title: Meta-analysis of the efficacy of different training strategies in animal models of ischemic stroke.
abstract: OBJECTIVE
  Although several studies have shown beneficial effects of training in animal stroke models, the most effective training strategy and the optimal time to initiate training have not been identified. The present meta-analysis was performed to compare the efficacy of different training strategies and to determine the optimal time window for training in animal stroke models.
  
  
  METHODS
  We searched the literature for studies analyzing the efficacy of training in animal models of ischemic stroke. Training was categorized into forced physical training, voluntary physical training, constraint-induced movement therapy, and skilled reaching training. Two reviewers independently extracted data on study quality, infarct size, and neurological outcome. Data were pooled by means of a meta-analysis.
  
  
  RESULTS
  Thirty-five studies with >880 animals were included. A meta-analysis of all treatments showed that training reduced the infarct volume by 14% (95% confidence interval, 2%-25%) and improved the cognitive function by 33% (95% confidence interval, 8%-50%), the neuroscore by 13.4% (95% confidence interval, 1.5%-25.3%), and the running function by 6.6% (95% confidence interval, 1.4%-11.9%). Forced physical training reduced the infarct volume and enhanced the running function most effectively, whereas skilled reaching training improved the limb function most effectively. A meta-regression illustrated that training was particularly efficacious when initiated between 1 and 5 days after stroke onset.
  
  
  CONCLUSIONS
  Our meta-analysis confirms that training reduces the infarct volume and improves the functional recovery in animal stroke models. Forced physical training and skilled reaching training were identified as particularly effective training strategies. The efficacy of training is time dependent.
authors.affiliation: From the Department of Neurology (A.S., M.S., J.-K.S., K.D., J.M.) and Institute of Epidemiology and Social Medicine (J.W.), University of Münster, Münster, Germany; Department of Neuropathology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (C.S.); and Department of Neurology, Bethel-EvKB, Bielefeld, Germany (W.-R.S.).
authors.forename: Antje
authors.initials: A
authors.lastname: Schmidt
authors.forename: Jürgen
authors.initials: J
authors.lastname: Wellmann
authors.forename: Matthias
authors.initials: M
authors.lastname: Schilling
authors.forename: Jan-Kolja
authors.initials: JK
authors.lastname: Strecker
authors.forename: Clemens
authors.initials: C
authors.lastname: Sommer
authors.forename: Wolf-Rüdiger
authors.initials: WR
authors.lastname: Schäbitz
authors.forename: Kai
authors.initials: K
authors.lastname: Diederich
authors.forename: Jens
authors.initials: J
authors.lastname: Minnerup
mesh_terms: D000818:Animals; D002545:Brain Ischemia / Q000517:prevention & control*; D002544:Cerebral Infarction / Q000473:pathology / Q000517:prevention & control; D003627:Data Interpretation, Statistical; D006801:Humans; D009048:Motor Skills / Q000502:physiology; D010805:Physical Conditioning, Animal / Q000379:methods*; D051381:Rats; D020127:Recovery of Function; D012420:Running / Q000502:physiology; D012453:Saimiri; D020521:Stroke / Q000517:prevention & control*; D016896:Treatment Outcome
keywords: exercise; meta-analysis; stroke