296 www.topicsingeriatricrehabilitation.com October–December 2014 Topics in Geriatric Rehabilitation • Volume 30, Number 4, 296-306 • Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI: 10.1097/TGR.0000000000000037 Background: In recent years, poststroke fatigue has received attention for being considered a multidimensional construct and a common and debilitating complain. Aims and Objectives: Review studies that can possibly determine the relationship between fatigue after stroke and physical activity and/or physical fitness. Methods: Search was carried out using key words “stroke” and “physical activity, physical factors, physical fitness,” and “fatigue.” Data were synthesized narratively. Results: Nineteen studies were included, which indicated that physical activity is negatively associated with a higher level of fatigue in some of them. Conclusion: The association between poststroke fatigue and physical activity/fitness is still uncertain. Key words: fatigue, physical activity, physical fitness, stroke A Review of the Relationship Between Poststroke Fatigue and Physical Activity Ana Paula Cunha Loureiro, MSc; Luiz César Guarita-Souza, MD, PhD; Anners Lerdal, PhD; Birgitta Langhammer, PhD activity. 6 This definition relates to central, whole-body, or chronic fatigue and is important to differentiate it from peripheral fatigue, which is a product of exertion and indic- ative of a lack of effective muscle fiber activation. 7,8 This type of fatigue is also known as exertion fatigue, is acute in nature, and is commonly experienced after exertion of physical power or use of mental effort. 8 “Normal” fatigue has also been reported as a state of general tiredness after a prolonged effort, resulting from energy expenditure, occurs rapidly, is of short duration, and improves with rest. 9 Fatigue becomes “pathological” when it causes a decrease in efficiency. 10 Fatigue can be part of a primary disease pro- cess such as stroke. The cause of fatigue after stroke is not known, nor is the relationship with other poststroke symptoms clear. Nevertheless, there are often contributions from comor- bid factors such as depression, sleep disturbance, anxiety, chronic pain, malnutrition, medication, or deconditioning. Neuromuscular impairment is also an important contribut- ing factor to fatigue in people after stroke. 2 It can lead to muscle weakness and increased energy demand, 11 which can limit performance of activities of daily living (ADL) and may result in an increased sense of effort and fatigability. Fatigue, among other factors, frequently interferes with functional gains during the rehabilitation process. 12 Survi- vors tend to be sedentary, have a low level of physical activ- ity, and have an increased cardiovascular risk. 13 Knowledge about the effects of fatigue on physical activity and physical fitness is still limited. A previous systematic review that dis- cussed this issue did not find sufficient evidence regarding fatigue after stroke to be associated with impaired physi- cal fitness. 14 Caspersen et al 15 defined common terms to promote better understanding and avoid wrong interpreta- tions of the relation between physical activity, exercise, and physical fitness. Physical activity is defined as “any bodily movement produced by skeletal muscles that results in energy expen- diture beyond resting expenditure” in different contexts of daily life, such as work, housekeeping, walking, and leisure. Exercise is “a subset of physical activity that is planned, structured, repetitive, and purposeful in the sense that improvement or maintenance of physical fitness is the objective.” 15 Physical fitness “includes cardiorespiratory F atigue is one of the most common complaints after stroke 1,2 and is understood as being multidimen- sional with mental, physical, and motivational aspects. 3 Several concepts of fatigue have been suggested, although an exact definition of poststroke fatigue is still lacking due to its subjective nature. 4 Fatigue has generally been defined as a feeling of early exhaustion, weariness, lack of energy, and aversion to effort, 1 distinct from sadness or weakness. 5 The awareness of a decreased capacity for physical or mental activity may be considered because of an imbalance in the availability, utilization, or restoration of resources needed to perform Author Affiliations: Department of Physical Therapy, School of Health and Biosciences (Ms Loureiro), and School of Medicine (Dr Guarita-Souza), Pontifical Catholic University of Paraná (PUCPR), Curitiba, PR, Brazil; Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway, and Lovisenberg Diakonale Hospital, Oslo, Norway (Dr Lerdal); and Physiotherapy Department, Faculty of Health Science, Oslo, Norway, Akershus University College of Applied Sciences, Oslo, Norway, and Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway (Dr Langhammer). The authors declare that they have no conflicts of interest in the research. A.P.C.L. has received a scholarship provided by CAPES (process no. BEX: 0590-13-4). Correspondence: Ana Paula Cunha Loureiro, MSc, Department of Physical Therapy, School of Health and Biosciences, Pontifical Catholic University of Paraná (PUCPR), R. Imaculada Conceição, 1155, zip code 80215- 901, Curitiba, PR, Brazil (anna.loureiro@gmail.com). Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. TGR-D-14-00022.indd 296 TGR-D-14-00022.indd 296 10/10/14 8:44 PM 10/10/14 8:44 PM