Meta-analysis of exercise intervention on cardiopulmonary function in stroke patients

doi:10.12307/2025.792

Abstract

Abstract: OBJECTIVE: Clinically, stroke patients experience significant cardiopulmonary dysfunction during rehabilitation, which increases the likelihood of recurrent stroke. However, exercise interventions can effectively improve cardiopulmonary function in stroke patients. This paper employs meta-analysis to conduct a comprehensive quantitative evaluation of domestic and international studies on the improvement of cardiopulmonary function in stroke patients through exercise interventions. It examines the effects of different exercise modalities on the cardiopulmonary function of stroke patients and explores the optimal exercise regimen.
METHODS: China National Knowledge Infrastructure (CNKI), WanFang Data, VIP, Web of Science, Cochrane Library, PubMed, and EBSCO databases were searched for articles published from inception to May 15, 2024, primarily including randomized controlled trials on exercise interventions improving cardiopulmonary function in stroke patients. Statistical analyses were conducted using Review Manager 5.4 and Stata 17 software.
RESULTS: (1) A total of 32 articles meeting the criteria were included, involving 1 826 stroke patients. (2) The results showed that exercise interventions significantly improved the oxygen uptake capacity of stroke patients [MD=2.10, 95%CI(1.57,2.63), P < 0.000 01]. The optimal exercise regimen for improving oxygen uptake capacity was high-intensity interval training, conducted 5-6 times per week, with each session lasting 41-60 minutes, for a duration of more than 12 weeks. (3) Exercise interventions also significantly enhanced the aerobic endurance of stroke patients [MD=38.00, 95%CI(29.55,46.45), P < 0.000 01]. The optimal regimen for improving aerobic endurance was high-intensity interval training, conducted 2-3 times per week, with each session lasting 41-60 minutes, for a duration of more than 12 weeks.
CONCLUSION: Exercise interventions can significantly improve the cardiopulmonary function of stroke patients, with high-intensity interval training being the most promising exercise modality. Therefore, the optimal exercise regimen for improving cardiopulmonary function in stroke patients is to conduct high-intensity interval training sessions lasting 41-60 minutes, starting with an intervention frequency of twice a week, gradually increasing the frequency based on tolerance, and continuing the intervention for more than 12 weeks. Future research should focus on collecting more high-quality, multi-faceted clinical studies and evidence to validate these conclusions, particularly in exploring the optimal exercise-to-rest ratio of high-intensity interval training for improving cardiopulmonary function in stroke patients.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: stroke, cardiopulmonary function, exercise intervention, meta-analysis, randomized controlled trial, systematic review, optimal exercise regimen, functional recovery, exercise physiology, engineered tissue construction

CLC Number:

Deng Yiran, Wang Xianliang, Li Dandan. Meta-analysis of exercise intervention on cardiopulmonary function in stroke patients[J]. Chinese Journal of Tissue Engineering Research, 2025, 29(24): 5203-5211.

