Exercise improves stair climbing performance after stroke: A systematic review of randomized trials with meta-analysis

Abstract

Background: Exercises have been used to improve outcomes after stroke. Objective: To examine the effects of planned, structured, and repetitive exercises of the paretic lower limb for improving stair climbing performance after stroke. Data Sources: MEDLINE, EMBASE, Cochrane Library, Allied and Complementary Medicine Database, and Physiotherapy Evidence Database (PEDro). Review Methods: Only randomized clinical trials were included. Participants in the reviewed studies were adults at any time after stroke. The experimental intervention consisted of exercises for the paretic lower limb in comparison with no intervention/placebo. Outcome data related to stair climbing performance were extracted from the eligible trials and combined in meta-analysis. The quality of included trials was assessed by the PEDro scores. The quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation system. Results: Nine trials, involving 314 participants, were included. The examined interventions were strength training, task-oriented training, or a combination of strength training with aerobic or task-oriented training. A random-effect meta-analysis provided very low-quality evidence that exercises improved stair climbing performance by standardized mean difference 0.4 (95% confidence interval [CI], 0–0.8). When only trials that reported the time to ascent/descent stairs were pooled, exercise improved stair climbing performance by 3.4 seconds (95% CI, 0.4–6.5). No trials examined the maintenance of benefits beyond the intervention period. Conclusion: This systematic review provided very-low-quality evidence that 6 weeks of planned, structured, and repetitive exercises, performed during 50 minutes, four times per week, improve stair climbing performance of moderately disabled individuals with chronic stroke.