Safety and Benefits of Moderate to High Intensity Aerobic Exercise During the Subacute Phase of Stroke: A Systematic Review and Meta-analysis.

Objective: To determine the safety and efficacy of moderate to high intensity exercise for patients in the subacute phase of stroke recovery. Data Sources: Embase, PubMed, Cochrane Central Register of Controlled Trials, CINAHL, ClinicalTrials.gov, Google Scholar, and previous meta-analyses published between January 1994 and October 2024. Study Selection: Title and abstract screening required consensus by 2 reviewers. A total of 27 randomized controlled trials met inclusion criteria. Studies were included if they enrolled participants <6 months post stroke. Interventions were eligible if they were of moderate or high cardiovascular intensity as defined by the American College of Sports Medicine. Acceptable comparator groups included sham, low intensity interventions, no exercise, relaxation, or cognitive interventions. Data Extraction: Three reviewers independently extracted data using the COVIDENCE platform, with each article reviewed by at least 2 individuals. Random effect meta-analyses were employed to generate pooled estimates of effects. Primary outcomes included severe cardiac and cerebral adverse events, measures of endurance, and gait speed. Secondary outcomes included death, blood pressure, balance, quality of life, and functional independence. Data Synthesis: Several measures of endurance and gait speed were significantly improved with moderate to high intensity interventions (change in 6-minute walk test, mean difference (MD): 33.11 m; 95% CI, 23.24-42.98; Conclusions: Moderate to high intensity exercise should be considered within acute rehabilitation facilities, skilled nursing facilities, and outpatient settings for patients in the subacute phase of post stroke rehabilitation and screened as appropriate. Physician collaboration for patient selection and continued active monitoring for SAEs is recommended.