Effects of Exercise on Mobility , Balance and Gait in Patients with the chronic Stroke: A systematic review and meta-analysis

Effects of Exercise on Mobility , Balance and Gait in Patients with the chronic Stroke: A systematic review and meta-analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Effects of Exercise on Mobility , Balance and Gait in Patients with the chronic Stroke: A systematic review and meta-analysis Yang Liu, Xueting Pan, Mi Jiang, Jiaxian Geng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6124658/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 07 Jul, 2025 Read the published version in Scientific Reports → Version 1 posted 10 You are reading this latest preprint version Abstract Background: Although exercise interventions are recommended after a stroke, their effects on mobility,balance and gait are still unclear. Objective : The aim of this research was to evaluate the effects of exercise training on mobility、balance and gait parameters, with a particular emphasis on the Timed Up and Go test (TUG), the Berg Balance Scale (BBS),the 6-Minute Walk Test (6MWT), and the 10-Meter Walk Test (10MWT). Methods: A systematic search was conducted across several databases, namely Web of Science, Embase, PubMed, and the Cochrane Library for randomized controlled trials (RCTs), to evaluate the effects of exercise interventions on mobility, balance and gait in chronic stroke patients. Results: After rigorous screening, 10 RCTs with both experimental and control groups (183/152 participants) were found eligible for inclusion. The meta-analysis demonstrated significant improvement in the mobility ability, as measured by TUG test after exercise intervention (mean difference [MD] = −5.10, p < 0.01, 95% confidence interval [CI] = −8.78 to −1.42). Furthermore, exercise effectively enhanced the balance ability, as measured by the BBS, among chronic stroke patients (MD = 2.82, p 0.05, 95% CI = −27.34 to 20.38) or 10MWT (MD = 0.02, p > 0.05, 95% CI −0.09 to 0.12). Conclusion： Exercise training interventions significantly increased mobility and balance scores in chronic stroke patients. However, they had no effect on gait scores. The subgroup analysis revealed significant enhancements in mobility index with PRT and notable improvements in BBS balance index with AT. Health sciences/Health care/Public health Health sciences/Health care/Quality of life stroke exercise training gait balance ability meta-analysis 1 Introduction Stroke is a major global health concern, capable of inducing diverse disabilities depending on the affected brain region and the severity of the incident [ 1 , 2 ] . Among these disabilities, motor impairments vary in intensity and can lead to impaired spatial perception, motor deficits, and disruptions in postural balance [ 3 ] . The resulting decline in mobility,balance and gait often leads to functional limitations, reduced mobility and a high risk of falls [ 4 ] . These challenges profoundly impact the quality of life for chronic stroke patients, emphasizing the need for effective rehabilitation to address these issues [ 5 ] . Rehabilitation initiatives targeting the mobility, balance, and gait play a pivotal role in augmenting the overall well-being and autonomy of chronic stroke patients (6). Consequently, rehabilitation interventions tailored specifically to enhance mobility,balance and gait are crucial for the management and recovery of chronic stroke patients. Mobility,gait and balance assessment are fundamental components of the evaluation of chronic stroke patients.In rehabilitation research, the TUG test serves as a major indicator of quality of life [ 2 – 5 ] ,with the Berg Balance Scale (BBS) being the most widely utilized tool to evaluate balance proficiency during stroke rehabilitation [ 1 ] .The 6MWT [ 6 , 7 ] , and the 10MWT test ( [ 8 – 10 ] represent primary indicators of gait functionality. In recent years, the integration of exercise intervention training into post-stroke rehabilitation practices has emerged as a promising approach, providing considerable advantages to post-stroke individuals. Diverse rehabilitation training modalities, including resistance training (RT) [ 11 , 12 ] , cross-training [ 3 ] , aerobic training (AT) [ 13 ] , and mirror therapy [ 14 – 19 ] , have exhibited potential usefulness for enhancing gait and balance to varying extents among chronic stroke patients. However, previous studies have reported conflicting views on the effectiveness of exercise training programs regarding improving symptoms [ 20 ] , balance [ 21 ] , and other relevant outcome measures. Some previous meta-analyses reported that AT and RT could improve mobility, balance and gait performance in patients who have recovered from a chronic stroke [ 22 – 26 ] . And other meta-analyses reported that AT and RT do not improve mobility,balance or gait performance in patients who have recovered from a chronic stroke [ 27 ] . Additional investigations are warranted to gain a comprehensive understanding of the influence of exercise intervention on the advancement of mobility, balance and gait capabilities in chronic stroke patients. Therefore, the present meta-analysis of randomized controlled trials (RCTs) investigated the effects of exercise intervention on the mobility, balance and gait abilities of chronic stroke patients.The primary objectives were to elucidate the collective effect size of exercise intervention on mobility, balance and gait outcomes, evaluate the potential heterogeneity across studies, and ascertain the underlying factors contributing to such heterogeneity. 2 Materials and Methods This review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and preregistered in the PROSPERO database (ID: CRD420-24500839). Search strategy Two authors (P.X.T. and L.Y.) systematically searched PubMed, Embase, Web of Science, and Cochrane Library databases from the respective date of inception until June 3, 2023. The search was conducted according to the PICOS principle, using a search strategy that incorporated specific terms for each component of the PICOS framework. The experimental group was defined by keywords such as “resistance training,” “training,” and “aerobic training,” while the control group encompassed terms such as “sham training” and “usual care.” Participants were identified through terms such as “stroke,” “chronic stroke,” and “acute stroke.” Outcome measures of interest included “TUG,” “BBS,” “10MWT,” and “6MWT.” The study type was restricted to “Randomized Controlled Trial” or “RCT.” By employing these meticulously selected keywords, relevant studies meeting the predetermined inclusion criteria were identified. Inclusion and exclusion criteria 2.1.1 Inclusion criteria The literature inclusion criteria were established based on the PICOS principle. The criteria for study inclusion were defined as follows. Inclusion criteria for the selection of appropriate studies were defned according to the PICOS approach: Population: stroke patients; Intervention: Exercise interventions only; Comparison/controls: disguised training or daily activities control group; Outcomes: BBS, TUG, 6MWT, 10MWT .The studies were