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Physical Exercise Reduces Fall-Related Outcomes Among People With Stroke: A Systematic Review and Meta-Analysis
Xun Li1, Yuk Kwan Chan1, Yiu Lam Tong1
1Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China.
Importance:
Stroke markedly increases fall risk. Physical exercise is a potential approach to reducing falls poststroke.
Objective:
The objective was to evaluate the effect of physical exercise on falls in people with stroke, and to examine participant and exercise protocol characteristics that may affect treatment response.
Design:
This was a systematic review and meta-analysis of randomized controlled trials.
Setting:
Following the PRISMA guidelines, PubMed, CINAHL, Cochrane Database, PsycINFO, Embase, and Web of Science databases were systematically searched.
Participants:
People with stroke were studied.
Intervention:
Physical exercise training was the intervention examined in this systematic review.
Main Outcomes And Measures:
Number of falls/injurious falls/fallers were the outcomes examined.
Results:
Eighteen studies (1536 participants) were included. Overall, physical exercise significantly reduced the number of falls by 39% (incidence rate ratio (IRR = 0.61, 95% CI = [0.47, 0.78]). The effect on the number of injurious falls (IRR = 0.63, 95% CI = [0.37, 1.05]) and fallers (IRR = 0.88; 95% CI = [0.73, 1.0]) was less apparent. Exploratory subgroup analyses revealed that programs focusing on balance training and those integrating physical exercise with cognitive components (eg, dual-task training/mind-body exercise) were most effective, compared with walking training, combined balance/walking training, and strength training. People in the chronic stage of stroke and with mild to moderate disability may benefit more from exercise.
Conclusions:
Physical exercise is effective in improving fall-related outcomes among people with stroke, particularly for people in the chronic stage with mild/moderate disability levels may gain more benefits. Physical exercise programs incorporating balance training and cognitive components may be more effective for fall prevention.
Relevance:
This results of this systematic review provide insight into exercise training for fall prevention in stroke rehabilitation.
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