Progressive resistance training increases strength after stroke but this may not carry over to activity: a systematic review

Question: Does progressive resistance training improve strength and activity after stroke? Does any increase in strength carry over to activity? Design: Systematic review of randomised trials with metaanalysis. Participants: Adults who have had a stroke. Intervention: Progressive resistance training compared with no intervention or placebo. Outcome measures: The primary outcome was change in strength. This measurement had to be of maximum voluntary force production and performed in muscles congruent with the muscles trained in the intervention. The secondary outcome was change in activity. This measurement had to be a direct measure of performance that produced continuous or ordinal data, or with scales that produced ordinal data. Results: Eleven studies involving 370 participants were included in this systematic review. The overall effect of progressive resistance training on strength was examined by pooling change scores from six studies with a mean PEDro score of 5.8, representing medium quality. The effect size of progressive resistance training on strength was 0.98 (95% CI 0.67 to 1.29, I-2 = 0%). The overall effect of progressive resistance training on activity was examined by pooling change scores from the same six studies. The effect size of progressive resistance training on activity was 0.42 (95% CI -0.08 to 0.91, I2 = 54%). Conclusion: After stroke, progressive resistance training has a large effect on strength compared with no intervention or placebo. There is uncertainty about whether these large increases in strength carry over to improvements in activity. (C) 2018 Australian Physiotherapy Association. Published by Elsevier B.V.