required to specify outcome measures and employ either an RCT or a controlled clinical trial design. RCT: Only studies employing an RCT design were considered for inclusion. Multiple Interventions: In instances where a single study provided valuable data for multiple interventions, multiple comparisons were undertaken (Table 1 ). Table 1 Criteria for inclusion of articles (PICOS). PICOS Detailed information P Population Chronic stroke I Intervention The experimental group received exercise intervention: resistance training (e.g., isokinetic muscle strength training or strength training) or aerobic training (cycle training or treadmill walking). C Comparison The control group generally underwent “disguised training or daily activities.” O Outcome Balance and gait-related indicators (Berg balance scale); Timed up and go test; 10-meter walk test; fast gait speed: 6-minute walk test. S Study design Randomized controlled trials 2.1.2 Exclusion criteria We excluded articles that were not available in Chinese or English; articles lacking sufficient information or incomplete data that rendered them unusable; studies in which the control group received interventions other than standard physiotherapy or routine activities; and studies in which the experimental group underwent combined interventions. Data extraction and quality assessment 2.1.3 Data extraction All relevant literature retrieved from the databases was imported into EndNote X20 software. After removing duplicate publications, the following data were extracted by two independent authors (PXT and LY): general information on the publications (first author’s name and publication year), characteristics of the studies (sample size, randomization, and blinding), participant information (age, gender, and time since stroke), mode of interventions (AT, RT, or progressive resistance training [PRT]), content of the interventions (modality, frequency, intensity, duration, and session length), and outcomes (observation time points, measurement tools, and follow-up). In case of inconsistencies between the two investigators, a third reviewer (GXJ) verified the information. After the search, the documents were analyzed to extract the aforementioned information. In cases of missing data, an attempt was made to contact the study investigators to obtain the necessary data. If the study authors were unresponsive or unreachable, the study was excluded. 2.1.4 Assessment of study quality The Physiotherapy Evidence Database (PEDro) scale was used to assess the risk of bias and methodological quality of included studies [ 28 ] . This scale scores studies on a scale of 0–10, with scores > 6, 4–5, and < 3 indicating a high, moderate, and low quality, respectively [ 29 ] . Two authors (PXT and LY) evaluated the studies, whereas a third author (JM) double-checked the information and assigned scores. Statistical analysis The statistical analysis for experimental outcome measures was conducted using the RevMan 5.3 software. Given that the outcome measures in this study are continuous variables, the mean difference (MD) was utilized as the effect size if the units of measurement were consistent across the included literature. However, if the units of measurement varied, the standardized MD (SMD) with the corresponding 95% confidence interval was employed as the effect size. The effect size heterogeneity among the studies was evaluated using the quantitative guidelines outlined in the Cochrane Handbook for Systematic Reviews. P-values and I 2 statistics were used to evaluate the extent of heterogeneity. The I 2 value represents the degree of heterogeneity, ranging from 0–100%. A value of 0% indicates no heterogeneity, 0–25% suggests minimal heterogeneity that can be disregarded, 25–50% indicates low heterogeneity, 50–75% implies moderate heterogeneity, and 75–100% represents substantial heterogeneity that cannot be overlooked. When I 2 was less than or equal to 50%, a fixed-effects model was employed for the meta-analysis. Conversely, a random-effects model was adopted when I 2 exceeded 50%. Subgroup analysis was conducted to identify and examine potential intermediate variables contributing to the observed heterogeneity. Statistical significance was considered when the p -value was less than 0.05, while a p -value equal to or greater than 0.05 indicated a lack of statistical significance. Data from acute intervention and training intervention studies were recorded as the baseline change, which refer to the average (M) and standard deviation (SD) of the difference before and after the intervention. These values were calculated using the following formula(R = 0.5 coefficient of association): M Change in Value = M Post − M Pre (1) $$\:{\text{S}\text{D}}_{Change\:in\:Value}\:=\sqrt{{\text{S}\text{D}}_{\text{p}\text{r}\text{e}}^{2}+{\text{S}\text{D}}_{\text{p}\text{o}\text{s}\text{t}}^{2}-（2\times\:\text{R}\times\:{\text{S}\text{D}}_{\text{p}\text{r}\text{e}}\times\:{\text{S}\text{D}}_{\text{p}\text{o}\text{s}\text{t}}）}$$ 2 3 Results Search results In total, 10 RCTs were identified and included in the meta-analysis. The experimental groups in the studies underwent AT 、 RT and PRT. The control groups either received disguised training or followed their usual daily activities. The assessment of mobility, balance and gait indicators was based on various measurement tools, such as such as the TUG,the BBS,the 6MWT and 10MWT.. Detailed information is present in Fig. 1and Table 2 . Table 2 Basic characteristics of included articles. Literature source Sample Size Age Time since stroke Exercise Intervention Intervention Measures Outcome Measures (Experimental group/control group) (Experimental group/control group) (Experimental group/control group) cycle frequency (Experimental group/control group) (Experimental group/control group) Flansbjer et al. (2008) [ 31 ] 15/9 61(5)/61(5) 18.9(7.9)/20(11.6) months 10weeks 2 times/week Progressive resistance training for lower limbs Daily activities (placebo) ②④ Toledano-Zarhi et al. (2011) [ 33 ] 14/14 68.6 ± 6.7/68.7 ± 6.1 60.2 ± 46.67/70 ± 67.4 months 6 weeks 2 times/week Strength training Daily activities (placebo) ④ Takatori et al. (2012) [ 21 ] 22/22 66.0 ± 6.9/711 ± 10.1 More than 12months 12weeks 2 times/week Strength training Daily activities (placebo) ②③ Flansbje et al. (2012) [ 20 ] 11/7 66 ± 4/66 ± 4 69 ± 10/50 ± 3 months 10weeks 2 times/week Progressive resistance training for lower limbs (PRT) Daily activities (placebo) ②③ Globas t al. (2012) [ 32 ] 18/18 68.6 ± 6.7/68.7 ± 6.1 60.2 ± 46.6/70 ± 67.4 months 14weeks 1–3 times/week High-intensity aerobic training Convectional rehabilitation (placebo) ①③④ Severinsen et al. (2014) [ 34 ] 14/16 68 (57–78)/66 (52–80) 19 (8–36)/16 (9–38) months 12weeks 3 times/week Progressive resistance training Pretend training (placebo) ③④ Severinsen et al. (2014) [ 34 ] 13/16 69 (50–80)/66 (52–80) 14 (11–29)/16 (9–38) months 12weeks 3 times/week High-intensity aerobic training Pretend training (placebo) ③④ Fernandez-Gonzalo et al. (2016) [ 30 ] 14/15 61.2 (9.8)/65.7 (12.7) 42 (43.2)/51.6 (58.8) months 12weeks 2 times/week, 4 sets * 7 reps Lower limb resistance training Daily