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

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.