Figures/Tables 9

发表偏倚检验：漏斗图显示大多数研究均匀分布在平均效应两侧(图6)。Egger检验结果(t=0.17，P=0.864)进一步说明不存在明显的发表偏倚。 Meta回归和调节变量亚组分析：因合并效应量异质性高于50%，故根据纳入文献特征提取干预方式、干预时间、干预频率、干预周期作为调节变量进行Meta分析。结果如表2所示，干预方式(P=0.037)的不同可能是产生异质性的主要原因之一。将干预方式、干预时间、干预频率、干预周期分别作为分组依据，尝试探索运动改善脑卒中患者摄氧能力的最佳运动方案。亚组分析结果见表3。干预方式方面，高强度间歇训练效果最好(MD=3.87)，组合训练次之(MD=2.62)；干预时间方面，每次干预41-60 min的效果最好(MD=2.84)，每次干预30-40 min(MD=1.70)与≥60 min(MD=1.62)的效果相似；干预频率方面，每周干预五六次(MD=2.17)的效果要强于两三次(MD=2.13)，但两种干预频率的效应量相近；干预周期方面，超过12周的干预效果最好(MD=2.41)，其次是干预4-8周(MD=1.94)。敏感性分析：首先，在随机效应和固定效应模型之间切换并重新进行统计分析后发现，所有统计结果无显著变化。其次，通过依次排除一项研究来评估每项研究的影响，结果显示，合并效应量(MD)的范围在1.99-2.17之间，I2的范围在73%-80%之间， P < 0.000 01。表明Meta分析结果稳定可靠。 2.4.2 运动干预对脑卒中患者有氧运动耐力的影响整体性检验：运动干预对脑卒中患者6 min步行测试成绩的分析共纳入18篇文献 [18，21-23，25-26，28-31，33-38，40，43]，共包含993例脑卒中患者。异质性检验发现各研究间存在低度异质性(I2=5%，P=0.40)。因此采用固定效应模型进行效应检验。结果如图7所示，与对照组相比，干预组脑卒中患者的有氧运动耐力水平有很大提高，且具有统计学意义[MD=38.00，95%CI(29.55，46.45)，P < 0.000 01]。发表偏倚检验：漏斗图显示大多数研究均匀分布在平均效应两侧"

