Physical fitness training for stroke patients.

This Cochrane review asked whether physical fitness training after stroke reduces death, disability, or dependence, and looked at broader effects on fitness, mobility, mood, and cognition. It pooled 75 randomised trials involving 3017 mostly ambulatory stroke survivors, covering cardiorespiratory training (32 studies, 1631 participants), resistance training (20 studies, 779 participants), and mixed training (23 studies, 1207 participants), comparing these against usual care or no intervention. Death was rare overall (19 of 3017 participants) and unaffected by any training type, based on low-certainty evidence. Disability improved with cardiorespiratory training (moderate-certainty evidence) and, to a smaller extent, mixed training (low-certainty evidence), with too few data to judge resistance training's effect on disability.

Cardiorespiratory fitness (VO2 peak) increased with cardiorespiratory training (moderate-certainty evidence). Risk of bias varied across trials, particularly from unequal amounts of exercise exposure between groups, and data on mood, quality of life, and cognition were too limited to draw conclusions.

This review combined results from 75 studies involving 3017 stroke survivors who could mostly walk, to see whether exercise training helps after stroke. It compared three types: cardiorespiratory (heart and lung) training, resistance (strength) training, and a mix of both, against usual stroke care. Deaths were rare in all groups (19 out of 3017 people), so the review could not tell whether exercise affects survival.

However, cardiorespiratory training was linked to improved disability scores, and mixed training showed a smaller improvement, though this evidence was rated as only low to moderate certainty. Cardiorespiratory training also improved fitness levels (measured by VO2 peak), walking speed, and balance.

There was not enough evidence on resistance training alone to judge its effect on disability, and information on mood, quality of life, and thinking skills was too limited to draw conclusions. No serious adverse events were reported, but the studies varied in how much exercise each group actually received, which is a limitation when interpreting the results.

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This synthesis pooled 75 RCTs (3017 participants) comparing cardiorespiratory, resistance, and mixed training against usual care or no intervention in mostly ambulatory stroke survivors. Mortality was rare (19/3017) and unaffected by intervention type across all comparisons, with low-certainty evidence limiting inference about survival effects.

No composite death-or-dependence outcome was reported in any included study. Disability improved with cardiorespiratory training (SMD 0.52, moderate certainty) and mixed training (SMD 0.23, low certainty), with insufficient data for resistance training alone. Secondary outcomes showed intervention-specific benefits: VO2 peak increased with cardiorespiratory training (MD 3.40 mL/kg/min, moderate certainty), alongside gains in walking speed and balance, generally low to moderate certainty.

Follow-up data were sparse, so persistence of benefit after training ended remains unclear beyond some mobility gains. Risk of bias varied, with unequal exercise exposure between intervention and control groups a recurring issue across comparisons. No serious adverse events were reported, though safety was not the review's primary focus.

Data on mood, quality of life, and cognition were too limited for conclusions, leaving substantial gaps for future trials to address regarding optimal exercise prescription and long-term outcomes.