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Shi C, Xiao Y, Zang D, Ren H. Effectiveness of Treadmill Training Intervention for the Management of Patients With Stroke: A Systematic Review and Meta-Analysis. Int J Nurs Pract 2025; 31:e70020. [PMID: 40344634 PMCID: PMC12063472 DOI: 10.1111/ijn.70020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 03/27/2025] [Accepted: 04/25/2025] [Indexed: 05/11/2025]
Abstract
BACKGROUND Treadmill training, including body weight-supported treadmill training (BWSTT), is widely used in stroke rehabilitation. However, its efficacy in improving walking outcomes may vary depending on patients' baseline functional status. OBJECTIVE This study aims to systematically evaluate effectiveness of treadmill training on walking speed and endurance in stroke survivors and to assess influence of baseline dependency and use of BWSTT. METHODS We performed systematic review and meta-analysis as per PRISMA 2020 guidelines. Comprehensive search was conducted using Scopus, MEDLINE, EMBASE, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Cochrane Library, Google Scholar and ScienceDirect for studies published from January 1964 to April 2024. Eligible studies were randomized controlled trials assessing treadmill training in stroke patients with outcomes as walking speed and/or endurance. Data extraction and risk of bias assessment were independently performed by two reviewers using Cochrane Risk of Bias-2 tool. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated using random effects model. Subgroup analyses were conducted based on baseline dependency and BWSTT use. RESULTS Fifty-nine studies were included. Meta-analysis demonstrated significant improvements in walking speed (SMD = 0.255; 95%CI: 0.141-0.369) and walking endurance (SMD = 0.277; 95%CI: 0.134-0.421) among stroke survivors receiving treadmill training. Subgroup analysis revealed that independent participants experienced greater benefits in walking speed (SMD = 0.345) and endurance (SMD = 0.374) compared to dependent participants. Studies employing BWSTT reported enhanced outcomes relative to those without BWSTT. Moderate to high heterogeneity was observed, and publication bias was detected. CONCLUSION Treadmill training, particularly when combined with BWSTT, effectively enhances walking speed and endurance in stroke survivors.
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Affiliation(s)
- Chenyi Shi
- Department of RehabilitationBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Yuxi Xiao
- Department of TraumaBeijing Water Conservancy HospitalBeijingChina
| | - Dawei Zang
- Department of RehabilitationBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Hongjun Ren
- Department of TraumaBeijing Water Conservancy HospitalBeijingChina
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Chasiotis AK, Papadopoulou M, Giannopapas V, Smyrni V, Theodorou A, Bakola E, Kitsos DK, Stavrogianni K, Stasinopoulos D, Bakalidou D, Tsivgoulis G, Giannopoulos S. Efficacy of Physical Therapy Rehabilitation in the Cardiovascular Deconditioning of Post-Stroke Survivors: A Systematic Review and Meta-Analysis. J Clin Med 2025; 14:3327. [PMID: 40429325 PMCID: PMC12111906 DOI: 10.3390/jcm14103327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2025] [Revised: 04/25/2025] [Accepted: 05/08/2025] [Indexed: 05/29/2025] Open
Abstract
Background/Objectives: The majority of stroke survivors undergo physical therapy rehabilitation to regain functionality and improve their overall quality of life. Given the wide range of physical therapy modalities and approaches in post stroke cardiovascular fitness rehabilitation, this systematic review and meta-analysis (SR-MA) aims to assess their efficacy as measured by peak oxygen consumption (VO2peak). Methods: Adhering to PRISMA guidelines; a detailed search of the MEDLINE PubMed; Cochrane Library; and Scopus databases was conducted. Results: Thirty-seven studies with a total of 1310 post-stroke patients were included. The aggregated mean VO2 pre-intervention was 15.30 mL/kg/min ([14.09, 16.51], I2 = 99.7%), increasing to 17.10 mL/kg/min post-intervention ([15.73, 18.46], I2 = 99.8%). The standardized mean difference in VO2 was 1.76 ([1.20, 2.31], I2 = 96.9%). Sensitivity analyses in a subset of RCTs revealed that cardiorespiratory rehabilitation demonstrates a statistically significant improvement in VO2peak levels compared to conventional physical therapy. There was a high degree of heterogeneity among included studies (potentially due to the lack of standardized protocols) while Egger's test (β = 0.32, p = 0.72) and funnel plot inspection were indicative of moderate publication bias with small study effects. Conclusions: Based on the results of this meta-analysis, the increase in VO2peak levels post-interventions ranged from 0.28 to 3.36 mL/kg/min, depending on intervention type. The ideal time to commence aerobic training rehabilitation was found to be six months post-stroke. According to previous studies on cardiovascular diseases, VO2peak can potentially act as a predictor of (a) the efficacy of intervention and (b) the patient's risk of stroke-recurrence and disability progression.
