Nindorera F1,2, Nduwimana I1,2, Thonnard JL1, Kossi O3,4
1Catholic University of Louvain, Institute of Neuroscience (IoNs), Brussels, Belgium, 2University Hospital Roi Khaled, National Center of Reference in Physiotherapy and Medical Rehabilitation, Bujumbura, Burundi, 3University Hospital of Parakou, Unit of Rehabilitation, Parakou, Benin, 4University of Parakou, Faculty of Public Health and Epidemiology, Parakou, Benin

Background: Stroke remains a major global health problem and its significance is likely to increase in the future because of ongoing demographic changes, including aging of the population and health transitions. Stroke remains a leading cause of long-term disability. The most severely affected activities are the abilities to transfer, dress and walk. Recovery of walking to regain independence in daily life is one of the main goals of stroke patients. Stroke patients with disability are more likely to be physically inactive which could lead to an increased cardiovascular risk. There is a lot of scientific evidence on the effectiveness of physical activity (Exercises) after stroke. Walking is a less expensive physical activity, easily accessible that promotes a functional autonomy.

Purpose: To determine the effectiveness of walking versus other physical activities for chronic stroke survivors.

Methods: This is a systematic review and Meta-analysis of recent Randomized Controlled Trials (from 2008 to 2018) published in English or in French. The research strategy was carried out through electronic databases (MEDLINE, EMBASE, The Cochrane Library (CENTRAL), Cochrane Methodology Register, Google scholar and INARI) using key terms related to stroke and physical activity (walking and other physical exercises). Only chronic stage stroke victims were included in this study. Articles with good methodological quality (Assessment of bias by two independent review authors using Cochrane risk-of-bias tool) were retained for the analysis. Data analyses will be performed by the Review Manager software and results will be added to the manuscript in the next two months (result updated).

Results: 104 RCTS met inclusion criteria. These include 61 RCTs on walking (overground walking, treadmill, circuit training, group walking, assistive walking …), 13 on cycling, 21 on strengthening and balance trainings and 9 on mental exercises (Tai Chi, Qigong, Virtual reality ...). 55 RCTs of walking concluded that walking trainings improve walking abilities, endurance, walking parameters (distance, speed ....), functional autonomy and quality of life and 6 RCTs concluded on effectiveness of assistive walking (Robot). Among 13 RCTs on cycling, 11 concluded that cycling improves cardiovascular performances whereas 2 RCTs found no real effect. Among 21 RCTs on strengthening and balance, 17 concluded that progressive resistance training is effective to improve muscle strength in chronic stroke but there appear to be long-term benefits and the 4 others concluded that balance trainings improve gait performance and participation. 7 RCTs showed that mental practices improve balance and seem to be more effective than conventional care, 2 RCTs didn't find difference.

Conclusion(s): Gait training, cycling, muscle strengthening and balance exercises have been shown to be effective in chronic stroke patients. They improve walking ability and functional independence. The ideal training frequency would be 45-60 min, 3 times a week minimum. These trainings are effective, accessible and not expensive.

Implications: These physical activities could be implemented in low-income countries where access to rehabilitative care is reduced. The results of this study will lead to a randomized controlled trial comparing the effectiveness of different physical activities for chronic stroke survivors in Burundi and Benin.

Keywords: Chronic stroke, walking, physical exercise

Funding acknowledgements: APEFE Asbl will fund the author to participate as a support to the development of medical rehabilitation in Burundi

Topic: Neurology: stroke; Professional issues

Ethics approval required: No
Institution: Catholic university of Louvain
Ethics committee: no committe is necessary
Reason not required: This study is a systematic review and Meta analysis of RCT yet published. protocole was sent to Cochrane Review (Prospero).

All authors, affiliations and abstracts have been published as submitted.

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