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Stroke – Better mobility

Evidence Summary
Physical activity following stroke, particularly walking, has been shown in a number of different studies to improve measures of walking endurance, walking speed and ability to walk unaided. These benefits have been seen after research interventions involving both walking specific training and interventions using cycle ergometer or circuit type activities, although not after resistance training.

Quality of Evidence
Grade A-This recommendation comes from a synthesis of studies in the form of a Cochrane review and thus can be considered of high quality.

Strength of Recommendation
Grade 1- This recommendation comes from a synthesis of studies in the form of a Cochrane review and thus can be considered strong

Conclusion
Supporting people to be physically active following stroke can result in improvements in both walking ability and walking capacity. This may be very beneficial in maximising independence and holistic function.

References
• Saunders DH, Sanderson M, Hayes S, Johnson L, Kramer S, Carter DD, Jarvis H, Brazzelli M, Mead GE. Physical fitness training for stroke patients Cochrane Database of Systematic Reviews 2020, Issue 3. Art. No.: CD003316. DOI: 10.1002/14651858.CD003316.pub7.
• Ada L, Dean CM, Lindley R. Randomized trial of treadmill training to improve walking in community-dwelling people after stroke: the AMBULATE trial. International Journal of Stroke 2013;8(6):436-44.
• Bateman A, Culpan FJ, Pickering AD, Powell JH, Scott OM, Greenwood RJ. The effect of aerobic training on rehabilitation outcomes after recent severe brain injury: a randomized controlled evaluation. Archives of Physical Medicine and Rehabilitation 2001;82(2):174-82.
• Kang HK, Kim Y, Chung Y, Hwang S. Effects of treadmill training with optic flow on balance and gait in individuals following stroke: randomized controlled trials. Clinical Rehabilitation 2012;26(3):246-55
• Katz-Leurer M, Carmeli E, Shochina M. The effect of early aerobic training on independence six months post stroke. Clinical Rehabilitation 2003;17(7):735.
• Kim M, Cho K, Lee W. Community walking training program improves walking function and social participation in chronic stroke patients. Tohoku Journal of Experimental Medicine 2014;234(4):281 6.
• Mudge S, Barber PA, Stott NS. Circuit-based rehabilitation improves gait endurance but not usual walking activity in chronic stroke: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation 2009;90(12):1989-96.
• Globas C, Becker C, Cerny J, Lam JM, Lindemann U, Forrester LW, et al. Chronic stroke survivors benefit from high intensity aerobic treadmill exercise: a randomized control trial. Neurorehabilitation and Neural Repair 2012;26(1):85-95.
• Ivey FM, Ryan AS, Hafer-Macko CE, Macko RF. Improved cerebral vasomotor reactivity after exercise training in hemiparetic stroke survivors. Stroke 2011;42(7):1994-2000.
• Jin H, Jiang Y, Wei Q, Chen L, Ma G. Effects of aerobic cycling training on cardiovascular fitness and heart rate recovery in patients with chronic stroke. Neuro Rehabilitation 2013;32(2):327-35.
• Moore JL, Roth EJ, Killian C, Hornby TG. Locomotor training improves daily stepping activity and gait efficiency in individuals poststroke who have reached a “plateau” in recovery. Stroke 2010;41(1):129-35.
• Park HJ, Oh DW, Kim SY, Choi JD. Effectiveness of community-based ambulation training for walking function of post-stroke hemiparesis: a randomized controlled pilot trial. Clinical Rehabilitation 2011;25(5):451-9.
• Salbach NM, Mayo NE, Robichaud-Ekstrand S, Hanley JA, Richards CL, Wood-Dauphinee S. The effect of a task oriented walking intervention on improving balance self-efficacy poststroke: a randomized, controlled trial. Journal of the American Geriatrics Society 2005;53(4):576-82.
• Yang YR, Wang RY, Lin KH, Chu MY, Chan RC. Task oriented progressive resistance strength training improves muscle strength and functional performance in individuals with stroke. Clinical Rehabilitation 2006;20:860–70.
• Zedlitz AMEE, Rietveld TCM, Geurts AC, Fasotti L. Cognitive and graded activity training can alleviate persistent fatigue after stroke: a randomized, controlled trial. Stroke 2012;43(4):1046–51.

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