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Affiliation(s)
- Athanasios K. Chasiotis
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.C.); (V.G.); (A.T.); (E.B.); (D.K.K.); (K.S.); (G.T.); (S.G.)
- Department of Physiotherapy, University of West Attica, 12243 Athens, Greece; (D.S.); (D.B.)
| | - Marianna Papadopoulou
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.C.); (V.G.); (A.T.); (E.B.); (D.K.K.); (K.S.); (G.T.); (S.G.)
- Department of Physiotherapy, University of West Attica, 12243 Athens, Greece; (D.S.); (D.B.)
| | - Vasileios Giannopapas
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.C.); (V.G.); (A.T.); (E.B.); (D.K.K.); (K.S.); (G.T.); (S.G.)
- Department of Physiotherapy, University of West Attica, 12243 Athens, Greece; (D.S.); (D.B.)
| | - Vassiliki Smyrni
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.C.); (V.G.); (A.T.); (E.B.); (D.K.K.); (K.S.); (G.T.); (S.G.)
| | - Aikaterini Theodorou
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.C.); (V.G.); (A.T.); (E.B.); (D.K.K.); (K.S.); (G.T.); (S.G.)
| | - Eleni Bakola
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.C.); (V.G.); (A.T.); (E.B.); (D.K.K.); (K.S.); (G.T.); (S.G.)
| | - Dimitrios K. Kitsos
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.C.); (V.G.); (A.T.); (E.B.); (D.K.K.); (K.S.); (G.T.); (S.G.)
| | - Konstantina Stavrogianni
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.C.); (V.G.); (A.T.); (E.B.); (D.K.K.); (K.S.); (G.T.); (S.G.)
- Department of Physiology, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece
| | - Dimitrios Stasinopoulos
- Department of Physiotherapy, University of West Attica, 12243 Athens, Greece; (D.S.); (D.B.)
| | - Daphne Bakalidou
- Department of Physiotherapy, University of West Attica, 12243 Athens, Greece; (D.S.); (D.B.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.C.); (V.G.); (A.T.); (E.B.); (D.K.K.); (K.S.); (G.T.); (S.G.)
| | - Sotirios Giannopoulos
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.C.); (V.G.); (A.T.); (E.B.); (D.K.K.); (K.S.); (G.T.); (S.G.)
