IJCS | Volume 32, Nº4, July/August 2019

409 Bavaresco Gambassi et al. Exercise and cardiovascular variables poststroke Int J Cardiovasc Sci. 2019;32(4):408-413 Review Article have observed that, regardless of the side affected by the stroke, the individuals showed impairments in the ACC, such as increased sympathetic and decreased parasympathetic system activities. 3,4,15,16 Exercise training has been used as a non- pharmacological strategy in the management of stroke survivors. Meta-analyses and review studies have reported an increase in strength and muscle function, as well as improvement in cardiovascular variables of stroke survivors in response to exercise training. 17-23 Although review studies on the association of exercise training and stroke have been gaining attention, the worldwide epidemic of this disease and its structural and functional consequences on cardiovascular and autonomous variables justify the need for further studies on adequate strategies to mitigate stroke damage. This would provide health professionals with more information on themost appropriate exercise prescription to prevent further stroke complications. Thus, the objective of the present study was to describe the effects of exercise training on cardiovascular and autonomic variables in stroke survivors. Methods Eligibility criteria Study selection The PICO (population, intervention, control/ comparison, and outcome variables) model was used for study selection. Studies were chosen for inclusion if they met the following four criteria: (A) post-stroke (> 6 months) patients of both genders, aged over 18 years; (B) structured exercise training program (aerobic and/or resistance); (C) randomized controlled trials; (D) cardiovascular (aerobic capacity) and/ or autonomic (resting heart rate in beats/min; heart rate variability) benefits of exercise. The reviewers documented the methodological quality of the studies and extracted relevant data. The following quality criteria were documented: baseline comparison of groups, randomization, all assessed outcomes, and details of participants (i.e., age, gender and time after stroke). The screening was performed by two independent reviewers. For each article, any discrepancy between the reviewers was resolved by re-reading and further analysis. In the first screening stage (titles plus abstracts), studies were selected when both reviewers agreed they were eligible for inclusion or if there were no disagreements on whether to exclude them. In the second screening stage (full text), studies were included when both reviewers agreed that they met all the inclusion criteria. Study identification and selection Relevant studieswere identified through computerized and manual searches. For data collection, PubMed and Physiotherapy Evidence Database (PEDro) databases were systematically searched from 2009 until December 2018 (last 10 years). The following keywords were used in the search: stroke, cerebrovascular accident, cerebral vascular accident, exercise training, aerobic training, aerobic exercise, resistance exercise and resistance training. This review was written in accordance with some items of the Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Assessment of article quality Themethodological quality of the studieswas evaluated using the PEDro scale. Two independent reviewers completed the checklist based on the PEDro scale. The PEDro scale evaluates the following aspects of methodological quality: (1) detailed eligibility criteria, (2) random allocation, (3) concealed allocation, (4) baseline prognostic similarity, (5) participant blinding, (6) therapist blinding, (7) outcome assessor blinding, (8) more than 85% follow-up for at least one primary outcome, (9) intention-to-treat analysis, (10) between- or within-group statistical analysis for at least one primary outcome, and 11) point estimates of variability given for at least one primary outcome. The internal validity of the randomized controlled trials was evaluated. A study with a PEDro score of 6 was considered level-1 evidence (6–8 good, 9–10 excellent) and a study with a score of 5 was considered level-2 evidence (4–5 acceptable, 4 poor). Data extraction The following characteristics were recorded for all articles: type of study, author, year of publication, participants (time after stroke, sample size, and age), cardiovascular and autonomic benefits. This procedure was performed by two reviewers: one reviewer collected the data and the second double-checked it.