Outcomes of progressive resistance strength training following stroke: a systematic review.

OBJECTIVE To determine whether progressive resistance strength training reduces impairments, activity limitations and participation restrictions after stroke. METHODS Electronic databases were searched to find trials conducted from 1966 to 2002. Articles were assessed independently by two reviewers according to the following inclusion criteria: (1) population: adults with stroke, (2) intervention: progressive resistive strength training in isolation, and (3) outcomes: changes in body function, physical activity or societal participation. RESULTS From the 350 articles initially identified, eight met the criteria for detailed review. Three were randomized controlled trials, with the remainder being single-case time-series analyses or pre-post trials. The five trials that measured impairments of muscle strength showed positive outcomes for progressive resistance strength training, with large effect sizes (d = 1.2-4.5). Few negative effects of strength training were reported, and these were minor. Only three of the eight trials that measured activity limitations reported improvements in activities such as walking and stair climbing. The effects of strength training on societal participation could not be determined due to insufficient data. CONCLUSIONS There is preliminary evidence that progressive resistance strength training programmes reduce musculoskeletal impairment after stroke. Whether strengthening enhances the performance of functional activities or participation in societal roles remains unknown.