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Bermudo-Gallaguet A, Ariza M, Agudelo D, Camins-Vila N, Boldó M, Peters S, Sawicka AK, Dacosta-Aguayo R, Soriano-Raya JJ, Via M, Clemente IC, García-Molina A, Durà Mata MJ, Torán-Monserrat P, Erickson KI, Mataró M. Effects of Mindfulness and Exercise on Growth Factors, Inflammation, and Stress Markers in Chronic Stroke: The MindFit Project Randomized Clinical Trial. J Clin Med 2025; 14:2580. [PMID: 40283415 PMCID: PMC12028070 DOI: 10.3390/jcm14082580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2025] [Revised: 03/21/2025] [Accepted: 04/02/2025] [Indexed: 04/29/2025] Open
Abstract
Background/Objectives: Stroke often leads to persistent cognitive and emotional impairments, which rehabilitation may mitigate. However, the biological mechanisms underlying such improvements remain unclear. This study investigated whether supplementing computerized cognitive training (CCT) with mindfulness-based stress reduction (MBSR) or physical exercise (PE) modulated biomarkers of neuroplasticity, inflammation, and stress in patients with chronic stroke compared to CCT alone. We also explored whether biomarker changes mediated or correlated with behavioral improvements. Methods: In a three-arm, single-blind, randomized controlled trial (NCT04759950), 141 patients with chronic stroke were randomized (1:1:1) to MBSR+CCT, PE+CCT, or CCT-only for 12 weeks. Plasma levels of brain-derived neurotrophic factor (BDNF), insulin-like growth factor-1 (IGF-1), vascular endothelial growth factor (VEGF), C-reactive protein (CRP), interleukin-6 (IL-6), and cortisol were measured at baseline and post-intervention. Cognitive, mental health, mindfulness, and fitness outcomes were also assessed. Between- and within-group changes were analyzed using ANCOVA and paired t-tests. Per-protocol and complete-case analyses were conducted. Results: Among the 109 participants with ≥80% adherence, the only significant between-group difference was for VEGF: it remained stable in the MBSR+CCT group but declined in PE+CCT and CCT-only. Within-group analyses showed significant decreases in cortisol in MBSR+CCT and PE+CCT, while IGF-1 levels declined across all groups. In contrast, BDNF, IL-6, and CRP did not show significant changes, and biomarker changes were not significantly associated with behavioral improvements. Complete-case analysis (n = 126) yielded similar findings. Conclusions: Our findings suggest that combining MBSR or PE with CCT may modulate certain biological processes relevant to stroke recovery. MBSR may help maintain VEGF levels, which could support vascular health, while MBSR and PE may contribute to lowering cortisol levels. However, since no clear association with behavioral improvements was found, further research is needed to determine the clinical relevance of these biomarker changes in stroke recovery.
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Affiliation(s)
- Adrià Bermudo-Gallaguet
- Departament de Psicologia Clínica i Psicobiologia, Facultat de Psicologia, Universitat de Barcelona (UB), Passeig de la Vall d’Hebron, 171, 08035 Barcelona, Spain; (A.B.-G.); (M.A.); (D.A.); (S.P.); (J.J.S.-R.); (M.V.); (I.C.C.)
- Institut de Neurociències, Universitat de Barcelona, Passeig de la Vall d’Hebron, 171, 08035 Barcelona, Spain
- Institut de Recerca Sant Joan de Déu Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
| | - Mar Ariza
- Departament de Psicologia Clínica i Psicobiologia, Facultat de Psicologia, Universitat de Barcelona (UB), Passeig de la Vall d’Hebron, 171, 08035 Barcelona, Spain; (A.B.-G.); (M.A.); (D.A.); (S.P.); (J.J.S.-R.); (M.V.); (I.C.C.)
| | - Daniela Agudelo
- Departament de Psicologia Clínica i Psicobiologia, Facultat de Psicologia, Universitat de Barcelona (UB), Passeig de la Vall d’Hebron, 171, 08035 Barcelona, Spain; (A.B.-G.); (M.A.); (D.A.); (S.P.); (J.J.S.-R.); (M.V.); (I.C.C.)
| | - Neus Camins-Vila
- Institut Nacional d’Educació Física de Catalunya (INEFC), Universitat de Barcelona (UB), 08038 Barcelona, Spain;
| | - Maria Boldó
- Servei de Rehabilitació, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, 08916 Badalona, Spain; (M.B.); (M.J.D.M.)
- Institut de Recerca Germans Trias i Pujol (IGTP), Campus Can Ruti, 08916 Badalona, Spain; (R.D.-A.); (A.G.-M.); (P.T.-M.)
| | - Sarah Peters
- Departament de Psicologia Clínica i Psicobiologia, Facultat de Psicologia, Universitat de Barcelona (UB), Passeig de la Vall d’Hebron, 171, 08035 Barcelona, Spain; (A.B.-G.); (M.A.); (D.A.); (S.P.); (J.J.S.-R.); (M.V.); (I.C.C.)
| | - Angelika Katarzyna Sawicka
- Applied Cognitive Neuroscience Lab, Department of Neurophysiology, Neuropsychology and Neuroinformatics, Medical University of Gdansk, 80-210 Gdansk, Poland;
| | - Rosalia Dacosta-Aguayo
- Institut de Recerca Germans Trias i Pujol (IGTP), Campus Can Ruti, 08916 Badalona, Spain; (R.D.-A.); (A.G.-M.); (P.T.-M.)
