Energy expenditure and cost during walking after stroke: A systematic review

Publication date: Available online 11 December 2015
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Sharon Flora Kramer, Liam Johnson, Julie Bernhardt, Toby Cumming
ObjectiveTo systematically review the evidence to determine energy expenditure (EE) in VO2 ml/kg/min and energy cost (EC) in VO2 ml/kg/m during walking post-stroke and how it compares to healthy controls. We aim to determine how applicable current exercise prescription guidelines are to stroke survivors.Data SourcesCENTRAL, Medline, EMBASE, CINAHL were searched on 9 October 2014 using search-terms related to stroke and energy expenditure. Additionally we screened reference lists of eligible studies.Study SelectionTwo independent reviewers screened titles and abstracts of 2,115 identified references. After screening the full text of 144 potentially eligible studies, we included 29 studies (501 stroke survivors, 123 healthy controls), including participants with confirmed stroke and a measure of volume of oxygen uptake (VO2) during walking using breath-by-breath analysis. Studies with (9 studies) and without (20 studies) a healthy control group were included.Data ExtractionTwo reviewers independently extracted data using a standard template including patient characteristics, outcome data and study methods.Data SynthesisMean age of stroke survivors was 57 years (range 40-67). Post-stroke EE was highly variable across studies and could not be pooled due to high heterogeneity. EE during steady-state overground walking at matched speeds was significantly higher in stroke survivors compared to healthy controls (MD 4.06 VO2 ml/kg/min; 95% CI 2.21-5.91; 1 study, n=26); there was no significant group difference at self-selected speeds. EC during steady-state overground walking was higher in stroke survivors at both self-selected (MD 0.47 VO2 ml/kg/m; 95% CI 0.29-0.66; 2 studies, n=38) and matched speeds compared to healthy controls (MD 0.27 VO2 ml/kg/m; 95% CI 0.03-0.51; 1 study, n=26).ConclusionsStroke survivors expend more energy during walking than healthy controls. Low intensity exercise as described in guidelines might be at a moderate intensity level for stroke survivors; there is a need for stroke specific exercise guidelines.



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