Resistance training in stroke rehabilitation: systematic review and meta-analysis

Abstract

Objective: This systematic review and meta-analysis investigates the effects of resistance training in supporting the recovery in stroke patients. Data sources: PubMed, the Cochrane Central Register of Controlled Trials and the PEDro databases were reviewed up to 30 April 2020. Review methods: Randomized controlled trials were included, who compared: (i) resistance training with no intervention, (ii) resistance training with other interventions and (iii) different resistance training protocols in stroke rehabilitation. Results: Overall 30 trials ( n = 1051) were enrolled. The parameters evaluated were: (1) gait, (2) muscular force and motor function, (3) mobility, balance and postural control, (4) health related quality of life, independence and reintegration, (5) spasticity and hypertonia, (6) cardiorespiratory fitness, (7) cognitive abilities and emotional state and (8) other health-relevant physiological indicators. The data indicates that: (i) resistance training is beneficial for the majority of parameters observed, (ii) resistance training is superior to other therapies on muscular force and motor function of lower and upper limbs, health related quality of life, independence and reintegration and other health-relevant physiological indicators, not significantly different from other therapies on walking ability, mobility balance and postural control and spasticity and hypertonia, and inferior to ergometer training on cardiorespiratory fitness and (iii) the type of resistance training protocol significantly impacts its effect; leg press is more efficient than knee extension and high intensity training is superior than low intensity training. Conclusion: Current data indicates that resistance training may be beneficial in supporting the recovery of stroke patients. However, the current evidence is insufficient for evidence-based rehabilitation.

Eficácia do treinamento resistido na força muscular e funcionalidade em indivíduos adultos após o acidente vascular cerebral: uma revisão sistemática de revisões

“…Os principais motivos de exclusão foram: revisões sistemáticas contendo protocolos de TR misto, com outras modalidades de treinamento, que não foram realizadas análises de resultados individuais para cada modalidade, revisões sobre TR muscular inspiratório e revisões que tiveram por finalidade investigar os princípios da prescrição do TR e/ou analisar protocolos de prescrição. Por fim, dez (10) estudos [8][9][10][17][18][19][20][21][22][23] atenderam aos critérios de elegibilidade, sendo sumarizado na Figura 1.…”

“…No tocante a força muscular e ganhos em 1RM, os estudos incluídos sugerem que houve um aumento estatisticamente significativo nos indivíduos que realizaram o TR [8,[18][19][20][21][22][23]. Contudo, esses resultados podem não ser clinicamente importantes.…”

Squash and Resistance Training: Relative Comparison on Speed, Explosive Power, Muscular Endurance and Flexibility

“…Weight-bearing exercise also results in the prevention of osteoporosis [10]. For a majority of people in rehabilitation or with an innate disability, such as following stroke or orthopaedic surgery, strength training for feeble muscles is a vital feature to improve recovery [14]. Several studies examined the impact of resistance training on different categories of body mass index [15][16][17][18][19][20][21].…”

Training muscle activation patterns of the lower paretic extremity using directional exertion improves mobility in persons with hemiparesis: a pilot study

“…A recent meta-analysis found that progressive resistance exercise at higher intensities improves strength in this population [ 5 ]. However, systematic reviews and meta-analyses paint an unclear picture of the role that strength training of the lower extremity and associated strength gains play in improving gait in persons who have experienced a stroke [ 6 – 8 ]. Possible factors preventing strength gains from translating into functional performance may include suboptimal training intensities and duration and/or a lack of appropriate progression of the intervention [ 9 , 10 ].…”

“…Alternatively, small effect sizes of strength training on gait parameters in this population may be the result of a lack of specificity of muscles selected and a failure to improve multiarticular movements requiring muscle activation of a coordinated group of muscles involved in locomotion. Strengthening exercises involving multiarticular muscles (e.g., leg press) appear to be better at improving strength and function in individuals with hemiparesis than isolated monoarticular exercises such as leg extensions [ 8 ].…”