One fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. with a pre-post lag-control design (Rimmer et al., 2000) investigated the effect of aerobic exercise on body composition, defined as a combination of body weight, body mass index, and total skinfold, in predominantly African-American patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. A significant reduction in body weight, body mass index, and total skinfold (indicating an improvement in body composition as most of the patients were considered overweight), was found in favor of the intervention group following a 12-week aerobic, strength and flexibilityThe ability to shift between different thoughts and actions so that when a problem arises, one can draw upon past mistakes and successes and use this knowledge to plan solutions (Anderson, 2008) exercise training program, compared to the control group who received no intervention.
Conclusion: There is limited evidence (level 2a) from one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that aerobic exercise improves body composition by reducing body weight, body mass index, and total skinfold in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Bone mineral density
Effective
1b
One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Pang et al., 2005) investigated the effect of aerobic exercise on bone mineral density in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. A significant difference in femoral neck bone mineral density on the paretic side (as measured using dual-energy x-ray absorptiometry), was found in favour of the intervention group who followed the FAME program (19 weeks of cardiorespiratory fitness, mobility, balance and leg muscle strength exercises), compared to the control group who followed a 19-week seated upper extremity exercise program. No significant difference was found on the non-paretic side.
Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. reporting that aerobic exercise improves femoral neck bone mineral density on the paretic side, but not the non-paretic side, in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Carbon dioxide production
Effective
2a
One fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Potempa et al., 1995) investigated the effect of aerobic exercise on carbon dioxide production. A significant between group difference was found for peak VCO2Volume of carbon dioxide production. in favour of the intervention group that received a 10-week progressive aerobic training program on a bicycle ergometer, compared to the control group that received a 10-week range of motion training program.
Conclusion: There is limited evidence (level 2a) from one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. demonstrating that aerobic exercise increases VCO2Volume of carbon dioxide production. in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Depression
Insufficient evidence
5
One repeated measures study (Rand et al., 2010) investigated the effect of aerobic exercise on depressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression. symptoms in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., as measured using the Geriatric DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression. Scale. No significant change in depressive symptoms was seen at 3 or 6 months.
Conclusion: There is insufficient evidence (level 5) to indicate whether aerobic exercise is effective in improving depressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression. in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. However, one repeated measures study found that aerobic exercise and recreation does not improve depressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression. symptoms.
Disability related to mobility
Not effective
2a
One fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Macko et al., 2005) investigated the effect of aerobic exercise on disability related to bodily mobility in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The intervention group received a 6-month progressive treadmill training program with a target of 35 minutes at 60-70% heart rate reserve, and the control group received a stretching program combined with 5-minutes of low-intensity treadmill training at 30-40% heart rate reserve. No significant between group difference was found on the Rivermead Mobility Index, indicating no effect on disability related to bodily mobility.
Conclusion: There is limited evidence (level 2a) from one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. indicating that aerobic exercise does not improve disability related to bodily mobility (as measured by the Rivermead Mobility Index) in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Endurance
Effective
2a
Two fair quality RCTs (Potempa et al., 1995, Rimmer et al., 2000) investigated the effect of aerobic exercise on endurance in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
In the first fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness., Potempa et al. (1995) found a significant increase in exercise time (indicating an improvement in endurance) in favour of the intervention group who received a 10-week progressive aerobic training program on a bicycle ergometer, compared to the control group who received a 10-week range of motion training program.
In the second fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness., using a lag-control design, Rimmer et al. (2000) found a significant increase in time to exhaustion, (indicating an improvement in endurance) in favour of the intervention group following a 12-week aerobic, strength and flexibilityThe ability to shift between different thoughts and actions so that when a problem arises, one can draw upon past mistakes and successes and use this knowledge to plan solutions (Anderson, 2008) training program, compared to the control group who received no intervention.
Conclusion: There is limited evidence (level 2a) from two fair quality RCTs that aerobic exercise improves endurance in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Executive function
Not effective
1b
One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Quaney et al., 2009) and one repeated measures study (Rand et al., 2010) investigated the effect of aerobic exercise on executive function in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
The high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Quaney et al., 2009) randomized patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to an intervention group that completed an 8-week progressive, resistive stationary bicycle exercise program, or a control group that completed an 8-week upper and lower extremity stretching program. No significant between-group differences in executive function were found on completion of the program (8-weeks) or on follow-up assessment (16-weeks), as measured by the Wisconsin Card Sorting Task, Stroop task and Trail-Making task.
The repeated measures study (Rand et al., 2010) investigated the effect of a 6-month aerobic and recreation program on executive function, as measured by the Stroop Test, Verbal Digital Span Backward Test (VDSBT), Trail Making Test (Part B), Walking While Talking test (WWT), and Rey Auditory Verbal Learning Test (RAVLT). In comparison to baseline scores, significant improvements were seen on the Stroop Test, WWT and RAVLT – long delay at 3 months, and persisted on the Stroop Test at 6 months.
Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that aerobic exercise does not improve executive function in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., when compared with a stretching program. NOTE: However, one repeated measures study found that participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. in an exercise and recreation program can improve performance of dual tasks, response inhibitionThe ability to suppress automatic actions that are inappropriate in a given context that interfere with a certain behavior (Grieve & Gnanasekaran, 2008) and memory in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Flexibility
Effective
2a
One fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. with a pre-post lag-control design (Rimmer et al., 2000) investigated the effect of aerobic exercise on flexibilityThe ability to shift between different thoughts and actions so that when a problem arises, one can draw upon past mistakes and successes and use this knowledge to plan solutions (Anderson, 2008) in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. A significant improvement in hamstring and low back flexibilityThe ability to shift between different thoughts and actions so that when a problem arises, one can draw upon past mistakes and successes and use this knowledge to plan solutions (Anderson, 2008) (as assessed by the sit and reach test), was found in favour of the intervention group following a 12-week aerobic, strength and flexibilityThe ability to shift between different thoughts and actions so that when a problem arises, one can draw upon past mistakes and successes and use this knowledge to plan solutions (Anderson, 2008) exercise training program, compared to the control group who received no intervention. No significant gain in shoulder flexibilityThe ability to shift between different thoughts and actions so that when a problem arises, one can draw upon past mistakes and successes and use this knowledge to plan solutions (Anderson, 2008) of the affected and unaffected extremity was reported pre/post exercise.
Conclusion: There is limited evidence (level 2a) from one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that an aerobic exercise improves hamstring and low back flexibilityThe ability to shift between different thoughts and actions so that when a problem arises, one can draw upon past mistakes and successes and use this knowledge to plan solutions (Anderson, 2008) , but does not improve shoulder flexibilityThe ability to shift between different thoughts and actions so that when a problem arises, one can draw upon past mistakes and successes and use this knowledge to plan solutions (Anderson, 2008) in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Note: The program included a flexibilityThe ability to shift between different thoughts and actions so that when a problem arises, one can draw upon past mistakes and successes and use this knowledge to plan solutions (Anderson, 2008) component making it difficult to differentiate the effect of the aerobic exercise alone.
Gait speed
Conflicting
4
Two high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Chu et al., 2004, Lee et al., 2008), two fai quality RCTs (Macko et al., 2005, Luft et al., 2008) and two non-controlled intervention studies (Rand et al., 2010, Kluding et al., 2011) examined the effect of aerobic exercise on gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. speed.
One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Chu et al., 2004) investigated the effect of aerobic exercise on functional mobility as measured by walking speed in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. A significant increase in walking speed (measured by self-selected gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. speed over 8 meters) was found in favour of the intervention group following an 8-week chest-deep water-aerobic program, compared to the control group who received arm and hand exercises while sitting.
The second high quality (Lee et al., 2008) found no significant improvement in walking speed following 10 to 12 weeks of aerobic cycling compared to sham cycling.
The first fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Macko et al., 2005) investigated the effect of aerobic exercise on gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. speed in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The intervention group received a 6-month progressive treadmill training program with a target of 35 minutes at 60-70% heart rate reserve, and the control group received a stretching program combined with 5-minutes of low-intensity treadmill training at 30-40% heart rate reserve. No significant between group difference was found for the 30-foot walking speed (at both usual pace or at fast pace), or the speed subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). of the Walking Impairment Questionnaire.
A second fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Luft et al., 2008) found a significant increase in peak effort treadmill walking velocity and average walking velocity over 6-minutes (over ground), for a group of patients who received 6 months of progressive task-repetitive treadmill training with a target of 40 minutes at 60% heart rate reserve, compared to a control group who received a therapist assisted stretching program for a comparable duration. No significant between group difference was found for fastest walking velocity over 10-meters (over ground).
One repeated measures study (Rand et al., 2010) investigated the effect of a 6-month aerobic and recreation program on gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. speed in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., as measured by the 5-meter walk test. A significant improvement in gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. speed was seen at 3 months and a non-significant trend was seen on re-assessment at 6 months, as compared to baseline measures.
A pre-post design study (Kluding et al., 2011) found no significant improvement in self-selected gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. speed (measured by the 10-m walk test) from baseline to post-intervention following a 12-week aerobic and strengthening exercise program. Note: This study did not compare aerobic training to a non-aerobic control, therefore it was not used to determine the level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) for the effectiveness of aerobic training.
Conclusion: There is conflicting evidence (level 4) as to whether aerobic exercise improves gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. speed in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. While 1 high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and 1 fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that aerobic exercise improves aspects of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. speed, another high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found no improvement in gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. speed. NOTE: The high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that found positive results provided chest-deep water-aerobic program as part of the intervention, while the high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that did not find positive results used aerobic cycling as the intervention.