activities (placebo) ①② Lund et al. (2018) [ 35 ] 14/17 67.3 ± 7.4/66.4 ± 8.8 19.8 (7.7)/17.1 (7.7) months 12weeks 3 times/week Lower limb resistance training Pretend training (placebo) ①③④ Lund et al. (2018) [ 35 ] 17/17 67.7 ± 9.4/66.4 ± 8.8 16.8 (5.4)/17.1 (7.7 months 12weeks 3 times/week High-intensity aerobic training Pretend training (placebo) ①③④ Bowden et al. (2020) [ 36 ] 16/19 67.2 ± 17.4/70.3 ± 14.2 1 month/1week 14weeks 6 times/week Gait and strength training Conventional rehabilitation (placebo) ②③ Gangopadhyay et al. (2021) [ 37 ] 15/15 52.07 ± 3.7/52.4 ± 3.9 More than 6 months 4 weeks 3 times/week, 40 minutes/session Aerobic training conventional rehabilitation (placebo) ①②③ Note: ①Balance and gait-related indicators (Berg balance scale, BBS), ②timed up and go test (TUG), ③10-meter walk test (10MWT) or fast gait speed (FGS), and ④6-minute walk test (6MWT). Table 3 PEDro scale. Research (Year) 1 2 3 4 5 6 7 8 9 10 11 Score Flansbjer et al. (2008) [ 31 ] 1 1 0 1 1 1 0 1 0 1 1 8 Toledano-Zarhi et al. (2011) [ 33 ] 1 1 0 1 0 0 0 0 1 1 1 6 Takatori et al. (2012) [ 21 ] 1 1 0 1 0 0 0 0 0 1 1 5 Flansbjer et al. (2012) [ 20 ] 1 1 0 1 0 0 0 1 0 1 1 6 Globas et al. (2012) [ 32 ] 1 1 0 1 0 0 0 1 0 1 1 6 Severinsen et al. (2014) [ 34 ] 1 1 0 1 0 0 0 1 0 1 1 6 Fernandez-Gonzalo et al. (2016) [ 30 ] 1 1 0 1 1 1 0 1 0 1 1 8 Lund et al. (2018) [ 35 ] 1 1 0 1 1 0 0 1 0 1 1 7 Bowden et al. (2020) [ 36 ] 1 1 0 1 0 0 0 0 0 1 1 5 Gangopadhyay et al. (2021) [ 37 ] 1 1 0 1 1 1 1 0 0 1 1 8 3.1.1 Impact of exercise intervention on TUG test in chronic stroke patients The 10 RCTs 145 participants. Four RCTs [ 20 , 21 , 30 , 31 ] examined the effects of exercise intervention on the TUG test in chronic stroke patients. The forest plot in Fig. 2 demonstrates a lack of heterogeneity across the studies. Utilizing a fixed-effects model ( I 2 = 0, p > 0.05), the meta-analysis revealed a significant improvement in TUG performance associated with exercise intervention [MD = − 5.10, p < 0.01, 95% CI = − 8.78 to − 1.42]. The TUG test consistently demonstrated lower scores in the exercise intervention cohort compared to the control cohort, suggesting substantial enhancement in the mobility among chronic stroke patients subjected to the exercise intervention. 3.1.2 Effects of exercise intervention on 6MWT and 10MWT in chronic stroke patients Among the eligible RCTs that evaluated the 6MWT, six RCTs were included in the meta-analysis of effect sizes [ 20 , 31 – 35 ] , comprising a sample size of 230 participants. As depicted in Fig. 3 , there was no substantial heterogeneity observed across the selected studies, and a fixed-effects model was applied ( I 2 = 0, p = 0.95; Fig. 3 ). The meta-analysis results indicated that exercise intervention did not significantly improve the 6MWT among chronic stroke patients. The between-group difference was not significant [ MD = − 3.48, p > 0.05, 95% CI = − 27.34 to − 20.38 ]. These outcomes emphasize the necessity for further studies to comprehensively investigate the effects of exercise interventions on the 6MWT performances in patients who have undergone a chronic stroke. Six RCTs [ 20 , 32 , 34 – 37 ] with a total of 287 participants were included in the analysis of the 10MWT. The forest plot in Fig. 4 revealed the presence of heterogeneity among the included RCTs, as indicated by an I 2 value of 61% ( p < 0.01). To address the observed heterogeneity, a random-effects model was utilized. The findings from the meta-analysis revealed that the exercise intervention did not lead to a significant enhancement in the maximum walking speed (10MWT) among patients who have suffered a chronic stroke. The observed difference between the intervention and control groups was not significant [MD = 0.02, p > 0.05, 95% CI = − 0.09 to 0.12]. These findings underscore the need for further methodologically rigorous research to elucidate the potential benefits of exercise interventions on improving the 10MWT outcomes in post-stroke individuals. 3.1.3 Impact of exercise intervention on BBS in chronic stroke patients Among the included RCTs, three [ 30 , 32 , 37 ] investigated the influence of exercise intervention on BBS, as assessed by the BBS, in chronic stroke patients, encompassing a total of 95 participants. The absence of heterogeneity among the RCTs is evident from Fig. 5 . The overall effect test model was used( p = 0.008, p < 0.05). The meta-analysis results revealed a statistically significant enhancement in BBS balance scores attributable to exercise intervention, as evidenced by the positive MD in the combined effect size. In particular, the intervention group displayed significantly higher BBS scores compared to the control group [MD = 2.82, p < 0.01, 95% CI = 0.74 to 4.90] , underscoring the significant effect of exercise intervention in improving the BBS balance measures. 3.1.4 The subgroup mate-analyses of exercise modes on mobility, balance and gait The subgroup meta-analyses conducted on exercise interventions in the 10 RCTs encompassed AT, RT and PRT. The meta-analysis for mobility is shown in Fig. 6 , which revealed a high heterogeneity ( I 2 = 0, p = 0.42, p > 0.05). The fixed-effect size model showed that exercise intervention had a significant effect on mobility [MD = -5.10, p = 0.007, p < 0.05,95% CI = − 8.78 to − 1.42],the results showed that PRT could significantly improve the mobility ( p = 0.001, p 0.05). The fixed-effect size model showed that exercise intervention had a significant effect on balance [MD = 2.82, p = 0.008, p < 0.01, 95% CI = 0.74–4.90],the results showed that AT could significantly improve the balance ( p = 0.02, p 0.05). The fixed-effect size model showed that exercise intervention had no significant effect on gait [MD = 0.16, p = 0.06, p > 0.05, 95% CI = − 0.01 to 0.33].These findings suggest that interventions such as AT and RT do not significantly improve the gait ability of chronic stroke patients, which is in line with the meta-analysis by Amanzonwé et al. Nevertheless, the subgroup analysis revealed significant enhancements in mobility index with PRT and notable improvements in BBS balance index with AT. 3.1.5 Assessment of risk of bias The summary of PEDro results (Table. 3) provides a methodological quality of the certainty of evidence assessment. Based on the PEDro evaluation, there are eight randomized controlled trials (RCTs) with PEDro scores ranging from 6 to 8, for which the certainty of evidence regarding the impact of exercise on chronic stroke patients is classified as 'high'. Additionally, two RCTs possessing PEDro scores of 5 have been assigned a 'moderate' certainty of evidence concerning the effects of exercise on chronic stroke patients.This distribution underscores the stringent selection criteria applied and reflects positively on the overall methodological quality of the studies included in the review. 