Energy consumption and cost during walking with different modalities of assistance after stroke: a systematic review and meta-analysis

Abstract

Purpose: To estimate pooled rates of gross and net energy consumption (ml/kg/min and J/kg/min) and energy cost (ml/kg/m and J/kg/m) during level surface walking with different assistance modalities post-stroke.

Materials and Methods: Four databases were searched using keywords related to stroke, walking, and energy requirements. Three independent reviewers screened 3296 records and included 42 studies in quantitative analysis.

Results: Pooled rates without significant important heterogeneity were identified for: gross energy consumption during unassisted overground walking at comfortable walking speed (10.55 ml/kg/min; 95% CI [9.93–11.16]), gross energy consumption during treadmill walking with rigid exoskeleton assistance (7.08 ml/kg/min; 95% CI [6.52–7.65]), gross energy cost during unassisted overground walking in patients with chronic stroke (0.24 ml/kg/m; 95% CI [0.28–0.48]), gross energy cost during unassisted treadmill walking in patients with subacute stroke (0.45 ml/kg/m; 95% CI 0.45–0.45]), and net energy cost during overground walking with assistive devices and orthoses in patients with chronic stroke (4.12 J/kg/m, 95% CI [3.55–4.69]).

Conclusions: Walking, unassisted and with the use of assistive devices and lower limb orthoses, induces low- to moderate-intensity exercise as recommended by exercise guidelines for stroke survivors. Future studies should explore whether bodyweight-supported or robot-assisted walking can also reach moderate-intensity.

Implications for Rehabilitation

• To induce sufficient cardiorespiratory stress during gait rehabilitation (i.e., moderate-intensity), therapists should train ambulatory patients with stroke without any assistance or if needed with the help of assistive devices or lower limb orthoses.

• For severely impaired patients who cannot walk independently, therapists could use bodyweight support systems, exoskeletons, or end-effectors to induce low-intensity aerobic exercise.

Keywords:

• Meta-analysis
• oxygen consumption
• stroke
• walking
• assistive devices
• orthosis
• bodyweight support
• exoskeleton

Acknowledgments

We would like to thank Professor Jan Taeymans, Professor David Beckwee and Dra. Laurence Leysen for their advice on statistical approaches for meta-analyses; and Chloe Giordano and Colton Sullivan for language editing.

Disclosure statement

N.L. is a SB (Strategic Basic Research) PhD fellow funded by the Research Foundation Flanders (FWO), Belgium. The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.