Effects of exercise on cardiovascular risk factors following stroke or transient ischemic attack: a systematic review and meta-analysis
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OBJECTIVE: This review aimed to investigate the effects of exercise-based interventions on cardiovascular risk factors in individuals with stroke or transient ischemic attack. DATA SOURCES: MEDLINE, EMBASE, PsycINFO, and CINAHL were searched from inceptions to 28 December 2016. REVIEW METHODS: Randomized controlled trials were included that involved exercise with or without other interventions, included participants of any age, with diagnosis of transient ischemic attack or stroke, at any stage of severity or time period following the event, and reported cardiovascular risk factor outcomes. Review Manager (version 5.3) was used to aggregate data from all studies and from those involving only exercise interventions. RESULTS: This review included 18 randomized controlled trials (930 participants) in the qualitative synthesis, 14 of which were included in the quantitative analysis (720 participants; ranging from 84 to 438 participants within individual meta-analyses). All interventions were effective in reducing resting systolic blood pressure (mean difference (MD): -5.32 mmHg, 95% confidence interval (CI): -9.46 to -1.18, P = 0.01), fasting glucose (MD: -0.11 mmol/L, 95% CI: -0.17 to -0.06, P < 0.0001), and fasting insulin (MD: -17.14 pmol/L, 95% CI: -32.90 to -1.38, P = 0.03), and increasing high-density lipoprotein cholesterol (MD: 0.10 mmol/L, 95% CI: 0.03-0.18, P = 0.008). Effects were maintained following meta-analysis of only exercise interventions. CONCLUSION: Findings suggest that exercise-based interventions are effective in reducing systolic blood pressure, fasting glucose, and fasting insulin, and increasing high-density lipoprotein cholesterol after stroke or transient ischemic attack, providing evidence for their implementation as a strategy for secondary prevention.
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