4 Discussion Our meta-analysis quantified the effects of different modes of exercise therapy on balance and gait in chronic stroke patients. Recent meta-analyses have suggested that AT [ 38 ] and RT [ 39 , 40 ] had no significant effects on improving balance. Saunders et al. [ 24 ] reported low-to-moderate quality evidence for improving balance through exercise therapy. However, our results showed that exercise interventions (AT, RT, and PRT) have a significant effect on BBS, but not on gait. Nevertheless, because of the small sample size, conclusions cannot be drawn for different stroke populations. 4.1 Impact of exercise intervention on TUG in chronic stroke patients Our meta-analysis revealed that exercise intervention could effectively improve the TUG index (MD = − 5.10, p < 0.01). The standing and walking test time in the experimental group was significantly lower than that in the control group, indicating that exercise intervention had a significant effect on improving the standing and walking test (TUG) index in chronic stroke patients, which is consistent with the previous findings of Flansbjer et al. [ 20 ] . A related study by Fernandez-Gonzalo et al. [ 30 ] showed that after 12 weeks of muscle resistance training based on “wheel resistance training” of lower limbs, the muscle contraction activities of participants were less than 2 minutes each time, which improved executive function, attention, and information processing speed. Our analysis showed that the TUG increased significantly in the experimental groups by 2.16 s. This progressive isokinetic muscle strength training improved the TUG results in a consistent manner [ 11 ] . 4.2 Impact of exercise intervention on 6MWT and 10MWT in chronic stroke patients Our meta-analysis suggests that exercise intervention does not lead to statistically significant differences in gait speed or endurance, as observed in the 6MWT (MD = − 3.48, p > 0.05) or the 10MWT (MD = 0.02, p > 0.05) . This finding aligns with the outcomes reported by Takatori and colleagues in their experimental investigation involving the 10MWT [ 21 ] . Both intervention and control groups exhibited improvements in gait performance, but only the TUG test showed significant improvement during follow-up. Furthermore, 6MWT and 10MWT test did not show significant changes. Consequently, further well-designed RCTs are warranted to explore the effects of exercise intervention on enhancing the 6MWT and 10MWT outcomes in chronic stroke patients. 4.3 Impact of exercise intervention on BBS in chronic stroke patients Post-stroke balance impairment is a major challenge [ 41 – 43 ] Additionally, imbalance is a crucial risk factor for falls among individuals after stroke. The findings from the present meta-analysis demonstrated a statistically significant improvement in the BBS scores among chronic stroke patients following exercise intervention (MD = 2.82, p < 0.01) . Research indicates that gait performance serves as an accurate predictor of fall risk and actual falls [ 44 ] . The intervention group, which underwent 12 weeks of lower limb wheel resistance training, exhibited significant enhancements in the TUG test results (p < 0.05), with a notable increase of 3.77 points in BBS scores [ 30 ] . Similarly, prolonged assisted walking training on a treadmill also yielded improvements in BBS scores among chronic stroke patients (33). Consequently, based on the synthesized findings from the meta-analysis, it can be postulated that a dedicated regimen of physical therapy, specifically directed toward the lower limbs, has the capability to improve balance in patients after cerebral vascular accidents. 4.4 Review limitations The experimental group used a single form of exercise intervention, while the control group used camouflage training or daily activities. Combined training such as combined AT and strength training was not performed. Joint training can be conducted for comprehensive analysis in the future. Although we performed subgroup analyses of different exercise patterns, interpretation of the results remains challenging due to differences in intervention type and study design. In addition, the quality of studies and potential measurement errors or unmeasured/unreported factors may lead to increased heterogeneity. Due to the limited number of available studies, we were unable to conduct further meta-analyses and subgroup analyses, particularly on the effects of different types of stroke. Furthermore, we could not recommend the best exercise intervention to improve gait and balance in chronic stroke patients. 5 Conclusion Our systematic review and meta-analysis revealed that exercise training interventions significantly increased mobility and balance scores in chronic stroke patients. However, they had no effect on gait scores. The subgroup analysis revealed significant enhancements in mobility index with PRT and notable improvements in BBS balance index with AT. Declarations Conflict of Interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Declarations of Human Ethics Human Ethics and Consent to Participate declarations: not applicable Author Contribution Yang Liu and Xueting Pan contributed equally to this work, sharing first authorship. They were involved in study design, data extraction, and manuscript drafting.Mi Jiang performed the statistical analysis and contributed to the interpretation of results.Jiaxian Geng, the corresponding author, supervised the study, revised the manuscript critically, and ensured the integrity of the work.All authors read and approved the final manuscript. Data Availability The original data generated and analyzed during the current study are available from the corresponding author upon reasonable request. 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HAN, P. et al. Clinical Evidence of Exercise Benefits for Stroke[J]. Adv. Exp. Med. Biol. 1000 , 131–151 (2017). SAUNDERS, D. H. et al. Physical fitness training for stroke patients[J]. Cochrane Database Syst. Rev. 3 (3), Cd003316 (2020). POGREBNOY, D. A. DENNETT. Exercise Programs Delivered According to Guidelines Improve Mobility in People With Stroke: A Systematic Review and Meta-analysis[J]. Arch. Phys. Med. Rehabil . 101 (1), 154–165 (2020). LEE, J. A. J. S. T. O. N. E. Combined Aerobic and Resistance Training for Cardiorespiratory Fitness, Muscle Strength, and Walking Capacity after Stroke: A Systematic Review and Meta-Analysis[J].J Stroke Cerebrovasc Dis. 29 (1):104498. (2020). AMANZONWé, E. R., TEDESCO TRICCAS, L., CODJO, L. & HANSEN, D. P. FEYS.O. KOSSI. Exercise dosage to facilitate the recovery of balance, walking, and quality of life after stroke[J]. South. Afr. J. Physiotherapy 79 (1). (2023). MAHER, C. G., SHERRINGTON, C. & HERBERT, R. D. A.M. MOSELEY.M. ELKINS. Reliability of the PEDro scale for rating quality of randomized controlled trials[J].Phys Ther. 83 (8):713–721. (2003). DE MORTON, N.A. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study[J]. Aust J. Physiother . 55 (2), 129–133 (2009). FERNANDEZ-GONZALO, R., FERNANDEZ-GONZALO, S., TURON, M. & PRIETO, C. P.A. TESCH.M.d.C. GARCíA-CARREIRA. Muscle, functional and cognitive adaptations after flywheel resistance training in stroke patients: a pilot randomized controlled trial[J].Journal of NeuroEngineering and Rehabilitation. 