Resistance training for people with stroke.

After a stroke, many people lose strength, especially on the affected side, and this is linked to greater disability. It makes sense to ask whether structured resistance training, working muscles against load or resistance, can help. This Cochrane review pooled 27 randomised trials involving just over 1000 stroke survivors, comparing resistance training programmes against usual care or non-exercise controls. The clearest finding is that resistance training does not change the risk of death during or after the intervention period, with high-certainty evidence.

It probably improves muscle strength in the arms and legs, particularly on the less affected side, and may produce a small improvement in balance. However, it showed little or no effect on comfortable walking speed, and evidence on disability, blood pressure, and cardiovascular events came from only one small study each, so conclusions there remain very uncertain. Long-term follow-up data were sparse across the board, limiting what can be said about lasting benefit.

If you're recovering from a stroke, weakness, especially on the affected side, is common and can make everyday movement harder. Researchers wanted to know whether resistance training, exercises that work muscles against resistance like weights or machines, could help beyond usual care. Looking across 27 studies with just over 1000 participants, they found that resistance training does not appear to affect the chance of dying, based on strong evidence.

It likely helps build muscle strength in the arms and legs, more so on the less affected side, and there may be a small improvement in balance. But it didn't seem to make people walk any faster in daily life, and there wasn't enough good evidence to say whether it improves disability, blood pressure, or the risk of another stroke or heart problem, since those results came from just single small studies. Most studies didn't follow people long enough afterward to know if strength or balance gains lasted.

No serious harms were reported, though some people didn't stick with the training.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This update of a long-running Cochrane review synthesised 27 randomised controlled trials (1004 participants, mean age 62), mostly ambulatory patients in sub-acute or chronic recovery stages, comparing resistance training against non-exercise controls. Only 8 of 27 trials included follow-up (mean 9.9 months), and 17 of 27 lacked balanced control exposure, limiting inferences about causal mechanism and duration of effect. Mortality showed no signal at end of intervention (RD 0.00, 95% CI -0.02 to 0.02; 24 studies, 880 participants) or follow-up (RD 0.00, 95% CI -0.05 to 0.05; 5 studies, 202 participants), both high-certainty.

Musculoskeletal fitness improved with moderate certainty overall, with moderate-to-large effects on leg strength (affected and unaffected sides) and moderate effects on arm strength, though affected-arm evidence was less certain. Comfortable walking speed showed no meaningful between-group difference (MD -0.00 m/s, 95% CI -0.08 to 0.07; moderate-certainty), while balance showed a small improvement (SMD 0.45, 95% CI 0.09 to 0.80; low-certainty) that persisted at follow-up in one trial.

Disability, blood pressure, and secondary cardiovascular events were each based on single small trials with very low certainty. Adherence was generally good with no reported adverse events, though acceptability varied.