Cardiovascular Conditioning for Comfortable Gait Speed and Total Distance Walked During the Chronic Stage of Stroke: A Meta-Analysis

To examine the effectiveness of cardiovascular conditioning on comfortable gait speed and total distance walked when initiated in the chronic stage of stroke through a meta-analysis. Methods: MEDLINE, CINAHL, EMBASE, and Scopus databases were searched from 1980 to June 2012. A study was selected if (1) it was a randomized controlled trial; (2) individuals in the study were entered into the study at or over 6 months post stroke; (3) cardiorespiratory training was initiated during the chronic stage of stroke; and (4) study participants were years of age. A standardized mean difference (SMD +/- SE and 95% confidence interval [Cl]) was calculated for comfortable gait speed and/or 6-minute walk test (6MWT). Results from all studies were then pooled using a random effects model. Treatment effect sizes were interpreted as small, >0.2; moderate, >0.5; or large, >0.8. Methodological quality of studies was assessed using the Physiotherapy Evidence Database (PEDro) tool. Results: Seven studies met inclusion criteria. The analysis demonstrated a moderate and significant effect on 6MWT post treatment (SMD = 0.581 +/- 0.277; 95% Cl, -0.037 to 1.125; P = .036) with an improvement of 111.4 m to a pooled average of 357.7 m. No significant improvement in comfortable gait speed was noted post treatment (SMD = 0.159 +/- 0.124; 95% Cl, -0.085 to 0.402; P = .202) or at follow-up (SMD = 0.248 +/- 0.256; 95% Cl, -0.253 to 0.750; P = .332). Conclusion: Cardiovascular conditioning resulted in clinically relevant gains in walking distance of over 100 m post treatment on the 6MVVT when initiated during the chronic stage of stroke. These results demonstrate that individuals in the chronic stage of stroke can still benefit from interventions to improve gait and mobility. This has important implications for outpatient and community-based programs.