References

[1] SACCO RL, KASNER SE, BRODERICK JP, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(7):2064-2089.
[2] LINDSAY MP, NORRVING B, SACCO RL, et al. World Stroke Organization (WSO): Global Stroke Fact Sheet 2019. Int J Stroke. 2019;14(8):806-817.
[3] SMITH AC, SAUNDERS DH, MEAD G. Cardiorespiratory fitness after stroke: a systematic review. Int J Stroke. 2012;7(6): 499-510.
[4] PASE MP, BEISER A, ENSERRO D, et al. Association of Ideal Cardiovascular Health With Vascular Brain Injury and Incident Dementia. Stroke. 2016;47(5):1201-1206.
[5] SUTBEYAZ ST, KOSEOGLU F, INAN L, et al. Respiratory muscle training improves cardiopulmonary function and exercise tolerance in subjects with subacute stroke: a randomized controlled trial. Clin Rehabil. 2010;24(3):240-250.
[6] KIM J, PARK JH, YIM J. Effects of respiratory muscle and endurance training using an individualized training device on the pulmonary function and exercise capacity in stroke patients. Med Sci Monit. 2014;20: 2543-2549.
[7] WANG C, XU Y, ZHANG L, et al. Comparative efficacy of different exercise methods to improve cardiopulmonary function in stroke patients: a network meta-analysis of randomized controlled trials. Front Neurol. 2024;15:1288032.
[8] LV W, WANG X, LIU J, et al. Eight-Section Brocade Exercises Improve the Sleep Quality and Memory Consolidation and Cardiopulmonary Function of Older Adults With Atrial Fibrillation-Associated Stroke. Front Psychol. 2019;10:2348.
[9] STOLLER O, DE BRUIN ED, KNOLS RH, et al. Effects of cardiovascular exercise early after stroke: systematic review and meta-analysis. BMC Neurol. 2012;12:45.
[10] HIGGINS JPT, THOMPSON SG, DEEKS JJ, et al. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557-560.
[11] 王丹, 翟俊霞, 牟振云, 等. Meta分析中的异质性及其处理方法[J]. 中国循证医学杂志,2009,9(10):1115-1118.
[12] 叶荣菊, 孙乐山, 张琴, 等. 有氧运动强度对脑卒中合并冠心病患者心功能及运动耐力的影响[J]. 心血管康复医学杂志, 2020,29(5):536-540.
[13] 徐泉, 潘钰, 杨晓辉, 等. 有氧运动联合常规康复治疗对卒中偏瘫患者心肺运动功能及康复效果的影响[J]. 中国脑血管病杂志,2017,14(9):465-469.
[14] 武昌, 秦小虎, 田智. 有氧运动联合常规康复治疗对卒中偏瘫患者心肺运动功能及康复效果的影响[J]. 临床医药文献电子杂志,2018,5(24):32-33.
[15] 冉龙飞, 聂志强, 郭军辉, 等. 等速肌力训练联合有氧运动对脑卒中患者心肺功能及下肢运动功能的影响[J]. 中国疗养医学,2022,31(12):1298-1302.
[16] 李兴顺. 定量评估有氧训练对老年脑卒中偏瘫患者心肺功能和身体恢复指标的影响[J]. 白求恩医学杂志,2020,18(4): 352-354.
[17] 谷磊, 武亮, 孙兴国. 定量评估有氧训练对老年脑卒中偏瘫病人心肺功能的影响[J]. 实用老年医学,2019,3(2):149-152.
[18] 付丛会, 陈梅, 李小通, 等. 抗阻训练对卒中慢性期患者呼吸功能、运动耐力及负性情绪的影响[J]. 中国卒中杂志,2022, 17(6):573-578+572.
[19] 陈普. 有氧运动+常规康复治疗对卒中偏瘫患者心肺功能及康复效果的影响评价[J]. 按摩与康复医学,2019,10(3):15-16.
[20] VANROY C, FEYS H, SWINNEN A, et al. Effectiveness of Active Cycling in Subacute Stroke Rehabilitation: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2017;98(8):1576-1585.e5.
[21] TOLEDANO-ZARHI A, TANNE D, CARMELI E, et al. Feasibility, safety and efficacy of an early aerobic rehabilitation program for patients after minor ischemic stroke: A pilot randomized controlled trial. NeuroRehabilitation. 2011;28(2):85-90.
[22] TANG A, SIBLEY KM, THOMAS SG, et al. Effects of an Aerobic Exercise Program on Aerobic Capacity, Spatiotemporal Gait Parameters, and Functional Capacity in Subacute Stroke. Neurorehabil Neural Repair. 2009;23(4):398-406.
[23] TANG A, ENG JJ, KRASSIOUKOV AV, et al. Exercise-induced changes in cardiovascular function after stroke: a randomized controlled trial. I Int J Stroke. 2014;9(7): 883-889.
[24] STOLLER O, DE BRUIN ED, SCHINDELHOLZ M, et al. Efficacy of Feedback-Controlled Robotics-Assisted Treadmill Exercise to Improve Cardiovascular Fitness Early After Stroke: A Randomized Controlled Pilot Trial. J Neurol Phys Ther. 2015;39(3):156-165.
[25] SHAO C, WANG Y, GOU H, et al. Strength Training of the Nonhemiplegic Side Promotes Motor Function Recovery in Patients With Stroke: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2023;104(2):188-194.