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08303 Mataró, Spain
| | - Juan José Soriano-Raya
- Departament de Psicologia Clínica i Psicobiologia, Facultat de Psicologia, Universitat de Barcelona (UB), Passeig de la Vall d’Hebron, 171, 08035 Barcelona, Spain; (A.B.-G.); (M.A.); (D.A.); (S.P.); (J.J.S.-R.); (M.V.); (I.C.C.)
- Institut de Neurociències, Universitat de Barcelona, Passeig de la Vall d’Hebron, 171, 08035 Barcelona, Spain
| | - Marc Via
- Departament de Psicologia Clínica i Psicobiologia, Facultat de Psicologia, Universitat de Barcelona (UB), Passeig de la Vall d’Hebron, 171, 08035 Barcelona, Spain; (A.B.-G.); (M.A.); (D.A.); (S.P.); (J.J.S.-R.); (M.V.); (I.C.C.)
- Institut de Neurociències, Universitat de Barcelona, Passeig de la Vall d’Hebron, 171, 08035 Barcelona, Spain
- Institut de Recerca Sant Joan de Déu Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
| | - Imma C. Clemente
- Departament de Psicologia Clínica i Psicobiologia, Facultat de Psicologia, Universitat de Barcelona (UB), Passeig de la Vall d’Hebron, 171, 08035 Barcelona, Spain; (A.B.-G.); (M.A.); (D.A.); (S.P.); (J.J.S.-R.); (M.V.); (I.C.C.)
- Institut de Neurociències, Universitat de Barcelona, Passeig de la Vall d’Hebron, 171, 08035 Barcelona, Spain
- Institut de Recerca Sant Joan de Déu Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
| | - Alberto García-Molina
- Institut de Recerca Germans Trias i Pujol (IGTP), Campus Can Ruti, 08916 Badalona, Spain; (R.D.-A.); (A.G.-M.); (P.T.-M.)
- Institut Guttmann, Universitat Autònoma de Barcelona, 08916 Badalona, Spain
| | - Maria José Durà Mata
- Servei de Rehabilitació, Hospital Universitari Germans Trias i Pujol, Campus Can Ruti, 08916 Badalona, Spain; (M.B.); (M.J.D.M.)
- Institut de Recerca Germans Trias i Pujol (IGTP), Campus Can Ruti, 08916 Badalona, Spain; (R.D.-A.); (A.G.-M.); (P.T.-M.)
| | - Pere Torán-Monserrat
- Institut de Recerca Germans Trias i Pujol (IGTP), Campus Can Ruti, 08916 Badalona, Spain; (R.D.-A.); (A.G.-M.); (P.T.-M.)
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08303 Mataró, Spain
- Grup de REcerca Multidisciplinar en Salut i Societat (GREMSAS), 08303 Mataró, Spain
- Department of Medicine, Faculty of Medicine, Universitat de Girona, 17003 Girona, Spain
| | - Kirk I. Erickson
- Advent Health Research Institute, Neuroscience, Orlando, FL 32803, USA;
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Maria Mataró
- Departament de Psicologia Clínica i Psicobiologia, Facultat de Psicologia, Universitat de Barcelona (UB), Passeig de la Vall d’Hebron, 171, 08035 Barcelona, Spain; (A.B.-G.); (M.A.); (D.A.); (S.P.); (J.J.S.-R.); (M.V.); (I.C.C.)
