Maintenance of cardiorespiratory fitness in people with stroke : A systematic review and meta-analysis

Objective
To determine if improvements in cardiorespiratory fitness are maintained in the short-, medium- and long-term after a cardiorespiratory fitness intervention in people with stroke.

Data Sources
MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, (CENTRAL) Cochrane, Web of Science, Sports Discus, and Physiotherapy Evidence Database were searched from inception.

Study Selection
Randomized controlled trials and cohort studies including (1) people with stroke; (2) cardiorespiratory fitness interventions; (3) a direct measure of cardiorespiratory fitness; and (4) short- (0 to <3 months), medium- (3-6 months), or long-term (>6 months) follow-up data.

Data Extraction
Two reviewers independently screened full texts and extracted data, including study methods, participant demographic information, stroke type and severity, outcome measures, intervention information, follow-up time points, and results, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A lower limit of −1.0 mL•kg−1•min−1 was used to determine maintenance (ie, no change) of cardiorespiratory fitness.

Data Synthesis
Fourteen studies (N=324 participants) were included. Participants completed cardiorespiratory fitness training 2-5 days per week over 4-13 weeks at moderate to high intensity (40%-70% heart rate reserve [HRR]; n=4 studies), high intensity (60% to <90% HRR; n=7 studies), and intervals of high intensity (85%-95% peak heart rate or maximal heart rate; n=3 studies). Most people with stroke did maintain cardiorespiratory fitness in the short- (−0.19 mL•kg−1•min−1 [95% CI, −1.66 to 1.28]), medium- (−0.61 mL•kg−1•min−1 [95% CI, −3.95 to 2.74]), and long-term (0.00 mL•kg−1•min−1 [95% CI, −2.23 to 2.23]) after completion of cardiorespiratory fitness interventions.

Conclusions
People with stroke maintain cardiorespiratory fitness after a cardiorespiratory fitness intervention in the short-, medium-, and longer-term. However, little is known about the impact of participant and intervention characteristics on the long-term maintenance of cardiorespiratory fitness.