Effect of aerobic training on vascular and metabolic risk factors for recurrent stroke: a meta-analysis

Figures & data

Figure 1. Flowchart of study selection procedure.

Table 1. PEDro assessments.

Article	1	2	3	4	5	6	7	8	9	10	11	Score
Faulkner et al. [22]	+	+	+	+	−	−	−	+	+	+	+	7/10
Ivey et al. [36]	+	+	−	+	−	−	−	−	−	+	+	4/10
Jin et al. [21]	+	+	+	+	−	−	−	−	−	+	+	5/10
Katz-Leurer et al. [23]	+	+	+	+	−	−	−	+	−	+	+	6/10
Ofori et al. [37]	+	+	−	+	−	−	−	−	−	+	+	4/10
Potempa et al. [20]	+	+	−	+	−	−	−	−	−	+	+	4/10
Tang et al. [34]	−	+	+	+	−	−	+	+	+	+	+	8/10
Wang et al. [33]	+	+	+	+	−	+	−	+	+	+	+	8/10
Wang et al. [35]	+	+	+	+	−	+	+	−	−	+	+	7/10

1. Eligibility criteria were specified; 2. Subjects were randomly allocated to groups (in a crossover study, subjects were randomly allocated an order in which treatments were received); 3. Allocation was concealed; 4. The groups were similar at baseline regarding the most important prognostic indicators; 5. There was blinding of all subjects; 6. There was blinding of all therapists who administered the therapy; 7. There was blinding of all assessors who measured at least one key outcome; 8. Measures of at least one key outcome were obtained from more than 85% of the subjects initially allocated to groups; 9. All subjects for whom outcome measures were available received the treatment or control condition as allocated or, where this was not the case, data for at least one key outcome was analysed by “intention to treat”; 10. The results of between-group statistical comparisons are reported for at least one key outcome; 11. The study provides both point measures and measures of variability for at least one key outcome.

Table 2. Study characteristics.

Study	N (e)	N (c)	Diagnosis	Time since stroke	PEDro
Faulkner et al. [22]	25	22	First TIA or minor stroke.	Hospitalized patients, Time not mentioned	7/10
Ivey et al. [36]	26	20	Hemiparetic stroke patients	>6 months	4/10
Jin et al. [21]	65	63	Stroke patients	>6 months	5/10
Katz-Leurer et al. [23]	46	46	Stroke patients	<30 days	6/10
Ofori et al. [37]	10	10	Hemiparetic stroke patients	<6 months	4/10
Potempa et al. [20]	19	23	Stroke patients	>6 months	4/10
Tang et al. [34]	25	25	Stroke patients	>12 months	8/10
Wang et al. [33]	24	24	Stroke patients, unable to walk	2–6 weeks	8/10
Wang et al. [35]	27	27	Stroke patients, unable to walk	1–6 months	7/10

c: control group; e: exercise group.

Table 3. Intervention characteristics.

Study	Frequency	Intensity	Time	Type (e)	Type (c)
Faulkner et al. [22]	12 weeks, 2 x p/w	50 to 90% of max HR	30–60 min p/s	Walking, Cycling	Usual care
Ivey et al. [36]	6 months, 3 x p/w	60–70% HRR	40 min p/s	Treadmill walking	Supervised stretching
Jin et al. [21]	12 weeks, 5 x p/w	50–70% HRR	40 min p/s	Cycling	Usual care
Katz-Leurer et al. [23]	8 weeks, 5 x p/w (week 1–2) 3 x p/w (week 3-8)	Max 60% HRR	10–30 min p/s	Leg cycle ergometer	Not mentioned
Ofori et al. [37]	8 weeks 3 x p/w,	10–15 on the Borg scale	30 min p/s	Leg cycle ergometer	Usual care
Potempa et al. [20]	10 weeks, 3 x p/w	From 30–50% HRR to max level	30 min p/s	Leg cycle ergometer	Passive range of motion exercises
Tang et al. [34]	6 months, 3 x p/w	Building from 40–80% HRR	60 min p/s	Brisk walking Leg cycle ergometer Marching on the spot Repeated sit to stand Platform steppers	Stretching, weight bearing, postural awareness balance (<40% HRR)
Wang et al. [33]	6 weeks 3 x p/w	50–70% HRR	40 min p/s	Leg cycle ergometer	Usual care
Wang et al. [35]	6 weeks 3 x p/w	50–70% HRR	40 min p/s	Leg cycle ergometer	Usual care