13(1). (2016). FLANSBJER, U. B., MILLER, M. & D. DOWNHAM .J. LEXELL. Progressive resistance training after stroke: Effects on muscle strength, muscle tone, gait performance and perceived participation[J]. J. Rehabil. Med. 40 (1), 42–48 (2008). GLOBAS, C. et al. Chronic Stroke Survivors Benefit From High-Intensity Aerobic Treadmill Exercise[J].Neurorehabilitation and Neural Repair. 26 (1):85–95. (2011). TOLEDANO-ZARHI, A. & TANNE, D. E. CARMELI.M. KATZ-LEURER. Feasibility, safety and efficacy of an early aerobic rehabilitation program for patients after minor ischemic stroke: A pilot randomized controlled trial[J].NeuroRehabilitation. 28 (2):85–90. (2011). SEVERINSEN, K., JAKOBSEN, J. K. & PEDERSEN, A. R. OVERGAARD.H. ANDERSEN. Effects of Resistance Training and Aerobic Training on Ambulation in Chronic Stroke[J]. Am. J. Phys. Med. Rehabil. 93 (1), 29–42 (2014). LUND, C. et al. Balance and walking performance are improved after resistance and aerobic training in persons with chronic stroke[J].Disability and Rehabilitation. 40 (20):2408–2415. (2017). BOWDEN, M. G., MONSCH, E. D., MIDDLETON, A. & DAUGHTRY, C. T. POWELL.S.V. KRAFT. Lessons Learned: The Difficulties of Incorporating Intensity Principles Into Inpatient Stroke Rehabilitation[J].Archives of Rehabilitation Research and Clinical Translation. 2(2). (2020). GANGOPADHYAY, S., SAHA, S. & SENGUPTA, M. B. MAITY.D. CHAKRABARTI. Effect of Body Weight Support Treadmill Training on Gait Recovery, Lower Limb Function and Dynamic Balance in Patients with Chronic Stroke: A Randomised Controlled Trial[J].Journal of Clinical and Diagnostic Research. (2021). VIVE, S. C. ELAM.L. BUNKETORP-KäLL. Comfortable and Maximum Gait Speed in Individuals with Chronic Stroke and Community-Dwelling Controls[J].Journal of Stroke and Cerebrovascular Diseases. 30 (10). (2021). VELDEMA, J. P. JANSEN. Ergometer Training in Stroke Rehabilitation: Systematic Review and Meta-analysis[J]. Arch. Phys. Med. Rehabil . 101 (4), 674–689 (2020). WIST, S. SATTELMAYER. Muscle strengthening for hemiparesis after stroke: A meta-analysis[J]. Ann. Phys. Rehabil Med. 59 (2), 114–124 (2016). DíAZ-LóPEZ, N., MONGE-PEREIRA, E., JODRA-CENTENO, E. & MOLINA-RUEDA.J.C. MIANGOLARRA-PAGE, F. Use of recognition of laterality through implicit motor imagery for the improvement of postural control and balance in subacute stroke patients: a randomized controlled study[J].Rev Neurol. 74 (12):375–382. (2022). LIM, C. G. Effect of Underwater Treadmill Gait Training With Water-Jet Resistance on Balance and Gait Ability in Patients With Chronic Stroke: A Randomized Controlled Pilot Trial[J].Front Neurol. 10 :1246. (2019). LEE, J., JEON, J., LEE, D., HONG, J. & KIM, J. Y. U. J. Effect of trunk stabilization exercise on abdominal muscle thickness, balance and gait abilities of patients with hemiplegic stroke: A randomized controlled trial[J].NeuroRehabilitation. 47 (4):435–442. (2020). HORTOBáGYI, T. et al. Beam Walking to Assess Dynamic Balance in Health and Disease: A Protocol for the BEAM Multicenter Observational Study[J].Gerontology. 65 (4):332–339. (2019). Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6124658","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":427803512,"identity":"b4df623e-5acf-47e7-bd14-eb5279eda3a5","order_by":0,"name":"Yang Liu","email":"","orcid":"","institution":"Nanchang Normal University","correspondingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Liu","suffix":""},{"id":427803513,"identity":"e4e1ac5c-d5dd-4562-93c8-7b5ecb7611f2","order_by":1,"name":"Xueting Pan","email":"","orcid":"","institution":"Sichuan Agricultural University","correspondingAuthor":false,"prefix":"","firstName":"Xueting","middleName":"","lastName":"Pan","suffix":""},{"id":427803515,"identity":"226397e7-5cd6-4d39-a80f-d5a90b6eb7d9","order_by":2,"name":"Mi Jiang","email":"","orcid":"","institution":"North east normal university","correspondingAuthor":false,"prefix":"","firstName":"Mi","middleName":"","lastName":"Jiang","suffix":""},{"id":427803517,"identity":"eebf8405-13ea-440c-8b22-1588ba560c34","order_by":3,"name":"Jiaxian Geng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1UlEQVRIiWNgGAWjYBACNvbmgw8+VDAwG4B4PMRo4ec5lmw44wwpWiRn5KhJc7YxMBCvxeBADoM047w6dnOJBMYHb9sY5M0Jazl7wLhwGxuz5YwEZsO5bQyGOxsIaTnYl5A8cxsPs8GNBDZp3jaGBIMDhLQc5jE4zDtHAqSF/TdRWiTbeAybeRsMwLYwE6WFn4ctmXHGsQRmgzMPmyXnnJMw3EBIC5v84+M/PtTUJRscTz744U2ZjTxBW2AgmYGBsQFISxCpHgjsiFc6CkbBKBgFIw4AAOvyPkp94loBAAAAAElFTkSuQmCC","orcid":"","institution":"Huzhou University","correspondingAuthor":true,"prefix":"","firstName":"Jiaxian","middleName":"","lastName":"Geng","suffix":""}],"badges":[],"createdAt":"2025-02-28 02:38:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6124658/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6124658/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-09458-1","type":"published","date":"2025-07-07T15:57:14+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":86700081,"identity":"9b17f1a8-4846-4ac1-8428-cc50a1cae35b","added_by":"auto","created_at":"2025-07-14 16:11:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1136003,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6124658/v1/69851524-f5f3-414a-8598-9d142b8a6e11.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of Exercise on Mobility , Balance and Gait in Patients with the chronic Stroke: A systematic review and meta-analysis","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eStroke is a major global health concern, capable of inducing diverse disabilities depending on the affected brain region and the severity of the incident\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Among these disabilities, motor impairments vary in intensity and can lead to impaired spatial perception, motor deficits, and disruptions in postural balance\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. The resulting decline in mobility,balance and gait often leads to functional limitations, reduced mobility and a high risk of falls\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. These challenges profoundly impact the quality of life for chronic stroke patients, emphasizing the need for effective rehabilitation to address these issues\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Rehabilitation initiatives targeting the mobility, balance, and gait play a pivotal role in augmenting the overall well-being and autonomy of chronic stroke patients (6). Consequently, rehabilitation interventions tailored specifically to enhance mobility,balance and gait are crucial for the management and recovery of chronic stroke patients.\u003c/p\u003e \u003cp\u003eMobility,gait and balance assessment are fundamental components of the evaluation of chronic stroke patients.In rehabilitation research, the TUG test serves as a major indicator of quality of life\u003csup\u003e[\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e,with the Berg Balance Scale (BBS) being the most widely utilized tool to evaluate balance proficiency during stroke rehabilitation \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e.The 6MWT \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e, and the 10MWT test (\u003csup\u003e[\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e represent primary indicators of gait functionality.