- Institut de Neurociències, Universitat de Barcelona, Passeig de la Vall d’Hebron, 171, 08035 Barcelona, Spain
- Institut de Recerca Sant Joan de Déu Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
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Villagra Moran VM, Nila IS, Madhuvilakku R, Sumsuzzman DM, Khan ZA, Hong Y. Elucidating the role of physical exercises in alleviating stroke-associated homeostatic dysregulation: a systematic review and meta-analysis. BMJ Open Sport Exerc Med 2024; 10:e001906. [PMID: 39650569 PMCID: PMC11624745 DOI: 10.1136/bmjsem-2024-001906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 10/10/2024] [Indexed: 12/11/2024] Open
Abstract
Background This study aimed to investigate the role of physical exercises as a non-pharmacological intervention for ameliorating post-stroke dysregulated homeostatic parameters. Methods Embase, PubMed, PEDro, ISI Web of Science and CENTRAL were searched until April 2024. Parallel randomised controlled trials (RCTs) analysing the effect of post-stroke physical exercises (PSPE) on homeostatic parameters such as blood glucose, oxygen consumption (VO2), high-density lipoprotein (HDL), low-density lipoprotein (LDL), systolic (SBP) and diastolic blood pressure (DBP) in individuals with stroke were selected. Results Sixteen RCTs (n=698) were included. PSPE reduced fasting glucose levels (MD=-0.22; 95% CI -0.22 to -0.02; p=0.00) and increased the VO2 (MD=2.51; 95% CI 1.65 to 3.37; p=0.00) and blood HDL levels (MD=0.07; 95% CI 0.00 to 0.13; p=0.00). However, we did not observe beneficial effects on LDL, SBP and DBP parameters. Further analyses demonstrated that both low and moderate exercises are more suitable for improving blood glucose and VO2 in this population. Discussion PSPE have the potential to improve dysregulated post-stroke parameters by reducing blood glucose levels and increasing VO2 and HDL levels. However, the small size and limited number of included studies limited the precision of our results. Further research is needed to comprehensively analyse the effects of PSPE, particularly on LDL levels and blood pressure. PROSPERO registration number CRD42023395715.
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Affiliation(s)
- Vanina Myuriel Villagra Moran
- Department of Physical Therapy, Graduate School of Inje University, Gimhae, Gyeongsangnam-do, Republic of Korea
- Biohealth Products Research Center (BPRC), Inje University, Gimhae, Gyeongsangnam-do, Republic of Korea
| | - Irin Sultana Nila
- Biohealth Products Research Center (BPRC), Inje University, Gimhae, Gyeongsangnam-do, Republic of Korea
- Department of Digital Anti-aging Healthcare, Graduate School of Inje University, Gimhae, Gyeongsangnam-do, Republic of Korea
| | - Rajesh Madhuvilakku
- Biohealth Products Research Center (BPRC), Inje University, Gimhae, Gyeongsangnam-do, Republic of Korea
- Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae, Gyeongsangnam-do, Republic of Korea
| | - Dewan Md Sumsuzzman
- Biohealth Products Research Center (BPRC), Inje University, Gimhae, Gyeongsangnam-do, Republic of Korea
- Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae, Gyeongsangnam-do, Republic of Korea
| | - Zeeshan Ahmad Khan
- Biohealth Products Research Center (BPRC), Inje University, Gimhae, Gyeongsangnam-do, Republic of Korea
- Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae, Gyeongsangnam-do, Republic of Korea
| | - Yonggeun Hong
- Department of Physical Therapy, Graduate School of Inje University, Gimhae, Gyeongsangnam-do, Republic of Korea
- Biohealth Products Research Center (BPRC), Inje University, Gimhae, Gyeongsangnam-do, Republic of Korea
- Department of Digital Anti-aging Healthcare, Graduate School of Inje University, Gimhae, Gyeongsangnam-do, Republic of Korea
- Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae, Gyeongsangnam-do, Republic of Korea
- Department of Rehabilitation Science, Graduate School of Inje University, Gimhae, Gyeongsangnam-do, Republic of Korea
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Wiley E, Noguchi KS, Fang H, Moncion K, Richardson J, MacDermid JC, Tang A. The implementation of sex-and gender-based considerations in exercise-based randomized controlled trials in individuals with stroke: A cross-sectional study. PLoS One 2024; 19:e0308519. [PMID: 39383122 PMCID: PMC11463778 DOI: 10.1371/journal.pone.0308519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/24/2024] [Indexed: 10/11/2024] Open
Abstract
