Effect of lower limb resistance training on ICF components in chronic stroke: A systematic review and meta-analysis of RCTs

Tales Andrade Pereira; Marcos Paulo Braz de Oliveira; Paula Regina Mendes da Silva Serrão; Carolina Tsen; Nataly Barbieri Coutinho; Rubens Vinícius Letieri; Adriana Teresa Silva Santos; Luciana Maria Dos Reis

doi:10.1016/j.rehab.2023.101766

Effect of lower limb resistance training on ICF components in chronic stroke: A systematic review and meta-analysis of RCTs

Ann Phys Rehabil Med. 2023 Oct;66(7):101766. doi: 10.1016/j.rehab.2023.101766. Epub 2023 Oct 24.

Authors

Tales Andrade Pereira¹, Marcos Paulo Braz de Oliveira², Paula Regina Mendes da Silva Serrão³, Carolina Tsen⁴, Nataly Barbieri Coutinho¹, Rubens Vinícius Letieri⁵, Adriana Teresa Silva Santos¹, Luciana Maria Dos Reis¹

Affiliations

¹ Department of Physical Therapy, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil.
² Healthy Aging Research Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil. Electronic address: marcospbraz@gmail.com.
³ Rheumatology and Hand Rehabilitation Research Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
⁴ Healthy Aging Research Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
⁵ Department of Physical Education, Federal University of North Tocantins, Araguaia, Tocantins, Brazil.

PMID: 37883831
DOI: 10.1016/j.rehab.2023.101766

Abstract

Background: Resistance training (RT) effectively promotes functional independence after stroke.

Objectives: To investigate the effect of lower limb RT on body structure and function (muscle strength, postural balance), activity (mobility, gait) and participation (quality of life, impact of stroke on self-perceived health) outcomes in individuals with chronic stroke.

Methods: Six databases were searched from inception until September 2022 for randomized controlled trials comparing lower limb RT to a control intervention. The random-effects model was used in the meta-analyses. Effect sizes were reported as standardized mean differences (SMD). Quality of evidence was assessed using the GRADE approach.

Results: Fourteen studies were included. Significant improvements were found in body structure and function after lower limb RT: knee extensors (paretic side - SMD: 1.27; very low evidence), knee flexors (paretic side - SMD: 0.51; very low evidence; non-paretic side - SMD: 0.52; low evidence), leg press (paretic side - SMD: 0.83; very low evidence) and global lower limb muscle strength (SMD: -1.47; low evidence). No improvement was found for knee extensors (p = 0.05) or leg press (p = 0.58) on the non-paretic side. No improvements were found in the activity domain after lower limb RT: mobility (p = 0.16) and gait (walking speed-usual: p = 0.17; walking speed-fast: p = 0.74). No improvements were found in the participation domain after lower limb RT: quality of life (p > 0.05), except the bodily pain dimension (SMD: 1.02; low evidence) or the impact of stroke on self-perceived health (p = 0.38).

Conclusion: Lower limb RT led to significant improvements in the body structure and function domain (knee extensors and flexors, leg press, global lower limb muscle strength) in individuals with chronic stroke. No improvements were found in the activity (mobility, gait [walking speed]) or participation (quality of life, impact of stroke on self-perceived health) domains.

Prospero registration number: CRD42021272645.

Keywords: International Classification of Functioning Disability and Health; Muscle strength; Rehabilitation; Resistance training; Stroke; Systematic review and meta-analysis.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Brain Damage, Chronic
Humans
Lower Extremity
Quality of Life
Randomized Controlled Trials as Topic
Resistance Training*
Stroke Rehabilitation* / methods
Stroke*
Walking