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Systematic review
Prescribing strength training for stroke recovery: a systematic review and meta-analysis of randomised controlled trials
  1. Kenneth S Noguchi1,
  2. Kevin Moncion1,
  3. Elise Wiley1,
  4. Ashley Morgan1,
  5. Eric Huynh1,
  6. Guilherme Moraes Balbim2,
  7. Brad Elliott3,
  8. Carlene Harris-Blake3,
  9. Brent Krysa3,
  10. Barb Koetsier3,
  11. Karolyn Pinili3,
  12. Marla K Beauchamp1,
  13. Stuart M Phillips4,
  14. Lehana Thabane5,6,
  15. Ada Tang1
  1. 1 School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
  2. 2 Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
  3. 3 MacStroke Canada Lab, Hamilton, Ontario, Canada
  4. 4 Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
  5. 5 Department of Health Research Methods, Evidence & Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
  6. 6 Biostatistics Unit, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
  1. Correspondence to Dr Ada Tang; atang{at}mcmaster.ca

Abstract

Objective To examine the effects of strength training on patient-important outcomes of stroke recovery and to quantify the influence of the exercise prescription on treatment effects.

Design Systematic review and meta-analysis.

Data sources Eight electronic databases (MEDLINE, EMBASE, EMCARE, AMED, PsycINFO, CINAHL, SPORTDiscus, and Web of Science) and two clinical trial registries (ClinicalTrials.gov and WHO International Clinical Trials Registry Platform) were searched from inception to 19 June 2024.

Eligibility criteria Randomised controlled trials were eligible if they examined the effects of strength training compared with no exercise or usual care and reported at least one exercise prescription parameter. An advisory group of community members with lived experience of stroke helped inform outcomes most relevant to stroke recovery.

Results Forty-two randomised trials (N=2204) were included. Overall risk of bias was high across most outcomes. Strength training improved outcomes rated as ‘critical for decision-making’ by the advisory group, including walking capacity (standardised mean difference (SMD)=0.95 (95% CI 0.34–1.56)), balance (SMD=1.13 (0.51–1.75)), functional ability and mobility (SMD=0.61 (0.09–1.14)), and habitual (mean difference (MD)=0.05 m/s (0.02–0.09)) and fast-paced walking speed (MD=0.09 m/s (0.01–0.17)), with very low to moderate certainty of evidence, mainly due to risk of bias and inconsistency. More frequent strength training, traditional strength training programmes and power-focused intensities (ie, emphasis on movement velocity) were positively associated with walking capacity, health-related quality of life and fast-paced walking speed.

Conclusion Strength training alone or combined with usual care improves stroke recovery outcomes that are important for decision-making. More frequent strength training, power-focused intensities and traditional programme designs may best support stroke recovery.

PROSPERO registration number CRD42023414077.

  • Exercise Therapy
  • Meta-analysis
  • Neurological rehabilitation

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All individual study data included in this review are available directly from the original manuscripts. Any other data used for this review are available on reasonable request.

https://doi.org/10.1136/bjsports-2024-108476

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    Data availability statement

    Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All individual study data included in this review are available directly from the original manuscripts. Any other data used for this review are available on reasonable request.

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    Footnotes

    • X @ksnoguchi, @BalbimMoraes, @mackinprof

    • Contributors KSN and AT conceived this review. KSN obtained funding for this review. MKB, SMP and LT provided methodological and content expertise. GMB, BE, CH-B, B Krysa, B Koetsier, KP, KSN, KM, EW, AM and AT participated in outcome selection and importance rating. KSN designed the search strategy. KSN, KM, EW, AM and EH screened titles, abstracts and full-text articles. KSN, KM, EW and EH extracted data. KSN and EW performed the risk of bias assessments. KSN completed the statistical analysis with input from LT. KSN and AT drafted the manuscript. All authors have reviewed the manuscript and approved submission of this work. AT is the guarantor for this review and accepts full responsibility for the work.

    • Funding This systematic review was, in part, supported by a McMaster Collaborative for Health and Aging Trainee Engagement Fund, awarded to KSN.

    • Competing interests SMP reports grants or contracts currently held or in the last 5 years from the US National Dairy Council, Dairy Farmers of Canada, Roquette Freres, Nestle Health Sciences, National Science and Engineering Research Council, Canadian Institutes for Health Research and the US NIH during the conduct of the study; personal fees from US National Dairy Council, non-financial support from Enhanced Recovery, outside the submitted work. In addition, SMP has a patent Canadian and US patents assigned to Exerkine, but reports no financial gains from any patent or related work. KSN is supported by an Ontario Graduate Scholarship and the McMaster Collaborative for Health and Aging Trainee Engagement Fund. The Trainee Engagement Fund provided financial support for the community advisory group of people with lived experience. There was no other specific funding for this work. KM is supported by an Ontario Graduate Scholarship. EW is supported by MIRA and AGEWELL NCE Inc., a member of the Networks of Centres of Excellence programme. EH was supported by a Canadian Institute for Health Research-Masters (CIHR CGSM) Scholarship. GMB is jointly funded by the Canadian Institutes of Health Research and Michael Smith Health Research BC. MKB and SMP are supported by the Canada Research Chairs Program. AT was supported by a Clinician-Scientist Award (Phase II) from the Ontario Heart and Stroke Foundation (P-19-TA-1192).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.