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Cited by 1,081Stroke Rehabilitation and RecoveryAcute Ischemic Stroke ManagementMedical Practices and Rehabilitation

Effects of Augmented Exercise Therapy Time After Stroke: A Meta-Analysis

Kwakkel, Gert, van Peppen, Roland, Wagenaar, Robert C., Wood Dauphinee, Sharon, Richards, Carol, Ashburn, Ann, Miller, Kimberly, Lincoln, Nadina +3 more·2004·Stroke
DOI 10.1161/01.str.0000143153.76460.7d
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Abstract

Background and Purpose— To present a systematic review of studies that addresses the effects of intensity of augmented exercise therapy time (AETT) on activities of daily living (ADL), walking, and dexterity in patients with stroke. Summary of Review— A database of articles published from 1966 to November 2003 was compiled from MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, PEDro, DARE, and PiCarta using combinations of the following key words: stroke, cerebrovascular disorders, physical therapy, physiotherapy, occupational therapy, exercise therapy, rehabilitation, intensity, dose–response relationship, effectiveness, and randomized controlled trial. References presented in relevant publications were examined as well as abstracts in proceedings. Studies that satisfied the following selection criteria were included: (1) patients had a diagnosis of stroke; (2) effects of intensity of exercise training were investigated; and (3) design of the study was a randomized controlled trial (RCT). For each outcome measure, the estimated effect size (ES) and the summary effect size (SES) expressed in standard deviation units (SDU) were calculated for ADL, walking speed, and dexterity using fixed and random effect models. Correlation coefficients were calculated between observed individual effect sizes on ADL of each study, additional time spent on exercise training, and methodological quality. Cumulative meta-analyses (random effects model) adjusted for the difference in treatment intensity in each study was used for the trials evaluating the effects of AETT provided. Twenty of the 31 candidate studies, involving 2686 stroke patients, were included in the synthesis. The methodological quality ranged from 2 to 10 out of the maximum score of 14 points. The meta-analysis resulted in a small but statistically significant SES with regard to ADL measured at the end of the intervention phase. Further analysis showed a significant homogeneous SES for 17 studies that investigated effects of increased exercise intensity within the first 6 months after stroke. No significant SES was observed for the 3 studies conducted in the chronic phase. Cumulative meta-analysis strongly suggests that at least a 16-hour difference in treatment time between experimental and control groups provided in the first 6 months after stroke is needed to obtain significant differences in ADL. A significant SES supporting a higher intensity was also observed for instrumental ADL and walking speed, whereas no significant SES was found for dexterity. Conclusion— The results of the present research synthesis support the hypothesis that augmented exercise therapy has a small but favorable effect on ADL, particularly if therapy input is augmented at least 16 hours within the first 6 months after stroke. This meta-analysis also suggests that clinically relevant treatment effects may be achieved on instrumental ADL and gait speed.

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  • Greater amounts of physical training poststroke is associated with improved outcomes (without harm) in a number of meta-analyses.

    “Greater amounts of physical training poststroke is associated with improved outcomes (without harm) in a number of meta-analyses,5,6 and many guidelines recommend increasing training dose.”

    From Prespecified dose-response analysis for A Very Early Rehabilitation Trial (AVERT) (2016) · cites this paper as [6]

  • In humans, a number of systematic reviews and meta-analyses suggest a dose-response relationship, with more intensive therapy resulting in improved functional outcome after stroke.

    “In humans, a number of systematic reviews and meta-analyses suggest a dose-response relationship, with more intensive therapy resulting in improved functional outcome after stroke.5,6,15”

    From Prespecified dose-response analysis for A Very Early Rehabilitation Trial (AVERT) (2016) · cites this paper as [6]

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1 of the 54 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. Hedges L, Olkin I. Statistical Methods for Meta-analysis. Orlanda, Fla: Academic Press; 1985.
  2. Raudenbush S. Random effects model. In: Cooper H, Hedges LV, eds. The Handbook of Research Synthesis. New York: Russell Sage Foundation; 1994:301-323.
  3. Tinson D. How stroke patients spend their days. Int Disabilities Studies. 1989;11:45-49.

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Authors
Kwakkel, G., van Peppen, R., Wagenaar, R. C., Wood Dauphinee, S., Richards, C., Ashburn, A., Miller, K., Lincoln, N., Partridge, C., Wellwood, I., & Langhorne, P.
Affiliations
  • Boston University (US)
  • From the Department of Physical Therapy and Research Institute for Fundamental and Clinical Human Movement Sciences (G.K., R.v.P.), VU University Medical Center, Amsterdam, the Netherlands; the Center of Excellence for Rehabilitation Medicine “De Hoogstraat” (G.K.), Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, the Netherlands; the Department of Rehabilitation Sciences and Center for Neurorehabilitation (R.C.W.), Sargent College of Health and Rehabilitation Sciences,...
ORCID
Venue
Stroke
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2004-11
Volume
35
Issue
11
Pages
2529-2539
ISSN
  • 0039-2499 (ISSN-L)
  • 1524-4628
DOI
10.1161/01.str.0000143153.76460.7d
OpenAlex
W2141635852
Cited by
1,081
References
54
Citations by year
2026: 30 · 2025: 39 · 2024: 30 · 2023: 32 · 2022: 53 · 2021: 59 · 2020: 52 · 2019: 56 · 2018: 57 · 2017: 47 · 2016: 56 · 2015: 73 · 2014: 70 · 2013: 51 · 2012: 55
FWCI
4.83
Type
journal article
Language
en
Open access
closed
Locations
  • Stroke (publishedVersion)
  • PubMed (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
  • ePrints Soton (University of Southampton) (submittedVersion)
  • Kent Academic Repository (University of Kent) (submittedVersion)
  • Pure Amsterdam UMC (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Funders
  • ZonMw
  • Koninklijk Nederlands Genootschap voor Fysiotherapie
Topics
  • Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
  • Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
Keywords
stroke rehabilitation, exercise therapy, treatment intensity, dose-response relationship, activities of daily living, walking speed, dexterity, instrumental activities of daily living, early rehabilitation, chronic stroke, treatment duration, walking training, upper limb training, gait training, balance training, stroke mortality, stroke recurrence, stroke complications, stroke risk factors
MeSH terms
Stroke Rehabilitation, Activities of Daily Living, Exercise Therapy, Humans

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