Memory
Insufficient evidence
5
One pre-post design study (Kluding et al., 2011) investigated the effect of aerobic exercise on memory in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and found a significant improvement in working memoryExecutive process responsible for the temporary storage and manipulation of information in both simple (e.g. recalling a series of digits such as a phone number) and complex cognitive tasks (e.g. coordinating two tasks simultaneously) (Van der Linden, 2007) (measured by the Digit Span Backwards task) but no significant improvement in self-reported memory (measured by the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Impact Scale memory component) from baseline to post-intervention following a 12-week aerobic and strengthening exercise program. Note: This study did not compare aerobic training to a non-aerobic control, therefore it was not used to determine the level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) for the effectiveness of aerobic training.
Conclusion: There is insufficient evidence (level 5) regarding the efficacy of aerobic exercise on memory. However, one non-controlled study reported improved working memoryExecutive process responsible for the temporary storage and manipulation of information in both simple (e.g. recalling a series of digits such as a phone number) and complex cognitive tasks (e.g. coordinating two tasks simultaneously) (Van der Linden, 2007) following an aerobic exercise program.
Mobility
Insufficient evidence
5
One pre-post design study (Kluding et al., 2011) investigated the effect of aerobic exercise on mobility in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. (measured by the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Impact Scale mobility subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). ) and found a strong trend toward significant improvement from baseline to post-intervention following a 12-week aerobic and strengthening exercise program. Note: This study did not compare aerobic training to a non-aerobic control, therefore it was not used to determine the level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) for the effectiveness of aerobic training.
Conclusion: There is insufficient evidence (level 5) regarding the efficacy of aerobic exercise on mobility. However, one non-controlled study reported a strong trend towards improved mobility following an aerobic exercise program.
Motor learning
Effective
1b
One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Quaney et al., 2009) investigated the effect of an aerobic exercise program on conditional learning (as measured by predictive force accuracy using Predictive Grip Force Modulation tasks) and on implicit learning (as measured by sequence-specific and random-sequence reaction times on the Serial Reaction Timed Task). Patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. were randomized to an intervention group that completed an 8-week progressive resistive stationary bicycle exercise program, or a control group that completed an 8-week upper and lower extremity stretching program. Significant between-group differences in both predictive force accuracy (conditional learning) and sequence-specific reaction time (implicit learning) were found in favour of the intervention group immediately following completion of the exercise program (8 weeks) but these differences were not maintained at follow-up assessment (16 weeks). No significant group differences were seen for random-sequence reaction time (implicit learning).
Conclusion: There is moderate evidence (level 1b) from one high quality study that aerobic exercise improves conditional learning and some aspects of implicit learning (sequence-specific reaction times) in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. in the short term, when compared with a stretching program.
Peak heart rate
Not effective
1b
One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Lee et al., 2008), one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Potempa et al., 1995) and one quasi-experimental non-randomized trial (Sunnerghagen, 2007) investigated the effect of aerobic exercise on peak heart rate in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
The high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Lee et al., 2008) found no significant improvement in peak rate (during a test of maximal effort on a bicycle ergometer) following 10 to 12 weeks of aerobic cycling compared to sham aerobic cycling. However, it should be noted that a trend toward significance was found (p=.07) and that the non-significant result may be due to a small N.
One fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Potempa et al., 1995) found no significant difference was found for peak heart rate during a maximal test on a bicycle ergometer between the intervention group, who received a 10-week training program on an adjusted bicycle ergometer and the control group who received a passive range of motion exercise program.
In the quasi-experimental non-randomized trial, Sunnerghagen (2007) investigated the effect of circuit training on strength, aerobic capacity, and activity and participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. in community-living “young” males with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The experimental group trained for 45 minutes 3x/week for 8 weeks on strength, endurance and aerobic capacity whereas the controls received no treatments. At post treatment non-significant differences were found within the experimental group for peak heart rate as tested while on the electrical bicycle ergonometer. Note: The quasi-experimental non randomized trial did not report between group differences and is therefore not included in determining level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines).
Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that aerobic exercise does not increase peak heart rate in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
In the first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness., Chu et al. (2004) found a significant increase in peak VO2Blood oxygen level. during a test of maximal effort on a bicycle ergometer (indicating an improvement in aerobic capacity) in favour of the intervention group following an 8-week chest-deep water-aerobic program, compared to the control group who received 8 weeks of arm and hand exercises while sitting.
In the second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness., Pang et al. (2005) found a significant increase in peak VO2Blood oxygen level. during a test of maximal effort on a bicycle ergometer (indicating an improvement in aerobic capacity) in favour of the intervention group immediately following a 19-week program of cardiorespiratory fitness, mobility, balance and leg muscle strength exercises (the FAME program), compared to the control group who followed a 19-week seated upper extremity exercise program.
The third high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Lee et al., 2008) showed a significant improvement in peak VO2Blood oxygen level. (during a test of maximal effort on a bicycle ergometer) following 10 to 12 weeks of aerobic cycling compared to sham aerobic cycling.
The fourth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Quaney et al., 2009) found a significant improvement in peak VO2Blood oxygen level. on metabolic stress testing in favour of the intervention group immediately following an 8-week progressive, resistive stationary bicycle exercise program, compared to the control group that completed an 8-week upper and lower extremity stretching program.
