Energy Expenditure and Cost During Walking After Stroke: A Systematic Review

Objectives: To systematically review the evidence to determine energy expenditure (EE) in volume of oxygen uptake ((V) over doto(2)) (mL/kg/min) and energy cost in oxygen uptake per meter walked (V) over dot o(2)/walking speed; mL/kg/m) during walking poststroke and how it compares with healthy controls; and to determine how applicable current exercise prescription guidelines are to stroke survivors. Data Sources: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and CINAHL were searched on October 9, 2014, using search terms related to stroke and EE. Additionally, we screened reference lists of eligible studies. Study Selection: Two independent reviewers screened titles and abstracts of 2115 identified references. After screening the full text of 144 potentially eligible studies, we included 29 studies (stroke survivors: n=501, healthy controls: n=123), including participants with confirmed stroke and a measure of (V) over dot o(2) during walking using breath-by-breath analysis. Studies with (9 studies) and without (20 studies) a healthy control group were included. Data Extraction: Two reviewers independently extracted data using a standard template, including patient characteristics, outcome data, and study methods. Data Synthesis: Mean age of stroke survivors was 57 years (range, 40-67y). Poststroke EE was highly variable across studies and could not be pooled because of high heterogeneity. EE during steady-state overground walking at matched speeds was significantly higher in stroke survivors than healthy controls (mean difference in (V) over dot o(2), 4.06 mL/kg/min; 95% confidence interval [CI], 2.21-5.91; 1 study; n=26); there was no significant group difference at self-selected speeds. Energy cost during steady-state overground walking was higher in stroke survivors at both self-selected (mean difference,.47 mL/kg/m; 95% CI,.29.66; 2 studies; n=38) and matched speeds compared with healthy controls (mean difference, .27 mL/kg/m; 95% CI, .03.51; 1 study; n=26). Conclusions: Stroke survivors expend more energy during walking than healthy controls. Low-intensity exercise as described in guidelines might be at a moderate intensity level for stroke survivors; there is a need for stroke-specific exercise guidelines. (C) 2016 by the American Congress of Rehabilitation Medicine