\u003c/p\u003e \u003cp\u003eIn recent years, the integration of exercise intervention training into post-stroke rehabilitation practices has emerged as a promising approach, providing considerable advantages to post-stroke individuals. Diverse rehabilitation training modalities, including resistance training (RT) \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e, cross-training \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e, aerobic training (AT) \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e, and mirror therapy \u003csup\u003e[\u003cspan additionalcitationids=\"CR15 CR16 CR17 CR18\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e, have exhibited potential usefulness for enhancing gait and balance to varying extents among chronic stroke patients. However, previous studies have reported conflicting views on the effectiveness of exercise training programs regarding improving symptoms \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e, balance \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e, and other relevant outcome measures.\u003c/p\u003e \u003cp\u003eSome previous meta-analyses reported that AT and RT could improve mobility, balance and gait performance in patients who have recovered from a chronic stroke \u003csup\u003e[\u003cspan additionalcitationids=\"CR23 CR24 CR25\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. And other meta-analyses reported that AT and RT do not improve mobility,balance or gait performance in patients who have recovered from a chronic stroke \u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. Additional investigations are warranted to gain a comprehensive understanding of the influence of exercise intervention on the advancement of mobility, balance and gait capabilities in chronic stroke patients.\u003c/p\u003e \u003cp\u003eTherefore, the present meta-analysis of randomized controlled trials (RCTs) investigated the effects of exercise intervention on the mobility, balance and gait abilities of chronic stroke patients.The primary objectives were to elucidate the collective effect size of exercise intervention on mobility, balance and gait outcomes, evaluate the potential heterogeneity across studies, and ascertain the underlying factors contributing to such heterogeneity.\u003c/p\u003e"},{"header":"2 Materials and Methods","content":"\u003cp\u003e This review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and preregistered in the PROSPERO database (ID: CRD420-24500839).\u003c/p\u003e \u003cp\u003eSearch strategy\u003c/p\u003e \u003cp\u003eTwo authors (P.X.T. and L.Y.) systematically searched PubMed, Embase, Web of Science, and Cochrane Library databases from the respective date of inception until June 3, 2023. The search was conducted according to the PICOS principle, using a search strategy that incorporated specific terms for each component of the PICOS framework. The experimental group was defined by keywords such as \u0026ldquo;resistance training,\u0026rdquo; \u0026ldquo;training,\u0026rdquo; and \u0026ldquo;aerobic training,\u0026rdquo; while the control group encompassed terms such as \u0026ldquo;sham training\u0026rdquo; and \u0026ldquo;usual care.\u0026rdquo; Participants were identified through terms such as \u0026ldquo;stroke,\u0026rdquo; \u0026ldquo;chronic stroke,\u0026rdquo; and \u0026ldquo;acute stroke.\u0026rdquo; Outcome measures of interest included \u0026ldquo;TUG,\u0026rdquo; \u0026ldquo;BBS,\u0026rdquo; \u0026ldquo;10MWT,\u0026rdquo; and \u0026ldquo;6MWT.\u0026rdquo; The study type was restricted to \u0026ldquo;Randomized Controlled Trial\u0026rdquo; or \u0026ldquo;RCT.\u0026rdquo; By employing these meticulously selected keywords, relevant studies meeting the predetermined inclusion criteria were identified.\u003c/p\u003e \u003cp\u003eInclusion and exclusion criteria\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1.1 Inclusion criteria\u003c/h2\u003e \u003cp\u003eThe literature inclusion criteria were established based on the PICOS principle. The criteria for study inclusion were defined as follows. Inclusion criteria for the selection of appropriate studies were defned according to the PICOS approach: Population: stroke patients; Intervention: Exercise interventions only; Comparison/controls: disguised training or daily activities control group; Outcomes: BBS, TUG, 6MWT, 10MWT .The studies were required to specify outcome measures and employ either an RCT or a controlled clinical trial design. RCT: Only studies employing an RCT design were considered for inclusion. Multiple Interventions: In instances where a single study provided valuable data for multiple interventions, multiple comparisons were undertaken (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCriteria for inclusion of articles (PICOS).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePICOS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDetailed information\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePopulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChronic stroke\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe experimental group received exercise intervention: resistance training (e.g., isokinetic muscle strength training or strength training) or aerobic training (cycle training or treadmill walking).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComparison\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe control group generally underwent \u0026ldquo;disguised training or daily activities.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBalance and gait-related indicators (Berg balance scale); Timed up and go test; 10-meter walk test; fast gait speed: 6-minute walk test.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudy design\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRandomized controlled trials\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003e2.1.2 Exclusion criteria\u003c/h2\u003e \u003cp\u003eWe excluded articles that were not available in Chinese or English; articles lacking sufficient information or incomplete data that rendered them unusable; studies in which the control group received interventions other than standard physiotherapy or routine activities; and studies in which the experimental group underwent combined interventions.