Effects of high-intensity exercise on rehabilitation of patients after stroke: a systematic review and meta-analysis of randomized controlled trials with high quality

Abstract

Objectives: To present the latest systematic review and meta-analysis of high-quality randomized controlled trials (RCTs) comparing high-intensity exercise with routine rehabilitation in stroke patients.

Methods: PubMed, Web of Science, and Cochrane were used to searching literature up to October 2024. RCTs with sample size of ≥50 individuals were included. Primary outcomes assessed were the Six-Minute Walking Test (6MWT), Ten-Meter Walk Test (10MWT), VO_2peak, Berg Balance Scale (BBS), Timed Up and Go test (TUG), and Montreal Cognitive Assessment (MoCA). Standardized mean differences (SMD) with 95% confidence intervals (CI) were used for pooling data. Stability was evaluated by sensitivity analysis.

Results: Seven RCTs with 724 participants were included. Meta-analysis revealed significant improvements in the 6MWT (SMD: 0.28; 95% CI: 0.11, 0.45) and BBS (SMD: 0.35; 95% CI: 0.03, 0.67) in the high-intensity exercise group. However, high-intensity exercise had no significant effect on VO_2peak, TUG, or 10MWT. Sensitivity analysis showed that all outcomes were stable except for the 10MWT. No significant publication bias was detected for any indicator.

Conclusion: High-intensity exercise significantly improves 6MWT and BBS in stroke patients, but does not significantly affect TUG, VO_2peak, 10MWT, or MoCA. Clinicians should encourage stroke patients with walking function to engage in structured high-intensity exercise to improve cardiopulmonary function.

Systematic review registration: CRD42024623036 Publicly accessible URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024623036.

Keywords: exercise; high-intensity; meta-analysis; randomized controlled trials; stroke.