Emerging evidence suggests that sex-and gender-based factors may influence responses to exercise post-stroke. The Sex and Gender Equity in Research (SAGER) guidelines (2016) published international standards for terminology and considerations for research design and trial reporting. The extent to which sex- and gender-based considerations have been implemented in stroke exercise trials is currently unknown. The objective of this cross-sectional study was to compare the proportion of studies that have implemented sex/gender considerations before and after the publication of the SAGER guidelines. We conducted a comprehensive search of the literature to identify exercise-based trials in individuals with stroke. Study titles, abstracts, introductions (hypothesis statements), methods, results and discussions were assessed for adherence to the SAGER guidelines. The proportion of studies adhering to SAGER guidelines published prior to and including December 31, 2016 and from 2017-March 2023 were compared. Of the 245 studies identified, 150 were published before December 31, 2016, of which 0 (0%) titles/abstracts, 0 (0%) introductions, 21 (14.0%) methods, 8 (5.3%) results, and 7 (4.7%) discussion sections adhered to the SAGER guidelines, and 35 (23.3%) reported proper sex and gender terminology. Of the 95 studies published between 2017-2023, 0 (0%) title/abstracts, 1 (1.0%) introduction, 16 (16.8%) methods, 5 (5.3%) results, and 10 (10.5%) discussion sections adhered to the guidelines, and 37 (38.9%) of studies included proper terminology. The implementation of sex- and gender-based considerations in stroke exercise trials is low, but positively the reporting of proper terminology has increased since the publication of standardized reporting guidelines. This study serves as a call to action for stroke rehabilitation researchers to incorporate sex- and gender-based considerations in all stages of research studies, to improve the rigour and generalizability of findings, and promote health equity.
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Affiliation(s)
- Elise Wiley
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Kenneth S. Noguchi
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Hanna Fang
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Kevin Moncion
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Joy C. MacDermid
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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Chen K, Wang Y, Li D, Li J, Huang Y, Huang M, Ma H. Impact of diverse aerobic exercise plans on glycemic control, lipid levels, and functional activity in stroke patients with type 2 diabetes mellitus. Front Endocrinol (Lausanne) 2024; 15:1389538. [PMID: 39359413 PMCID: PMC11446103 DOI: 10.3389/fendo.2024.1389538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 08/28/2024] [Indexed: 10/04/2024] Open
Abstract
Aims This study aimed to assess the effects of Low-to-Moderate Intensity Continuous Training (LMICT), Moderate-Intensity Interval Training (MIIT), and Reduced-Exertion High-Intensity Training (REHIT) on blood glucose regulation, functional recovery, and lipid levels in individuals who have experienced a stroke and are diagnosed with Type 2 Diabetes Mellitus (T2DM). Methods Forty-two T2DM stroke patients were randomly allocated to four groups: LMICT, MIIT, REHIT, and a control group (CON). Participants continuously monitored their blood glucose levels throughout the intervention using continuous glucose monitoring (CGM) devices. The study comprised two exercise intervention cycles: the first lasting from Day 3 to Day 14 and the second from Day 15 to Day 28, with the initial two days serving as contrasting periods. Primary outcomes encompassed CGM-derived blood glucose measurements, the Barthel Index (BI), Fugl-Meyer Assessment lower-extremity subscale (FMA-LE), and alterations in triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c). Results Compared with the CON, the MIIT group showed significant improvements in mean glucose (MG), glucose standard deviation (SD), time above range (TAR), and time in range (TIR). The REHIT group exhibited significantly reduced time below range (TBR), glucose SD, and coefficient of variation (CV). Regarding lipid levels, although the REHIT group achieved a significant reduction in TG levels compared with the CON, the overall effects of LMICT, MIIT, and REHIT on lipid profiles were relatively modest. Concerning functional recovery, the REHIT group significantly improved the BI and FMA-LE. Conclusion Although the short-term quantitative impact of exercise on lipid levels may be limited, both REHIT and MIIT significantly improved glycemic management and reduced glucose variability in post-stroke patients with Type 2 Diabetes Mellitus. Additionally, REHIT notably enhanced functional recovery.
