title: Energy Expenditure and Cost During Walking After Stroke: A Systematic Review.
abstract: OBJECTIVE
  To systematically review the evidence to determine energy expenditure (EE) in volume of oxygen uptake (V̇O2) (mL/kg/min) and energy cost in oxygen uptake per meter walked (V̇O2/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.
  
  
  METHODS
  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.
  
  
  METHODS
  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 V̇O2 during walking using breath-by-breath analysis. Studies with (9 studies) and without (20 studies) a healthy control group were included.
  
  
  METHODS
  Two reviewers independently extracted data using a standard template, including patient characteristics, outcome data, and study methods.
  
  
  RESULTS
  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 V̇O2, 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.
authors.affiliation: Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia; The Florey Department of Neuroscience and Mental Health, University of Melbourne, VIC, Australia. Electronic address: sharon.kramer@florey.edu.au.
authors.forename: Sharon
authors.initials: S
authors.lastname: Kramer
authors.affiliation: Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia; Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, VIC, Australia.
authors.forename: Liam
authors.initials: L
authors.lastname: Johnson
authors.affiliation: Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia; School of Health Science, Latrobe University, Melbourne, VIC, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Bernhardt
authors.affiliation: Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia.
authors.forename: Toby
authors.initials: T
authors.lastname: Cumming
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004734:Energy Metabolism / Q000502:physiology*; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D017741:Survivors; D016138:Walking / Q000502:physiology*
keywords: Meta-analysis as topic; Rehabilitation; Stroke; Walking