[26] SANDBERG K, KLEIST M, FALK L, et al. Effects of Twice-Weekly Intense Aerobic Exercise in Early Subacute Stroke: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2016;97(8):1244-1253.
[27] RIMMER JH, RAUWORTH AE, WANG EC, et al. A Preliminary Study to Examine the Effects of Aerobic and Therapeutic (Nonaerobic) Exercise on Cardiorespiratory Fitness and Coronary Risk Reduction in Stroke Survivors. Arch Phys Med Rehabil. 2009;90(3):407-412.
[28] MUNARI D, PEDRINOLLA A, SMANIA N, et al. High-intensity treadmill training improves gait ability, VO2peak and cost of walking in stroke survivors: preliminary results of a pilot randomized controlled trial. Eur J Phys Rehabil Med. 2018;54(3):408-418.
[29] MARZOLINI S, BROOKS D, OH P, et al. Aerobic With Resistance Training or Aerobic Training Alone Poststroke: A Secondary Analysis From a Randomized Clinical Trial. Neurorehabil Neural Repair. 2018;32(3): 209-222.
[30] MACKO RF, IVEY FM, FORRESTER LW, et al. Treadmill Exercise Rehabilitation Improves Ambulatory Function and Cardiovascular Fitness in Patients With Chronic Stroke. Stroke. 2005;36(10):2206-2211.
[31] MACKAY-LYONS M, MCDONALD A, MATHESON J, et al. Dual Effects of Body-Weight Supported Treadmill Training on Cardiovascular Fitness and Walking Ability Early After Stroke: A Randomized Controlled Trial. Neurorehabil Neural Repair. 2013; 27(7):644-653.
[32] LENNON O, CAREY A, GAFFNEY N, et al. A pilot randomized controlled trial to evaluate the benefit of the cardiac rehabilitation paradigm for the non-acute ischaemic stroke population. Clin Rehabil. 2008;22(2): 125-133.
[33] LEE MJ, KILBREATH SL, SINGH MF, et al. Comparison of Effect of Aerobic Cycle Training and Progressive Resistance Training on Walking Ability After Stroke: A Randomized Sham Exercise–Controlled Study. J Am Geriatr Soc. 2008;56(6): 976-985.
[34] JIN H, JIANG Y, WEI Q, et al. Effects of aerobic cycling training on cardiovascular fitness and heart rate recovery in patients with chronic stroke. NeuroRehabilitation. 2013;32(2):327-335.
[35] IVEY FM, STOOKEY AD, HAFER-MACKO CE, et al. Higher Treadmill Training Intensity to Address Functional Aerobic Impairment after Stroke. J Stroke Cerebrovasc Dis. 2015; 24(11):2539-2546.
[36] IVEY FM, PRIOR SJ, HAFER-MACKO CE, et al. Strength Training for Skeletal Muscle Endurance after Stroke. J Stroke Cerebrovasc Dis. 2017;26(4):787-794.
[37] GLOBAS C, BECKER C, CERNY J, et al. Chronic stroke survivors benefit from high-intensity aerobic treadmill exercise: a randomized control trial. Neurorehabil Neural Repair. 2012;26(1):85-95.
[38] GJELLESVIK TI, BECKER F, TJØNNA AE, et al. Effects of High-Intensity Interval Training After Stroke (The HIIT Stroke Study) on Physical and Cognitive Function: A Multicenter Randomized Controlled Trial. Arch Phys Med Rehabil. 2021;102(9):1683-1691.
[39] GJELLESVIK TI, BECKER F, TJØNNA AE, et al. Effects of High-Intensity Interval Training After Stroke (the HIIT-Stroke Study): A Multicenter Randomized Controlled Trial. Arch Phys Med Rehabil. 2020;101(6): 939-947.
[40] DUNCAN P, STUDENSKI S, RICHARDS L, et al. Randomized Clinical Trial of Therapeutic Exercise in Subacute Stroke. Stroke. 2003; 34(9):2173-2180.
[41] CHANG WH, KIM MS, HUH JP, et al. Effects of Robot-Assisted Gait Training on Cardiopulmonary Fitness in Subacute Stroke Patients: A Randomized Controlled Study. Neurorehabil Neural Repair. 2012;26(4): 318-324.
[42] CARR M, JONES J. Physiological Effects of Exercise on Stroke Svivors. Top Stroke Rehabil. 2003;9(4):57-64.
