Strengthening interventions increase strength and improve activity after stroke: a systematic review

Aust J Physiother. 2006;52(4):241-8. doi: 10.1016/s0004-9514(06)70003-4.


Question: Is strength training after stroke effective (ie, does it increase strength), is it harmful (ie, does it increase spasticity), and is it worthwhile (ie, does it improve activity)?

Design: Systematic review with meta-analysis of randomised trials.

Participants: Stroke participants were categorised as (i) acute, very weak, (ii) acute, weak, (iii) chronic, very weak, or (iv) chronic, weak.

Intervention: Strengthening interventions were defined as interventions that involved attempts at repetitive, effortful muscle contractions and included biofeedback, electrical stimulation, muscle re-education, progressive resistance exercise, and mental practice.

Outcome measures: Strength was measured as continuous measures of force or torque or ordinal measures such as manual muscle tests. Spasticity was measured using the modified Ashworth Scale, a custom made scale, or the Pendulum Test. Activity was measured directly, eg, 10-m Walk Test, or the Box and Block Test, or with scales that measured dependence such as the Barthel Index.

Results: 21 trials were identified and 15 had data that could be included in a meta-analysis. Effect sizes were calculated as standardised mean differences since various muscles were studied and different outcome measures were used. Across all stroke participants, strengthening interventions had a small positive effect on both strength (SMD 0.33, 95% CI 0.13 to 0.54) and activity (SMD 0.32, 95% CI 0.11 to 0.53). There was very little effect on spasticity (SMD -0.13, 95% CI -0.75 to 0.50).

Conclusion: Strengthening interventions increase strength, improve activity, and do not increase spasticity. These findings suggest that strengthening programs should be part of rehabilitation after stroke.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Aged
  • Exercise / physiology
  • Exercise Therapy / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Motor Activity*
  • Muscle Strength / physiology*
  • Muscle Weakness / physiopathology
  • Physical Therapy Modalities*
  • Randomized Controlled Trials as Topic
  • Stroke / physiopathology
  • Stroke Rehabilitation*