Note: This difference between groups was not seen on follow-up assessment 8 weeks later.
The first fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Potempa et al. (1995) found a significant increase in peak VO2Blood oxygen level. during a test at maximal effort on a bicycle ergometer (indicating an improvement in aerobic capacity) in favour of the intervention group following a 10-week training program on an adjusted bicycle ergometer compared to the control group who received a passive range of motion exercise program.
The second fair quality study (Rimmer et al. (2000) – using a lag-control design – found a significant increase in peak VO2Blood oxygen level. during a test of maximum effort on a bicycle ergometer (indicating an improvement in aerobic capacity) in favour of the intervention group following a 12-week aerobic, strength and flexibilityThe ability to shift between different thoughts and actions so that when a problem arises, one can draw upon past mistakes and successes and use this knowledge to plan solutions (Anderson, 2008) training program, compared to the control group who received no intervention.
Note: The control group then went on to receive the intervention as indicated by the “lag-control” study design.
The third fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Macko et al. (2005) found a significant increase in peak VO2Blood oxygen level. during a treadmill stress test (indicating an improvement in aerobic capacity) in favour of the intervention group following a 6-month progressive treadmill training program with a target length of 35 minutes at 60-70% heart rate reserve, compared to the control group who received a stretching program combined with 5-minutes of low-intensity treadmill training at 30-40% heart rate reserve.
A fourth fair quality study, Janssen et al. (2008) investigated the effectiveness of FES-assisted leg cycling training on improving aerobic capacity, maximal power output, muscle strength and functional performance in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Both groups received cycling training in conjunction with FES twice a week for 6 weeks. However, the treatment group received FES evoking muscle contractions while the control group received sensible FES, which could be felt but did not evoke muscle contractions. At post treatment there was no statistically significant difference between groups in aerobic capacity as measured by VO2Blood oxygen level. max.
Note: This study did not compare aerobic training to a non-aerobic control, therefore it was not used to determine the level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) for the effectiveness of aerobic training.
In the fifth fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness., Luft et al. (2008) found a significant increase in peak VO2Blood oxygen level. during a treadmill stress test, for a group of patients who received 6 months of progressive task-repetitive treadmill training with a target of 40 minutes at 60% heart rate reserve, compared to the control group who received a therapist assisted stretching program for a comparable duration.
In the quasi-experimental non-randomized trial, Sunnerghagen (2007) investigated the effect of circuit training on strength, aerobic capacity, and activity and participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. in community-living “young” males with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The experimental group trained for 45 minutes 3x/week for 8 weeks on strength, endurance and aerobic capacity whereas the controls received no treatments. At post treatment non-significant differences were found within the experimental group for peak VO2Blood oxygen level. .
Note: The quasi-experimental non-randomized trial did not report between group differences and is therefore not included in determining level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines).
The second quasi-experimental (Rimmer et al., 2009) found no difference in peak VO2Blood oxygen level. between moderate intensity, shorter duration (MISD) exercise or low-intensity longer duration exercise (LILD) compared to conventional therapeutic exercise (TE) following 14 weeks of intervention.
One non-controlled intervention study (Macko et al., 2001) investigated the effect of aerobic exercise on peak VO2Blood oxygen level. in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. A significant increase in peak VO2Blood oxygen level. during a treadmill stress test, indicating an improvement in aerobic capacity, was found for 23 patients who received a 6-month progressive treadmill training program with a target of approximately 40 minutes at 60-70% heart rate reserve.
A pre-post design study (Kluding et al., 2011) found a strong trend toward significantly improved peak VO2Blood oxygen level. from baseline to post-intervention following a 12-week aerobic and strengthening exercise program.
Note: This study did not compare aerobic training to a non-aerobic control, therefore it was not used to determine the level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) for the effectiveness of aerobic training.
Conclusion: There is strong evidence (level 1a) from four high quality RCTs, four fair quality RCTs, and one non-controlled intervention study that aerobic exercise significantly increases peak VO2Blood oxygen level. (indicating an improvement in aerobic capacity) in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. when compared with a range of control therapies including stretching exercises, sham aerobic activity, conventional therapy and no intervention.
Peak volume of total exhalation
Effective
2a
One fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Potempa et al., 1995) investigated the effect of aerobic exercise on volume of exhalation (VEVolume of total expiration. ). A significant between group difference was found for peak VEVolume of total expiration. in favour of the intervention group that received a 10-week progressive aerobic training program on a bicycle ergometer, compared to the control group that received a 10-week range of motion training program.
Conclusion: There is limited evidence (level 2a) from one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. demonstrating that aerobic exercise increases peak VEVolume of total expiration. in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Peak workload
Effective
1a
Two high quality RCTs (Chu et al., 2004, Lee et al., 2008), three fair quality RCTs (Potempa et al., 1995, Rimmer et al., 2000, Janssen et al., 2008), one quasi-experimental non-randomized trial, (Sunnerghagen, 2007) and one non-controlled intervention study (Macko et al., 2001) investigated the effect of aerobic exercise on peak workload in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Chu et al., 2004) investigated the effect of aerobic exercise on peak workload in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. A significant increase in peak workload during a test of maximal effort on a bicycle ergometer, indicating an improvement in aerobic capacity, was found in favour of the intervention group following an 8-week chest-deep water-aerobic program, compared to the control group who received arm and hand exercises while sitting.