\u003c/p\u003e \u003cp\u003eData extraction and quality assessment\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.1.3 Data extraction\u003c/h2\u003e \u003cp\u003eAll relevant literature retrieved from the databases was imported into EndNote X20 software. After removing duplicate publications, the following data were extracted by two independent authors (PXT and LY): general information on the publications (first author\u0026rsquo;s name and publication year), characteristics of the studies (sample size, randomization, and blinding), participant information (age, gender, and time since stroke), mode of interventions (AT, RT, or progressive resistance training [PRT]), content of the interventions (modality, frequency, intensity, duration, and session length), and outcomes (observation time points, measurement tools, and follow-up). In case of inconsistencies between the two investigators, a third reviewer (GXJ) verified the information. After the search, the documents were analyzed to extract the aforementioned information. In cases of missing data, an attempt was made to contact the study investigators to obtain the necessary data. If the study authors were unresponsive or unreachable, the study was excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.1.4 Assessment of study quality\u003c/h2\u003e \u003cp\u003eThe Physiotherapy Evidence Database (PEDro) scale was used to assess the risk of bias and methodological quality of included studies \u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. This scale scores studies on a scale of 0\u0026ndash;10, with scores\u0026thinsp;\u0026gt;\u0026thinsp;6, 4\u0026ndash;5, and \u0026lt;\u0026thinsp;3 indicating a high, moderate, and low quality, respectively \u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. Two authors (PXT and LY) evaluated the studies, whereas a third author (JM) double-checked the information and assigned scores.\u003c/p\u003e \u003cp\u003eStatistical analysis\u003c/p\u003e \u003cp\u003eThe statistical analysis for experimental outcome measures was conducted using the RevMan 5.3 software. Given that the outcome measures in this study are continuous variables, the mean difference (MD) was utilized as the effect size if the units of measurement were consistent across the included literature. However, if the units of measurement varied, the standardized MD (SMD) with the corresponding 95% confidence interval was employed as the effect size. The effect size heterogeneity among the studies was evaluated using the quantitative guidelines outlined in the Cochrane Handbook for Systematic Reviews. P-values and I\u003csup\u003e2\u003c/sup\u003e statistics were used to evaluate the extent of heterogeneity. The I\u003csup\u003e2\u003c/sup\u003e value represents the degree of heterogeneity, ranging from 0\u0026ndash;100%. A value of 0% indicates no heterogeneity, 0\u0026ndash;25% suggests minimal heterogeneity that can be disregarded, 25\u0026ndash;50% indicates low heterogeneity, 50\u0026ndash;75% implies moderate heterogeneity, and 75\u0026ndash;100% represents substantial heterogeneity that cannot be overlooked. When I\u003csup\u003e2\u003c/sup\u003e was less than or equal to 50%, a fixed-effects model was employed for the meta-analysis. Conversely, a random-effects model was adopted when I\u003csup\u003e2\u003c/sup\u003e exceeded 50%. Subgroup analysis was conducted to identify and examine potential intermediate variables contributing to the observed heterogeneity. Statistical significance was considered when the \u003cem\u003ep\u003c/em\u003e-value was less than 0.05, while a \u003cem\u003ep\u003c/em\u003e-value equal to or greater than 0.05 indicated a lack of statistical significance. Data from acute intervention and training intervention studies were recorded as the baseline change, which refer to the average (M) and standard deviation (SD) of the difference before and after the intervention. These values were calculated using the following formula(R\u0026thinsp;=\u0026thinsp;0.5 coefficient of association):\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eM \u003csub\u003eChange in Value\u003c/sub\u003e = M \u003csub\u003ePost \u0026minus;\u003c/sub\u003e M \u003csub\u003ePre\u003c/sub\u003e (1)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Equ1\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equ1\" name=\"EquationSource\"\u003e\n$$\\:{\\text{S}\\text{D}}_{Change\\:in\\:Value}\\:=\\sqrt{{\\text{S}\\text{D}}_{\\text{p}\\text{r}\\text{e}}^{2}+{\\text{S}\\text{D}}_{\\text{p}\\text{o}\\text{s}\\text{t}}^{2}-（2\\times\\:\\text{R}\\times\\:{\\text{S}\\text{D}}_{\\text{p}\\text{r}\\text{e}}\\times\\:{\\text{S}\\text{D}}_{\\text{p}\\text{o}\\text{s}\\text{t}}）}$$\u003c/div\u003e\u003cdiv class=\"EquationNumber\"\u003e2\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cp\u003eSearch results\u003c/p\u003e \u003cp\u003eIn total, 10 RCTs were identified and included in the meta-analysis. The experimental groups in the studies underwent AT 、 RT and PRT. The control groups either received disguised training or followed their usual daily activities. The assessment of mobility, balance and gait indicators was based on various measurement tools, such as such as the TUG,the BBS,the 6MWT and 10MWT.. Detailed information is present in Fig.\u0026nbsp;1and Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBasic characteristics of included articles.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLiterature source\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSample Size\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTime since stroke\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eExercise Intervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eIntervention Measures\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eOutcome Measures\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Experimental group/control group)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(Experimental group/control group)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(Experimental group/control group)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ecycle\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003efrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e(Experimental group/control group)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Experimental group/control group)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFlansbjer et al.\u003c/p\u003e \u003cp\u003e(2008) \u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15/9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61(5)/61(5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.9(7.9)/20(11.6) months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eProgressive resistance training for lower limbs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDaily activities (placebo)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e②④\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eToledano-Zarhi et al. (2011) \u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14/14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.6\u0026thinsp;\u0026plusmn;\u0026thinsp;6.7/68.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.2\u0026thinsp;\u0026plusmn;\u0026thinsp;46.67/70\u0026thinsp;\u0026plusmn;\u0026thinsp;67.4 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eStrength training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDaily activities (placebo)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e④\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTakatori et al. (2012) \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22/22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.0\u0026thinsp;\u0026plusmn;\u0026thinsp;6.9/711\u0026thinsp;\u0026plusmn;\u0026thinsp;10.