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Affiliation(s)
- Kangcheng Chen
- School of Athletic Performance, Shanghai University of Sport, Shanghai, China
| | - Yulong Wang
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Dongxia Li
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Jun Li
- School of Athletic Performance, Shanghai University of Sport, Shanghai, China
| | - Yong Huang
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Meiling Huang
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Haifeng Ma
- School of Athletic Performance, Shanghai University of Sport, Shanghai, China
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Moncion K, Rodrigues L, Wiley E, Noguchi KS, Negm A, Richardson J, MacDonald MJ, Roig M, Tang A. Aerobic exercise interventions for promoting cardiovascular health and mobility after stroke: a systematic review with Bayesian network meta-analysis. Br J Sports Med 2024; 58:392-400. [PMID: 38413134 DOI: 10.1136/bjsports-2023-107956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To determine the superiority of aerobic exercise (AE) interventions on key outcomes of stroke recovery, including cardiorespiratory fitness (V̇O2peak, primary outcome), systolic blood pressure (SBP) and mobility (6 min Walk Test (6MWT) distance and 10 m Usual Gait Speed) after stroke. DATA SOURCES MEDLINE, EMBASE, Web of Science, CINAHL, CENTRAL, SPORTDiscus, PsycINFO and AMED Allied and Complementary Medicine were searched from inception to February 2023. ELIGIBILITY CRITERIA Randomised controlled trials were included that compared the effects of any AE interventions (low-intensity, moderate-intensity, high-intensity continuous training (HICT), high-intensity interval training (HIIT)) to no exercise, usual care or other AE interventions in individuals poststroke. ANALYSES Systematic review with Bayesian network meta-analysis (NMA) methodology was employed. Surface under the cumulative ranking curve (SUCRA) values were used to rank interventions. The Grading of Recommendations, Assessment, Development and Evaluation minimally contextualised framework for NMA was followed. RESULTS There were 28 studies (n=1298) included in the NMA for V̇O2peak, 11 (n=648) for SBP, 28 (n=1494) for 6MWT and 18 (n=775) for the 10 m Usual Gait Speed. The greatest effect on V̇O2peak, 6MWT and 10 m Usual Gait Speed was observed after HIIT and HICT. No differences between interventions were found for SBP. SUCRA values identified HIIT as the superior AE intervention for all outcomes of interest. HIIT was the most effective intervention for improving V̇O2peak (2.9 mL/kg/min (95% credible interval 0.8 to 5.0) moderate certainty) compared with usual care. CONCLUSION This NMA suggests that higher-intensity AE is superior to traditional low-intensity to moderate-intensity AE for improving outcomes after stroke.
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Affiliation(s)
- Kevin Moncion
- School of Rehabilitation Sciences, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Lynden Rodrigues
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Laval, Quebec, Canada
| | - Elise Wiley
- School of Rehabilitation Sciences, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Kenneth S Noguchi
- School of Rehabilitation Sciences, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Ahmed Negm
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Julie Richardson
- School of Rehabilitation Sciences, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
- Department of Health Research Methods Evidence and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Maureen Jane MacDonald
- Department of Kinesiology, McMaster University Faculty of Science, Hamilton, Ontario, Canada
| | - Marc Roig
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Laval, Quebec, Canada
| | - Ada Tang
- School of Rehabilitation Sciences, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
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Cocco C, Siotto M, Guerrini A, Germanotta M, Galluccio C, Cipollini V, Cortellini L, Pavan A, Lattanzi S, Insalaco S, Ruco E, Mosca R, Campana B, Aprile I. Systemic Oxidative Stress in Subacute Stroke Patients Undergoing Rehabilitation Treatment. Antioxidants (Basel) 2024; 13:354. [PMID: 38539887 PMCID: PMC10967715 DOI: 10.3390/antiox13030354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 02/29/2024] [Accepted: 03/11/2024] [Indexed: 01/03/2025] Open
Abstract
The imbalance in oxidative stress in acute stroke has been extensively studied; on the contrary, its investigation in the subacute phase is limited. The aim of this study was to analyse the variation in the systemic oxidative status in subacute post-stroke patients before (T0) and after a six-week rehabilitation treatment (T1) and to investigate the relationship between systemic oxidative status and rehabilitation outcomes. We enrolled 109 subjects in two different centres, and we analysed their serum hydroperoxide levels (d-ROMs), biological antioxidant power (BAP), thiol antioxidant components (-SHp), and relative antioxidant capacity (OSI and SH-OSI indices). Activity of Daily Living (ADL), hand grip strength, and walking endurance were evaluated using the modified Barthel Index, the Hand Grip test, and the 6-min walk test, respectively. At T0, most of the patients showed very high levels of d-ROMs and suboptimal levels of the BAP, OSI, and SH-OSI indices. Comparing the T1 and T0 data, we observed an improvement in the rehabilitation outcomes and a significant decrease in d-ROMs (549 ± 126 vs. 523 ± 148, p = 0.023), as well as an improvement in the OSI and SH-OSI indices (4.3 ± 1.3 vs. 4.7 ± 1.5, p = 0.001; 11.0 ± 0.4 vs. 1.2 ± 0.4, p < 0.001). In addition, significant correlations were seen between the oxidative stress parameters and the rehabilitation outcomes. These results suggest monitoring the systemic oxidative stress status in post-stroke patients in order to plan a tailored intervention, considering its relationship with functional recovery.