A second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Lee et al., 2008) showed a significant improvement in peak power output (during a test of maximal effort on a bicycle ergometer) following 10 to 12 weeks of aerobic cycling compared to sham aerobic cycling.
The first fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Potempa et al. 1995) found a significant increase in peak workload during a maximal test on a bicycle ergometer (indicating an improvement in aerobic capacity) in favour of the intervention group following a 10-week training program on an adjusted bicycle ergometer compared to the control group that received a passive range of motion exercise program.
The second fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Rimmer et al. (2000), using a lag-control design, also found a significant increase in peak workload (indicating an improvement) in favour of the intervention group following a 12-week aerobic, strength and flexibilityThe ability to shift between different thoughts and actions so that when a problem arises, one can draw upon past mistakes and successes and use this knowledge to plan solutions (Anderson, 2008) exercise training program, compared to the control group which received no intervention.
In the third fair quality study, Janssen et al. (2008) investigated the effectiveness of FES- assisted leg cycling training on improving aerobic capacity, maximal power output, muscle strength and functional performance in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Both groups received cycling training in conjunction with FES twice a week for 6 weeks. However, the treatment group received FES evoking muscle contractions while the control group received sensible FES which could be felt but did not evoke muscle contractions. At post treatment there was no statistically significant difference between groups in maximal power output as measured by PO max. Note: This study did not compare aerobic training to a control of non-aerobic training, therefore it was not used in determining level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines).
In the quasi-experimental non-randomized trial, Sunnerghagen (2007) investigated the effect of circuit training on strength, aerobic capacity, and activity and participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. in community-living “young” males with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The experimental group trained for 45 minutes 3x/week for 8 weeks on strength, endurance and aerobic capacity whereas the controls received no treatments. At post treatment non-significant differences were found within the experimental group for peak workload as tested while on the electrical bicycle ergometer. Note: The quasi-experimental non randomized trial did not report between group differences and is therefore not included in determining level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines).
One non-controlled intervention study (Macko et al., 2001) investigated the effect of aerobic exercise on peak workload in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. A significant increase in peak workload during a treadmill stress test, indicating an improvement in aerobic capacity, was found for 23 patients who received a 6-month progressive treadmill training program with a target of approximately 40 minutes at 60-70% heart rate reserve.
Conclusion: There is strong evidence (level 1a) from two high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness., 2 fair quality RCTs, and one non-controlled intervention study, that aerobic exercise significantly increases peak workload – indicating an improvement in aerobic capacity – in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. However, one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that the use of FES- assisted cycling training compared to cycling training alone does not improve maximal power output in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Note that in this study, both groups performed cycling on a bicycle ergometer.
Perceived self-efficacy in functional mobility
Not effective
1b
One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Lee et al., 2008) investigated the effect of aerobic exercise on perceived self-efficacy in functional mobility and found no improvement following 10 to 12 weeks of aerobic cycling compared to sham cycling.
Conclusion: There is moderate evidence (level 1b) from one high quality study that aerobic exercise does not improve perceived self-efficacy in functional mobility when compared to sham activity.
Quality of life
Not effective
1b
One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Lee et al. 2008) investigated the effect of aerobic exercise on quality of life and found no improvement following 10 to 12 weeks of aerobic cycling compared to sham cycling.
Conclusion: There is moderate evidence (level 1b) from one high quality study that aerobic exercise does not improve quality of life.
Respiratory exchange ratio
Not effective
1b
One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Pang et al., 2005) and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Potempa et al., 1995) and one quasi-experimental non-randomized trial (Sunnerghagen, 2007) examined the effect of aerobic exercise on respiratory exchange ratio in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
The high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Pang et al., 2005), investigated the effect of aerobic exercise on respiratory exchange ratio in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. No significant difference was found for respiratory exchange ratio between the intervention group who followed the FAME program (19 weeks of cardiorespiratory fitness, mobility, balance and leg muscle strength exercises), and the control group who followed a 19-week seated upper extremity exercise program.
The fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Potempa et al., 1995), investigated the effect of aerobic exercise on respiratory exchange ratio. No significant between group differences were found between the intervention group who received a 10-week progressive aerobic training program on a bicycle ergometer, and the control group who received a 10-week range of motion training program.
In the quasi-experimental non-randomized trial, Sunnerghagen (2007) investigated the effect of circuit training on strength, aerobic capacity, and activity and participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. in community-living “young” males with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The experimental group trained for 45 minutes 3x/week for 8 weeks on strength, endurance and aerobic capacity whereas the controls received no treatments. At post treatment non-significant differences were found within the experimental group for respiratory exchange ratio. Note: The quasi-experimental non randomized trial did not report between group differences and is therefore not included in determining level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines).
Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. demonstrating that aerobic exercise has no significant effect on respiratory exchange ratio in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Resting heart rate
Not effective
2a
One fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Potempa et al., 1995) investigated the effect of aerobic exercise on resting heart rate. No significant between group differences in resting heart rate were found between the intervention group who received a 10-week progressive aerobic training program on a bicycle ergometer, and the control group who received a 10-week range of motion training program.
Conclusion: There is limited evidence (level 2a) from one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that aerobic exercise has no significant effect on resting heart rate in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Sensorimotor function
Not effective
1b
One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Quaney et al., 2009), one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Potempa et al., 1995) and one non-controlled study (Kluding et al., 2011) investigated the effect of aerobic exercise on sensorimotor function in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
The high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Quaney et al., 2009) investigated the effects of aerobic exercise on motor function (as measured by the Fugl-Meyer sensorimotor test). Patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. were randomized to an intervention group that completed an 8-week progressive, resistive stationary bicycle exercise program, or a control group that completed an 8-week upper and lower extremity stretching program. No significant between-group difference in sensorimotor function was found on completion of the program (8-weeks) or on follow-up assessment (16-weeks).
The fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Potempa et al., 1995) found no significant overall difference in sensorimotor function (as measured by the Fugl-Meyer Index (FMI) between the intervention group, who received a 10-week progressive aerobic training program on a bicycle ergometer, and the control group, who received a 10-week range of motion training program. It is of note, however, that a significant correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation. was found between improvement in aerobic capacity (as evaluated by peak VO2Blood oxygen level. ) and improvement in sensorimotor function, indicating that exercise training may benefit those who can train at an intensity that improves aerobic capacity.
A pre-post design study (Kluding et al., 2011) found a significant improvement in motor function (as measured by the Fugl-Meyer test and StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Impact Scale) from baseline to post-intervention following a 12-week aerobic and strengthening exercise program. Note: This study did not compare aerobic training to a non-aerobic control, therefore it was not used to determine the level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) for the effectiveness of aerobic training.
Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that aerobic exercise does not significantly improve sensorimotor function in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. when compared with range of motion therapy.
Stair climbing
Not effective
2a
One fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Macko et al., 2005) investigated the effect of aerobic exercise on stair climbing in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The intervention group received a 6-month progressive treadmill training program with a target of 35 minutes at 60-70% heart rate reserve, and the control group received a stretching program combined with 5-minutes of low-intensity treadmill training at 30-40% heart rate reserve. No significant between group difference was found for the stair climbing subscales of the Walking Impairment Questionnaire.
Conclusion: There is limited evidence (level 2a) from one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. indicating that aerobic exercise does not improve stair climbing in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Strength (Lower extremity)
Conflicting
4
Three high quality RCTs (Chu et al., 2004, Pang et al., 2005, Lee et al., 2008), two fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Rimmer et al., 2000, Janssen et al., 2008), one quasi-experimental non-randomized trial (Sunnerghagen, 2007) and one repeated measures study (Rand et al., 2010) investigated the effect of aerobic exercise on lower extremity muscle strength in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
In the first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness., Chu et al. (2004) found a significant increase in strength on the paretic lower limb (measured with a dynamometer for isokinetic flexor and extensor muscle strength) in favour of the intervention group following an 8-week chest-deep water-aerobic program, compared to the control group who received arm and hand exercises while sitting. However, no significant between group difference was found for the non-paretic side.
In the second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness., Pang et al. (2005) found a significant difference in leg muscle strength as measured by a hand-held dynamometer for isometric knee extension, in favour of the intervention group following 19 weeks of cardiorespiratory fitness, mobility, balance and leg muscle strength exercises (the FAME program), compared to the control group who followed a 19-week seated upper extremity exercise program.
The third high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Lee et al., 2008) found no significant improvement in lower extremity strength (measured by stair climbing power and lower limb weight lifting ability) following 10 to 12 weeks of aerobic cycling compared to sham aerobic cycling.
In one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness., using a pre-post lag-control design, Rimmer et al. (2000) investigated the effect of aerobic exercise on strength in predominantly African-American patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. A significant increase in the amount of weight the patients were able to lift during a bench press and a leg press, indicating an improvement in strength, was found in favour of the intervention group following a 12-week aerobic, strength and flexibilityThe ability to shift between different thoughts and actions so that when a problem arises, one can draw upon past mistakes and successes and use this knowledge to plan solutions (Anderson, 2008) exercise training program, compared to the control group who received no intervention.
In the second fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness., Janssen et al., (2008) investigated the effectiveness of FES- assisted leg cycling training on improving aerobic capacity, maximal power output, muscle strength and functional performance in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Both groups received cycling training in conjunction with FES twice a week for 6 weeks. However, the treatment group received FES evoking muscle contractions while the control group received sensible FES which could be felt but did not evoke muscle contractions. At post treatment there was no statistically significant difference between groups in strength as measured by Maximum Voluntary Contraction. Note: This study did not compare aerobic training to a control of non-aerobic training, therefore it was not used in determining level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines).
