Abstract Body: Introduction: Stroke patients often experience varying degrees of locomotor deficits. Research has shown that physical rehabilitation can help improve these deficits to different extents. Our analysis aims to compare functional outcomes in stroke patients after high-intensity training (HIT) with those achieved through various other exercise intensities.
Methods: A comprehensive search of PubMed, Cochrane, Embase, and Scopus databases were performed for studies comparing HIT with low and moderate intensity training (LIT, MIT), or usual activity (UA) in stroke patients. We evaluated changes from baseline in the 6-minute walking test (6MWT), fastest speed, and comfortable speed. Subgroup analyses were performed by exercise intensity and stroke onset, as well as separate analyses according to follow-up periods.
Results: 12 studies were included, encompassing 1,019 patients, with 54% undergoing HIT. An analysis of ten studies with 860 patients showed that control group had a 49m greater improvement in 6MWT than HIT group (95%CI 21.62-76.38; p<0.01). Subgroup analysis showed a 44m and 59m greater improvement in subacute (95%CI 3.55-86.37; p=0.03) and chronic stroke (95%CI 2.57-116.58; p=0.04) in control, respectively. MIT and UA also showed a 28.7m (95%CI 16.04-41.43; p<0.01) and 63m (95%CI 21.55-104.76; p<0.01) greater improvement in 6MWT compared to HIT. A separate analysis of three studies showed that chronic stroke patients in control group achieved greater improvement in 6MWT (MD 29.34m;95%CI 4.57-54.11;p=0.02) with follow-up periods of less than three months. Analysis of eight studies involving 414 patients found significantly higher fastest speed (MD 0.16m/s;95%CI 0.08-0.23;p<0.01) and comfortable speed (MD 0.11m/s; 95%CI 0.07-0.15; p<0.01) in control group compared to HIT group. Subgroup analysis indicated MIT (MD 0.16m/s;95%CI 0.07-0.26;p<0.01) and UA (MD 0.25m/s; 95%CI 0.10-0.39; p<0.01) significantly increased fastest speed compared to HIT. Additionally, comfortable speed showed a significant increase after LIT (MD 0.13m/s;95%CI 0.03-0.24;p=0.02), MIT (MD 0.10m/s;95%CI 0.04-0.15;p<0.01), and UA (MD 0.16m/s;95%CI 0.04-0.28;p=0.01).
Conclusion: Moderate-intensity training and usual activity yield better functional outcomes than high-intensity training in stroke patients, particularly benefiting chronic stroke patients within three months. Further studies should determine the impact levels and optimal daily duration for long-term benefits.