c: Control group; e: exercise group; HR: heart rate; HRR: heart rate reserve; max: maximal; min: minutes; p/s: per session; p/w: per week; TIA: transient ischemic attack.

Table 4. Summary of meta-analysis.

Risk factor	Studies	N total	N aerobic training	N control	Mean difference	95% confidence interval	I2	p value
Systolic blood pressure	6	377	190	187	−3.59	−6.14, −1.05	45%	0.006*
Diastolic blood pressure	6	377	190	187	−1.12	−2.77, 0.53	60%	0.18
Resting heart rate	7	422	213	209	−0.80	−2.50, 0.91	45%	0.36
2-hour blood glucose	2	88	44	44	−1.09	−2.73, 0.54	91%	0.19
Fasting insulin	3	134	70	64	−1.48	−3.13, 0.16	78%	0.08
Fasting glucose	4	184	95	89	−0.12	−0.23, −0.02	3%	0.02*
HOMA-IR	3	134	70	64	−0.41	−0.91, 0.08	37%	0.10
HDL cholesterol	3	138	69	69	0.02	−0.05, 0.08	0%	0.62
LDL cholesterol	3	138	69	69	0.06	−0.15, 0.28	0%	0.57
Triglycerides	3	138	69	69	−0.03	−0.33, 0.27	95%	0.87
Peripheral pulse pressure	2	97	50	47	−3.44	−9.17, 2.30	0%	0.24
Meta-analysis of only high quality studies (PEDro score ≥ 6)
Systolic blood pressure	3	187	96	91	−4.95	−8.24, −1.66	0%	0.003*
Diastolic blood pressure	3	187	96	91	−1.42	−2.96, 0.13	0%	0.07
Resting heart rate	4	232	119	113	0.37	−2.27, 3.01	40%	0.78
Fasting insulin	2	88	44	44	−0.63	−1.50, 0.23	41%	0.15
Fasting glucose	3	138	69	69	−0.09	−0.26, 0.08	34%	0.28
HOMA-IR	2	88	44	44	−0.28	−0.65, 0.09	0%	0.13
Meta-analysis of only studies with a shorter intervention period (max 12 weeks)
Systolic blood pressure	5	327	165	162	−3.79	−6.75, −0.83	56%	0.01*
Diastolic blood pressure	5	327	165	162	−1.34	−3.30, 0.62	68%	0.18
Resting heart rate	6	372	188	184	−0.90	−2.80, 0.99	54%	0.35
Fasting insulin	2	88	44	44	−0.63	−1.50, 0.23	41%	0.15
Fasting glucose	2	88	44	44	−0.13	−0.28, 0.02	32%	0.09
HOMA-IR	2	88	44	44	−0.28	−0.65, 0.09	0%	0.13
HDL-cholesterol	2	88	44	44	0.02	−0.06, 0.10	22%	0.63
LDL-cholesterol	2	88	44	44	0.05	−0.20, 0.30	0%	0.70
Triglycerides	2	88	44	44	−0.16	−0.49, 0.17	97%	0.35

Units: Systolic blood pressure: mmHg; diastolic bloodpressure: mmHg; resting heart rate: BPM; 2-h blood glucose: mmol/l; fasting insulin: μU/ml; fasting glucose: mmol/l; HDL cholesterol: mmol/l; LDL cholesterol: mmol/l; Triglycerides: mmol/l; peripheral pulse pressure: mmHg.

*Significant result from meta-analysis.

Figure 2. Forest plots of primary outcomes.

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