In the quasi-experimental non-randomized trial, Sunnerghagen (2007) investigated the effect of circuit training on strength, aerobic capacity, and activity and participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. in community-living “young” males with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The experimental group trained for 45 minutes 3x/week for 8 weeks on strength, endurance and aerobic capacity whereas the controls received no treatments. Strength was measure pre and post intervention using a dynamometer to assess isometric knee extension and flexion. At post treatment there was a significant improvement for strength in the paretic leg but not for the non-paretic leg as measured by a dynamometer. Note: The quasi-experimental non randomized trial did not report between group differences and is therefore not included in determining level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines).
In the repeated measures study, Rand et al., 2010 investigated the effect of a 6-month aerobic and recreation program on isometric muscle knee strength in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., as measured by a dynamometer. Significant improvement in strength was seen at 3 months and a non-significant trend was seen on re-assessment at 6 months, as compared to baseline data. Note: This study did not specify whether muscle strength was measured on the paretic side only or on both the paretic and non-paretic limbs.
Conclusion: There is conflicting evidence (level 4) as to whether aerobic exercise improves lower extremity strength in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. While 1 high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found no improvement in strength, 2 high quality RCTs and 1 fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that aerobic exercise improves lower extremity strength. Note: The two high quality RCTs and the fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that found an improvement in strength involved a strength-training component.
Strength (Upper extremity)
Effective
2a
In one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness., using a pre-post lag-control design, Rimmer et al. (2000) investigated the effect of aerobic exercise on strength in predominantly African-American patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. A significant increase in the amount of weight the patients were able to lift during a bench press, indicating an improvement in strength, was found in favour of the intervention group following a 12-week aerobic, strength and flexibilityThe ability to shift between different thoughts and actions so that when a problem arises, one can draw upon past mistakes and successes and use this knowledge to plan solutions (Anderson, 2008) exercise training program, compared to the control group who received no intervention. No significant between group differences in hand grip strength in the affected and unaffected extremity was reported.
Conclusion: There is limited evidence (level 2a) from 1 fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that aerobic exercise is effective in improving upper extremity strength but not hand grip strength in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Submaximal VO2
Not effective
2b
One quasi-experimental (Rimmer et al., 2009) found no difference in submaximal VO2Blood oxygen level. between moderate intensity, shorter duration (MISD) exercise or low-intensity longer duration exercise (LILD) compared to conventional therapeutic exercise (TE) following 14 weeks of intervention.
Conclusion: There is limited evidence (level 2b) from one quasi-experimental studyAn experimental study in which the participants are not randomized to receive treatments and as such the investigators lack control over allocation to interventions. This study design is inferior to a randomized controlled trial (RCT) but is valuable in answering research questions when an RCT is not possible either because of ethical constraints or logistic restraints. that aerobic exercise does not improve submaximal VO2Blood oxygen level. in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Pang et al., 2005) investigated the effect of aerobic exercise on walking distance in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. A significant increase in walking distance, measured by the 6-minute walk test, was found in favour of the intervention group who followed the FAME program (19 weeks of cardiorespiratory fitness, mobility, balance and leg muscle strength exercises), compared to the control group who received a 19-week seated upper extremity exercise program.
The second high quality (Lee et al., 2008) found no significant improvement in walking distance following 10 to 12 weeks of aerobic cycling compared to sham cycling.
In the first fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness., Macko et al. (2005) investigated the effect of aerobic exercise on walking distance in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The intervention group received a 6-month progressive treadmill training program with a target of 35 minutes at 60-70% heart rate reserve, and the control group received a stretching program combined with 5-minutes of low-intensity treadmill training at 30-40% heart rate reserve. A significant difference was found in favour of the intervention group for 6-minute walking distance and the distance subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society). of the Walking Impairment Questionnaire compared to the control group.
In the second fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness., Janssen et al., (2008) investigated the effectiveness of FES- assisted leg cycling training on improving aerobic capacity, maximal power output, muscle strength and functional performance in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Both groups received cycling training in conjunction with FES twice a week for 6 weeks. However, the treatment group received FES evoking muscle contractions while the control group received sensible FES which could be felt but did not evoke muscle contractions. At post treatment there was no statistically significant difference between groups in walking distance as measured by the 6-minute walking test. Note: This study did not compare aerobic training to a control of non-aerobic training, therefore it was not used in determining level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines).
Conclusion: There is conflicting evidence (level 4) between 1 high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that found aerobic exercise improves walking distance and 1 high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that found no improvement in walking distance following aerobic exercise, in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. It should be noted that the high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that found no improvement involved aerobic cycling, whereas the other studies involved more gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety. related aerobic activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. .
Walking economy
Effective
2b
One non-controlled intervention exercise study (Macko et al., 2001) investigated the effect of aerobic exercise on walking economy in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. A significant increase in VO2Blood oxygen level. during sub-maximal walking, indicating an improvement, was found for 23 patients following a 6-month progressive treadmill training program with a target of approximately 40 minutes at 60-70% heart rate reserve.
