Progressive resistance training improves muscle strength of paretic lower limb in chronic stroke patients: a systematic review

  • Gopaul U
  • van Vliet P
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Abstract

Background: Strength training has been recommended for stroke survivors to decrease muscle weakness. However, for chronic stroke patients, there is no specific recommendation on muscle strength training strategies. Moreover, little is known about the effectiveness of progressive resistance training (PRT) on increasing muscle strength in lower limbs (LL) and consequently improving gait. Long-term effects of PRT on muscle strength and gait performance amongst chronic stroke survivors are also unclear. Purpose: Primary aim: To determine the effectiveness of PRT in improving the muscle strength of the paretic LL. Secondary aims: To determine whether 1. PRT improves gait performance. 2. PRT adversely affects spasticity. 3. Improvements in muscle strength and gait performance are maintained over time post-PRT intervention. Methods: Electronic databases were searched including PEDro, CENTRAL, EMBASE, JBI, AMED, MEDLINE, CINAHL. Randomised controlled trials (RCTs) were included involving ambulant, adult stroke survivors at least 6-months post-stroke. The interventions incorporated PRT of paretic LL. Results: Six RCTs (218 participants) and 2 additional publications (further analysis of pre-existing data and followup study) were included. Due to the heterogeneity of studies with regard to dose and tasks involved in PRT and outcome measures, it was inappropriate to perform meta-analysis. Therefore, the results were summarized in narrative form. Three RCTs administered PRT only. One RCT administered PRT along with adjunct exercises (10-20 min graded-treadmill walking, stepping or cycling and home exercises). 2 additional RCTs administered PRT along with sham cycling. Two RCTs (PRT only) showed that PRT was effective in improving muscle strength of paretic LL in chronic stroke patients but failed to show gait improvement. A third RCT (PRT with adjunct exercises) found a significant improvement in muscle strength, gait speed and stair climbing. A fourth RCT and fifth (PRT with sham cycling) found a significant improvement in muscle strength and stair climbing but not in gait speed. A sixth RCT (PRT only) did not find any improvement in muscle strength or gait performance. Two studies (PRT with adjunct exercises and PRT only) evaluated spasticity and no exacerbation was reported post-intervention. There was a lack of long-term follow-up, with only one study (PRT only) investigating the effects on strength at 5-months and 4-years post-intervention, with a significant improvement as compared to baseline in dynamic (isotonic) strength found at both time points. In this same study, gait performance was measured by the timed upand- go and significantly improved at 5-months follow-up as compared to baseline. Conclusion(s): PRT was effective in improving LL muscle strength, without adversely affecting spasticity. There was conflicting evidence on the effect of PRT on gait performance. Strength gains did not necessarily translate into improved gait outcomes. Moreover, there was also a lack of evidence to support long-term improvement in muscle strength and gait. Future research should include long-term follow-up on the effect of PRT on muscle strength of paretic LL and the translation into improved gait outcomes. Implications: PRT could be used to improve LL muscle strength in chronic stroke survivors.

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Gopaul, U., & van Vliet, P. (2015). Progressive resistance training improves muscle strength of paretic lower limb in chronic stroke patients: a systematic review. Physiotherapy, 101, e465–e466. https://doi.org/10.1016/j.physio.2015.03.3253

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