Effect of exercise-based interventions on stroke rehabilitation: an umbrella review of systematic reviews and meta-analyses
Minghui Du, Longwei Chen, Yan Li, Xia Liang, Yueying Liu, Mengyue Guo, Zeyi Zhang, Y. D. Wei, Y. Li
Abstract
Despite the extensive evidence available, a systematic synthesis and quality evaluation of exercise-based interventions for stroke rehabilitation is still lacking. We systematically searched PubMed, Embase, Web of Science, and Cochrane Library. Study quality and evidence certainty were evaluated using AMSTAR, JBI, ROBIS, and GRADE frameworks. Intervention efficacy was analyzed against functional metrics, with an in-depth analysis of intensity, dosage, and recovery stage. Initially, 4367 studies were retrieved, of which 144 were included. After categorization according to the predefined criteria, 51 articles were included in the final data analysis. The umbrella review revealed that exercise-based interventions primarily improved patients’ physical function, mobility, and participation. Specifically, exercise enhanced neuromotor control (BBS: MD [1.35 to 13.17]; TIS: MD [2.46 to 4.32]), musculoskeletal function (FMA-LE: MD [2.44 to 3.05]), cardiopulmonary and metabolic function (VO2 prek: MD [2.62 to 5.01], fasting blood glucose: MD [-0.22 to -0.02]), basic mobility (gait speed: MD [0.05 to 0.16]), and QoL (global health: MD [5.14 to 12.38]). Limb training and core stability exercises were commonly prescribed for patients in the acute phase. Strength training was frequently used in the subacute phase. Aerobic exercise, Tai Chi, and exergaming were typical exercise-based interventions for individuals in the chronic phase. Exercise-based interventions are effective at all stages of stroke recovery, improving physical function, mobility, and participation. Individuals in the acute phase benefit from core stability exercises combined with bed rest. Individuals in the subacute phase should focus on strength training, supplemented by constraint-induced movement therapy. Individuals in the chronic phase are advised to engage in aerobic exercise supplemented by activities such as Tai Chi and exergaming. PROSPERO registration number: No. CRD42025637376.