Conclusion: There is limited evidence (level 2b) from one non-controlled exercise study reporting that aerobic exercise improves walking economy in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Walking endurance
Insufficient evidence
5
Two non-controlled studies (Rand et al., 2010, Kluding et al., 2011) investigated the effect of aerobic exercise on walking endurance in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
One repeated measures study (Rand et al., 2010) found a significant improvement in walking endurance, as measured by the 6 Minute Walk Test at 3 and 6 months, as compared to baseline, following a 6-month aerobic and recreation program.
A pre-post design study (Kluding et al., 2011) found a strong trend toward significantly improved aerobic fitness (measured by the 6 Minute Walk Test) from baseline to post-intervention following a 12-week aerobic and strengthening exercise program. Note: This study did not compare aerobic training to a non-aerobic control, therefore it was not used to determine the level of evidence1a (Strong) : Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings 1b(Moderate): 1 RCT of high quality (PEDro ≥ 6) 2a (Limited): At least 1 fair quality RCT (PEDro = 4-5) 2b (Limited): At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.) 3 (Consensus): Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results 4 (Conflicting): Conflicting evidence of 2 or more equally well-designed studies 5 (No evidence): No well-designed studies – only case studies/case descriptions or cohort studies/single subject series with no multiple baselines) for the effectiveness of aerobic training.
Conclusion: There is insufficient evidence (level 5) to indicate whether aerobic exercise is effective in improving walking endurance in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. However, two non-controlled studies found that aerobic exercise may be effective in improving walking endurance.
References
Chu KS, Eng JJ, Dawson AS, Harris JE, Ozkaplan A & Gylfadottir S. (2004). Water-based exercise for cardiovascular fitness in people with chronic stroke: A randomized controlled trial. Archives of Physical Medicine & Rehabilitation, 85, 870-874.
Janssen TW, Beltman JM, Elich P, Koppe PA, Konijnenbelt H, de Haan A, Gerrits KH. (2008). Effects of electric stimulation-assisted cycling training in people with chronic stroke. Arch Phys Med Rehabil , 89:463-469.
Kluding, P. M., Tsen, B. Y., & Billinger, S. A. (2011). Exercise and executive function in individuals with chronic study: A pilot study. Journal of Neurologic Physical Therapy, 35, 11-17.
Lee M., Kilbreath S.L., Singh M.F., Zeman B., Lord S.R., Raymond J., & Davis G.M. (2008). Comparison of Effect of Aerobic Cycle Training and Progressive Resistance Training on Walking Ability After Stroke: A Randomized Sham Exercise-Controlled Study. J Am Geriatr Soc, 56, 976-985.
Macko R, Smith G, Dobrovolny L, Sorkin J, Goldberg A & Silver K (2001). Treadmill Training Improves Fitness Reserve in Chronic Stroke Patients. Archives of Physical Medicine & Rehabilitation, 82, 879-84.
Macko RF, Ivey FM, Forrester LM, Hanley D, Sorkin JD, Katzel LI, Silver KH & Goldberg AP (2005). Treadmill exercise rehabilitation improves ambulatory function and cardiovascular fitness in patients with chronic stroke: A randomized, controlled trial. Stroke, 36, 2206- 2211.
Pang MYC, Eng JJ, Dawson AS, McKay HA & Harris JE (2005). A community-based fitness and mobility exercise program for older adults with chronic stroke: a randomized, controlled trial. Journal of American Geriatrics Society, 53(10), 1667-1674.
Potempa K, Lopez M, Braun LT, Szidon P, Fogg L & Tincknell T (1995). Physiological outcomes of aerobic exercise training in hemiparetic stroke patients. Stroke, 26(1), 101-105.
Rand, D., Eng, J. J., Liu-Ambrose, T., & Tawashy, A. E. (2010). Feasability of a 6-month exercise and recreation program to improve executive functioning and memory in individuals with chronic stroke. Neurorehabilitation and Neural Repair, 24, 722-729.
Rimmer JH, Riley B, Creviston T & Nicola T (2000). Exercise training in a predominantly African-American group of stroke survivors. Medicine & Science in Sports & Exercise, 32(12), 1990-1996.
Rimmer J, Rauworth A, Wang E, Nicola T & Hill B. (2009). A Preliminary Study to Examine the Effects of Aerobic and Therapeutic (Nonaerobic) Exercise on cardiorespiratory Fitness and Coronary Risk Reduction in Stroke Survivors. Arch Phys Med Rehabil, 90, 407-12.
Quaney, B. M., Boyd, L. A., McDowd, J. M., Zahner, L. H., He, J., Mayo, M. S., & Macko, R. F. (2009). Aerobic exercise improves cognition and motor function. Neurorehabilitation and Neural Repair, 23, 879-885.
Sunnerghagen KS (2007). Circuit Training in Community-Living “Younger” Men After Stroke. Journal of Stroke and Cerebrovascular Diseases, 16, 122-129.
