title: Factors Influencing the Efficacy of Aerobic Exercise for Improving Fitness and Walking Capacity After Stroke: A Meta-Analysis With Meta-Regression.
abstract: To assess the influence of dosing parameters and patient characteristics on the efficacy of aerobic exercise (AEX) poststroke.
  
  
  
  A systematic review was conducted using PubMed, MEDLINE, Cumulative Index of Nursing and Allied Health Literature, Physiotherapy Evidence Database, and Academic Search Complete.
  
  
  
  Studies were selected that compared an AEX group with a nonaerobic control group among ambulatory persons with stroke.
  
  
  
  Extracted outcome data included peak oxygen consumption (V˙o2peak) during exercise testing, walking speed, and walking endurance (6-min walk test). Independent variables of interest were AEX mode (seated or walking), AEX intensity (moderate or vigorous), AEX volume (total hours), stroke chronicity, and baseline outcome scores.
  
  
  
  Significant between-study heterogeneity was confirmed for all outcomes. Pooled AEX effect size estimates (AEX group change minus control group change) from random effects models were V˙o2peak, 2.2mL⋅kg-1⋅min-1(95% confidence interval [CI], 1.3-3.1mL⋅kg-1⋅min-1); walking speed, .06m/s (95% CI, .01-.11m/s); and 6-minute walk test distance, 29m (95% CI, 15-42m). In meta-regression, larger V˙o2peak effect sizes were significantly associated with higher AEX intensity and higher baseline V˙o2peak. Larger effect sizes for walking speed and the 6-minute walk test were significantly associated with a walking AEX mode. In contrast, seated AEX did not have a significant effect on walking outcomes.
  
  
  
  AEX significantly improves aerobic capacity poststroke, but may need to be task specific to affect walking speed and endurance. Higher AEX intensity is associated with better outcomes. Future randomized studies are needed to confirm these results.
authors.affiliation: Department of Rehabilitation Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio; Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, Ohio. Electronic address: Pierce.Boyne@uc.edu.
authors.forename: Pierce
authors.initials: P
authors.lastname: Boyne
authors.affiliation: Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, Ohio; Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Welge
authors.affiliation: Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Brett
authors.initials: B
authors.lastname: Kissela
authors.affiliation: Department of Rehabilitation Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio; Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Kari
authors.initials: K
authors.lastname: Dunning
mesh_terms: D015444:Exercise / Q000502:physiology; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D010101:Oxygen Consumption; D010807:Physical Endurance; D010809:Physical Fitness; D000071939:Stroke Rehabilitation / Q000379:methods*; D013997:Time Factors
keywords: Cardiovascular deconditioning; Exercise; Locomotion; Rehabilitation; Stroke