Frontiers in physiology · 2025
Effects of resistance exercise on patients with post-stroke dysphagia based on ACSM recommendations: a systematic review of randomized controlled trials.
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Ye Yu, Wu Kairui, Liu Yingquan, Ji Hongjie, Li Hongtao, Jiang Bo, Xu Fangyuan, Li Xuejun, Hu Peijia, Cheng Hongliang
Аннотация
BACKGROUND: Resistance exercise shows potential for improving swallowing function in post-stroke dysphagia (PSD), though optimal dose-response parameters remain unclear. While the American College of Sports Medicine (ACSM) framework effectively guides exercise prescriptions in healthy populations, its application to PSD rehabilitation lacks meta-analytical validation. This study evaluates varying resistance exercise dosages on swallowing outcomes in PSD patients.
METHODS: We systematically searched PubMed, Embase, Web of Science, and Cochrane for randomized controlled trials (RCTs) investigating resistance training in PSD. Interventions were stratified using ACSM compliance criteria (6/8 and 7/8 thresholds) into high-adherence versus low/uncertain-adherence groups. Subgroup analyses employed random-effects meta-analyses.
RESULTS: Analysis included 19 RCTs (n = 566). Using 6/8 ACSM criteria, 11 studies comprised the high-adherence group and eight the low/uncertain group. High-adherence interventions demonstrated improved positively oriented scores [SMD = -1.72 (95% CI -3.26 to -0.18)], enhanced safety [SMD = -0.93 (95% CI -1.54 to -0.32)], and worsened negatively oriented scores [SMD = 2.27 (95% CI 0.66-3.87)]. Low-adherence groups showed non-significant improvements in positively oriented scores [SMD = -0.47 (95% CI -1.02 to 0.09)], negatively oriented scores [SMD = 0.43 (95% CI -0.09-0.94)], and safety [MD = -1.85 (95% CI -3.83 to 0.13)]. Applying stricter 7/8 criteria reclassified nine studies as high-adherence and 10 as low/uncertain. High-adherence groups exhibited greater positively oriented scores improvement [SMD = -2.15 (95% CI -4.11 to -0.20)], safety enhancement [MD = -1.05 (95% CI -1.58 to -0.51)], and negatively oriented scores decline [SMD = 2.85 (95% CI 0.82-4.89)]. Low-adherence groups maintained non-significant outcomes: positively oriented scores [SMD = -0.33 (95% CI -0.75 to 0.10)], negatively oriented scores [SMD = 0.32 (95% CI -0.09-0.74)], and safety [MD = -1.39 (95% CI -2.84 to 0.07)].
CONCLUSION: Resistance exercise demonstrates superior therapeutic effects over non-resistance interventions for PSD. High adherence to ACSM-recommended dosages yields significantly greater improvements in swallowing function and safety compared to low/uncertain adherence regimens. These findings validate the clinical utility of ACSM guidelines for optimizing resistance exercise prescriptions in PSD rehabilitation.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251041450.
METHODS: We systematically searched PubMed, Embase, Web of Science, and Cochrane for randomized controlled trials (RCTs) investigating resistance training in PSD. Interventions were stratified using ACSM compliance criteria (6/8 and 7/8 thresholds) into high-adherence versus low/uncertain-adherence groups. Subgroup analyses employed random-effects meta-analyses.
RESULTS: Analysis included 19 RCTs (n = 566). Using 6/8 ACSM criteria, 11 studies comprised the high-adherence group and eight the low/uncertain group. High-adherence interventions demonstrated improved positively oriented scores [SMD = -1.72 (95% CI -3.26 to -0.18)], enhanced safety [SMD = -0.93 (95% CI -1.54 to -0.32)], and worsened negatively oriented scores [SMD = 2.27 (95% CI 0.66-3.87)]. Low-adherence groups showed non-significant improvements in positively oriented scores [SMD = -0.47 (95% CI -1.02 to 0.09)], negatively oriented scores [SMD = 0.43 (95% CI -0.09-0.94)], and safety [MD = -1.85 (95% CI -3.83 to 0.13)]. Applying stricter 7/8 criteria reclassified nine studies as high-adherence and 10 as low/uncertain. High-adherence groups exhibited greater positively oriented scores improvement [SMD = -2.15 (95% CI -4.11 to -0.20)], safety enhancement [MD = -1.05 (95% CI -1.58 to -0.51)], and negatively oriented scores decline [SMD = 2.85 (95% CI 0.82-4.89)]. Low-adherence groups maintained non-significant outcomes: positively oriented scores [SMD = -0.33 (95% CI -0.75 to 0.10)], negatively oriented scores [SMD = 0.32 (95% CI -0.09-0.74)], and safety [MD = -1.39 (95% CI -2.84 to 0.07)].
CONCLUSION: Resistance exercise demonstrates superior therapeutic effects over non-resistance interventions for PSD. High adherence to ACSM-recommended dosages yields significantly greater improvements in swallowing function and safety compared to low/uncertain adherence regimens. These findings validate the clinical utility of ACSM guidelines for optimizing resistance exercise prescriptions in PSD rehabilitation.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251041450.