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D. Ernstzen1, D. Bhoolia1, R. Dalvie1, A. Kuriakose1, S. Huang1, B. Simpson1, D. Stanford1
1Stellenbosch University, Physiotherapy, Cape Town, South Africa
Background: Stroke is defined as a neurological deficit caused by an acute focal injury of the central nervous system by a vascular cause. Stroke is one of the leading causes of disability globally and in Sub Saharan Africa. The impact is multidimensional, influencing the physical, mental and social wellbeing of those affected. Emerging evidence suggests that physical exercise might have a positive effect on mental health and quality of life (QOL) however, uncertainty exists regarding which type of exercise has a greater impact on patient outcomes.
Purpose: To determine the effectiveness of aerobic exercise and/or progressive resistance exercise (PRE) compared with usual care, on QOL, depression and anxiety in adults post stroke.
Methods: A systematic review of randomised clinical trials (RCTs) was conducted. Seven computerised bibliographic databases were searched and were accessed via the Stellenbosch University Library: PubMed, Cochrane Library, PEDro (Physiotherapy Evidence Database), ScienceDirect, Scopus, ProQuest and CINAHL. The main search terms used were “stroke”, “aerobic training”, “progressive resistance training”, “depression” and “usual care”. The quality of the eligible trials was critically appraised according to the PEDro scale. Heterogeneous results were narratively analysed, and homogenous results were analysed using RevMan 5© software to pool results from the included articles.
Results: Four randomised controlled trials, that complied to the inclusion criteria, were included for this review, with an average PEDro score of 7/10 and a total of 534 participants. Two studies implemented aerobic exercise and two implemented PRE. The exercise programs differed in format and in duration. Usual care consisted of general medical care administered by their physician, antidepressant medication and education classes. The intervention group (IG) was favoured over the control group (CG) with regards to depression. With regards to QOL outcomes, results were mixed and only one subset of data favoured the IG. The overall effect of aerobic and/or PRE was larger than the effect that usual care had on depression and QOL. Statistically, no significant differences were found between the IG and CG for anxiety outcome levels.
Conclusion(s): Level II evidence suggests that PRE and aerobic exercise has an effect in reducing depressive symptoms, however the results suggest that anxiety symptoms are not improved in the same population. The results regarding QOL in participants presenting with subacute and chronic stroke are mixed as only one subset of data favoured the IG. Physiotherapists are advised to use group programs including PRE and/or aerobic exercise to improve depressive symptoms and affect QOL.
Implications: Aerobic exercises and/or PRE can be executed in the clinical setting in South Africa with minimal costing. Aerobic exercises are cost effective and has many benefits in a clinical setting or at home. For PRE, therabands and simple household items can be used, which are inexpensive and easy to use. There should be a focus on motivating the participants to adhere to the physical programmes over time. Additionally, in the South African context, exercise may be implemented in a community setting and can be offered by a peer or community member, under the supervision of a physiotherapist.
Funding, acknowledgements: Stellenbosch University’s Undergraduate Research Department granted funding for this systematic review.
Keywords: Stroke, Depression, anxiety, quality of life, Aerobic exercise, progressive resistance exercise
Topic: Neurology: stroke
Did this work require ethics approval? No
Institution: N/A
Committee: N/A
Reason: Systematic review
All authors, affiliations and abstracts have been published as submitted.