[43] BANG DH, SON YL. Effect of intensive aerobic exercise on respiratory capacity and walking ability with chronic stroke patients: a randomized controlled pilot trial. J Phys Ther Sci. 2016;28(8):2381-2384.
[44] GIRARD V, BELLAVANCE-TREMBLAY H, GAUDET-DROUIN G, et al. Cardiorespiratory strain during stroke rehabilitation: Are patients trained enough? A systematic review. Ann Phys Rehabil Med. 2021;64(4): 101443.
[45] LOE H, NES BM, WISLØFF U. Predicting VO2peak from Submaximal- and Peak Exercise Models: The HUNT 3 Fitness Study, Norway. PloS One. 2016;11(1):e0144873.
[46] LUO L, MENG H, WANG Z, et al. Effect of high-intensity exercise on cardiorespiratory fitness in stroke survivors: A systematic review and meta-analysis. Ann Phys Rehabil Med. 2020;63(1):59-68.
[47] MONTERO D, DIAZ-CAÑESTRO C, LUNDBY C. Endurance Training and V˙O2max: Role of Maximal Cardiac Output and Oxygen Extraction. Med Sci Sports Exerc. 2015; 47(10):2024-2033.
[48] ROSS R, BLAIR SN, ARENA R, et al. Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement From the American Heart Association. Circulation. 2016;134(24):e653-e699.
[49] TOMCZAK CR, THOMPSON RB, PATERSON I, et al. Effect of acute high-intensity interval exercise on postexercise biventricular function in mild heart failure. J Appl Physiol (1985). 2011;110(2):398-406.
[50] FU TC, WANG CH, LIN PS, et al. Aerobic interval training improves oxygen uptake efficiency by enhancing cerebral and muscular hemodynamics in patients with heart failure. Int J Cardiol. 2013;167(1):41-50.
[51] LITTLE JP, GILLEN JB, PERCIVAL ME, et al. Low-volume high-intensity interval training reduces hyperglycemia and increases muscle mitochondrial capacity in patients with type 2 diabetes. J Appl Physiol (1985). 2011;111(6):1554-1560.
[52] GIBALA MJ, MCGEE SL, GARNHAM AP, et al. Brief intense interval exercise activates AMPK and p38 MAPK signaling and increases the expression of PGC-1alpha in human skeletal muscle. J Appl Physiol (1985). 2009;106(3):929-934.
[53] LITTLE JP, SAFDAR A, BISHOP D, et al. An acute bout of high-intensity interval training increases the nuclear abundance of PGC-1α and activates mitochondrial biogenesis in human skeletal muscle. Am J Physiol Regul Integr Comp Physiol. 2011;300(6): R1303-1310.
[54] TAN R, NEDERVEEN JP, GILLEN JB, et al. Skeletal muscle fiber-type-specific changes in markers of capillary and mitochondrial content after low-volume interval training in overweight women. Physiol Rep. 2018;6(5): e13597.
[55] CROZIER J, ROIG M, ENG JJ, et al. High-Intensity Interval Training After Stroke: An Opportunity to Promote Functional Recovery, Cardiovascular Health, and Neuroplasticity. Neurorehabil Neural Repair. 2018;32(6-7):543-556.
[56] 祖秀明. 耐力训练与高强度间歇训练对肥胖儿童健康相关指标的影响[J]. 西南国防医药,2014,24(4):408-411.
[57] CORTE DE ARAUJO AC, ROSCHEL H, PICANÇO AR, et al. Similar health benefits of endurance and high-intensity interval training in obese children. PloS One. 2012; 7(8):e42747.
[58] BIDDLE SJH, BATTERHAM AM. High-intensity interval exercise training for public health: a big HIT or shall we HIT it on the head?. Int J Behav Nutr Phys Act. 2015;12:95.
[59] HERBERT P, GRACE FM, SCULTHORPE NF. Exercising caution: prolonged recovery from a single session of high-intensity interval training in older men. J Am Geriatr Soc. 2015;63(4):817-818.
[60] ROGNMO Ø, MOHOLDT T, BAKKEN H, et al. Cardiovascular risk of high- versus moderate-intensity aerobic exercise in coronary heart disease patients. Circulation. 2012;126(12):1436-1440.
[61] WEWEGE MA, AHN D, YU J, et al. High-Intensity Interval Training for Patients With Cardiovascular Disease-Is It Safe? A Systematic Review. J Am Heart Assoc. 2018; 7(21):e009305.