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Affiliation(s)
- Carola Cocco
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (C.C.); (A.G.); (M.G.); (C.G.); (V.C.); (L.C.); (A.P.); (S.L.); (S.I.); (E.R.); (R.M.); (B.C.); (I.A.)
| | - Mariacristina Siotto
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (C.C.); (A.G.); (M.G.); (C.G.); (V.C.); (L.C.); (A.P.); (S.L.); (S.I.); (E.R.); (R.M.); (B.C.); (I.A.)
| | - Alessandro Guerrini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (C.C.); (A.G.); (M.G.); (C.G.); (V.C.); (L.C.); (A.P.); (S.L.); (S.I.); (E.R.); (R.M.); (B.C.); (I.A.)
- Department of Science and Technology for Humans and the Environment, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Marco Germanotta
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (C.C.); (A.G.); (M.G.); (C.G.); (V.C.); (L.C.); (A.P.); (S.L.); (S.I.); (E.R.); (R.M.); (B.C.); (I.A.)
| | - Caterina Galluccio
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (C.C.); (A.G.); (M.G.); (C.G.); (V.C.); (L.C.); (A.P.); (S.L.); (S.I.); (E.R.); (R.M.); (B.C.); (I.A.)
| | - Valeria Cipollini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (C.C.); (A.G.); (M.G.); (C.G.); (V.C.); (L.C.); (A.P.); (S.L.); (S.I.); (E.R.); (R.M.); (B.C.); (I.A.)
| | - Laura Cortellini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (C.C.); (A.G.); (M.G.); (C.G.); (V.C.); (L.C.); (A.P.); (S.L.); (S.I.); (E.R.); (R.M.); (B.C.); (I.A.)
| | - Arianna Pavan
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (C.C.); (A.G.); (M.G.); (C.G.); (V.C.); (L.C.); (A.P.); (S.L.); (S.I.); (E.R.); (R.M.); (B.C.); (I.A.)
| | - Stefania Lattanzi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (C.C.); (A.G.); (M.G.); (C.G.); (V.C.); (L.C.); (A.P.); (S.L.); (S.I.); (E.R.); (R.M.); (B.C.); (I.A.)
| | - Sabina Insalaco
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (C.C.); (A.G.); (M.G.); (C.G.); (V.C.); (L.C.); (A.P.); (S.L.); (S.I.); (E.R.); (R.M.); (B.C.); (I.A.)
| | - Elisabetta Ruco
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (C.C.); (A.G.); (M.G.); (C.G.); (V.C.); (L.C.); (A.P.); (S.L.); (S.I.); (E.R.); (R.M.); (B.C.); (I.A.)
| | - Rita Mosca
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (C.C.); (A.G.); (M.G.); (C.G.); (V.C.); (L.C.); (A.P.); (S.L.); (S.I.); (E.R.); (R.M.); (B.C.); (I.A.)
| | - Biagio Campana
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (C.C.); (A.G.); (M.G.); (C.G.); (V.C.); (L.C.); (A.P.); (S.L.); (S.I.); (E.R.); (R.M.); (B.C.); (I.A.)
| | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (C.C.); (A.G.); (M.G.); (C.G.); (V.C.); (L.C.); (A.P.); (S.L.); (S.I.); (E.R.); (R.M.); (B.C.); (I.A.)
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