Efeitos do treino intervalado de alta intensidade em indivíduos pós-acidente vascular encefálico: uma revisão sistemática

Abstract

Stroke is a highly prevalent health condition and is considered one of the main causes of disability worldwide. Cardiorespiratory fitness, gait capacity and quality of life are often compromised in individuals after a stroke. The efficacy of aerobic training has been studied in post-stroke individuals. Despite this, the ideal prescription for this population is still not completely clear. Among the possibilities for performing aerobic training is high-intensity interval training. Its effectiveness for this population, however, is still unclear. The objective of this systematic review was to investigate the effect of high-intensity interval training on cardiorespiratory fitness, blood pressure, gait outcomes, and quality of life of individuals after stroke. For this review, searches were performed in the Medline, PEDro, SciELO and LILACS databases using keywords related to the intervention (“high intensity interval training”) and to the population (“stroke”). The methodological quality of the included studies was assessed using the PEDro scale. After selection, five randomized controlled trials with a median of 7 points on the PEDro scale were included. The study sample ranged from 16 to 71 participants, with a total number of 220. The experimental groups practiced high-intensity interval training mostly through treadmill training. Other modalities used were stationary bicycle and plyometric exercises. The intensity range varied between 77%-95% of the maximum heart rate, or 85%-95% of the VO2max. One of the studies described the progression of the intensity based on the maximum tolerated speed and another study followed the intensity through the evaluation of the perception of effort, which should not exceed the limit of 14 on the Borg scale. The total duration of the practice varied between 15-52 minutes. The high intensity bursts duration ranged between 30 seconds and 5 minutes, and recovery periods between 30 seconds and 3 minutes. In most studies, the weekly frequency was 3 times and the total duration was 12 weeks. The control groups underwent continuous aerobic training or received guidance on how to exercise and change their lifestyle or performed high-intensity interval training in a different mode. The measurement instruments used were varied. Cardiorespiratory fitness had as parameter the VO2peak obtained in treadmill test or the maximum load in the execution of the Graded Cycling Test with Talk Test. The 6-minute walk test, 10-meter walk test, dynamic gait index and metabolic gait cost, as well as stride length, cadence and step length of the two lower limbs were evaluated for gait outcomes. Quality of life was assessed using the Euro-Quality of Life-5 Dimension, Health Survey Questionnaire SF-36 and Stroke Impact Scale scales. The results of this review showed a positive effect of high-intensity interval training on cardiorespiratory fitness and gait outcomes in the population after stroke. Of the five studies that assessed cardiorespiratory fitness, three of them (60%) showed results with significant intergroup improvement after the intervention and one article showed intragroup improvement. Of the three studies that investigated the effect of high-intensity interval training on gait outcomes in post-stroke individuals, two studies (66.6%) found intergroup improvement after training and one of them showed significant intragroup improvement. The effect of high-intensity interval training on blood pressure and quality of life was inconclusive. Further studies are suggested to investigate the effect of high-intensity interval training on these and other outcomes in the post-stroke population.