Priority 9 Stroke Rehabilitation and Long-term Care

UNCERTAINTY: What are the best interventions including exercise to improve strength and fitness, promote recovery and prevent further stroke in stroke survivors? (JLA PSP Priority 9)
Overall ranking 9
JLA question ID 0106/9b
Explanatory note

Physical health is important for recovery and maintenance of activities of daily living, and to reduce the risk of secondary stroke. However, levels of physical activity, cardiorespiratory fitness, muscle strength and power are low after stroke [Ref. 4]. Strategies to improve strength and fitness may be complex as stroke survivors may experience additional stroke-related impairments including fatigue, muscle control problems and cognitive problems. Interventions to increase physical fitness could reduce mortality and reduce disability through increased function.  However further well‐designed randomised trials are needed to determine the optimal exercise prescription, the range of benefits and any long‐term benefits.  (Saunders et al, see Evidence). 

Ref 4: RCP National Clinical Guidelines
Evidence

There are a number of Cochrane reviews looking at different forms of strength and fitness training in stroke, these include:

English C, Hillier SL, Lynch EA. Circuit class therapy for improving mobility after stroke. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD007513. DOI: 10.1002/14651858.CD007513

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 
Health Research Classification System category Stroke
Extra information provided by this PSP
Original uncertainty examples What research is there on the effectiveness of strength training for physical rehabilitation/recovery? ~ What fitness /strength based programmes are most effective? ~ How does strength training impact physical recovery? ~ Can exercise bring back strength and balance on my right side, and do I have to continue exercise for the rest of my life in order to keep strength and balance? ~ What research has been done to establish the benefits of strength training for recovery from stroke? 
Submitted by Stroke Survivor x 8, Health/social care professional x 6, Research Recommendations x 2, Not stated x 1, Carer x 1
PSP information
PSP unique ID 0106
PSP name Stroke Rehabilitation and Long-term Care
Total number of uncertainties identified by this PSP. 93  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 19/20th April 2021