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMore than 12months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eStrength training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDaily activities (placebo)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e②③\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFlansbje et al. (2012) \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11/7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66\u0026thinsp;\u0026plusmn;\u0026thinsp;4/66\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69\u0026thinsp;\u0026plusmn;\u0026thinsp;10/50\u0026thinsp;\u0026plusmn;\u0026thinsp;3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eProgressive resistance training for lower limbs (PRT)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDaily activities (placebo)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e②③\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlobas t al. (2012) \u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18/18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.6\u0026thinsp;\u0026plusmn;\u0026thinsp;6.7/68.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.2\u0026thinsp;\u0026plusmn;\u0026thinsp;46.6/70\u0026thinsp;\u0026plusmn;\u0026thinsp;67.4 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u0026ndash;3 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eHigh-intensity aerobic training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eConvectional rehabilitation (placebo)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e①③④\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeverinsen et al. (2014) \u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14/16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (57\u0026ndash;78)/66 (52\u0026ndash;80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (8\u0026ndash;36)/16 (9\u0026ndash;38) months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eProgressive resistance training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ePretend training (placebo)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e③④\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeverinsen et al. (2014) \u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13/16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (50\u0026ndash;80)/66 (52\u0026ndash;80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (11\u0026ndash;29)/16 (9\u0026ndash;38) months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eHigh-intensity aerobic training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ePretend training (placebo)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e③④\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFernandez-Gonzalo et al. (2016) \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14/15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.2 (9.8)/65.7 (12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42 (43.2)/51.6 (58.8) months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 times/week, 4 sets * 7 reps\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eLower limb resistance training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDaily activities (placebo)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e①②\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLund et al. (2018) \u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14/17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4/66.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.8 (7.7)/17.1 (7.7) months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eLower limb resistance training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ePretend training (placebo)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e①③④\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLund et al. (2018) \u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17/17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4/66.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.8 (5.4)/17.1 (7.7 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eHigh-intensity aerobic training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ePretend training (placebo)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e①③④\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBowden et al. (2020) \u003csup\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16/19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67.2\u0026thinsp;\u0026plusmn;\u0026thinsp;17.4/70.3\u0026thinsp;\u0026plusmn;\u0026thinsp;14.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 month/1week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 times/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eGait and strength training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eConventional rehabilitation (placebo)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e②③\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGangopadhyay et al. (2021) \u003csup\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15/15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.07\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7/52.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMore than 6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 times/week, 40 minutes/session\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eAerobic training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003econventional rehabilitation (placebo)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e①②③\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eNote: ①Balance and gait-related indicators (Berg balance scale, BBS), ②timed up and go test (TUG), ③10-meter walk test (10MWT) or fast gait speed (FGS), and ④6-minute walk test (6MWT).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePEDro scale.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResearch (Year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFlansbjer et al. (2008) \u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eToledano-Zarhi et al. (2011) \u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTakatori et al. (2012) \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFlansbjer et al. (2012) \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlobas et al. 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(2016) \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLund et al. (2018) \u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBowden et al. (2020) \u003csup\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGangopadhyay et al. (2021) \u003csup\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.1.1 Impact of exercise intervention on TUG test in chronic stroke patients\u003c/h2\u003e \u003cp\u003eThe 10 RCTs 145 participants. Four RCTs \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e examined the effects of exercise intervention on the TUG test in chronic stroke patients. The forest plot in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e demonstrates a lack of heterogeneity across the studies. Utilizing a fixed-effects model (\u003cem\u003eI\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), the meta-analysis revealed a significant improvement in TUG performance associated with exercise intervention [MD\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;5.10, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, \u003cem\u003e95% CI\u0026thinsp;=\u0026thinsp;\u0026minus;\u003c/em\u003e\u0026thinsp;8.78 to \u0026minus;\u0026thinsp;1.42]. The TUG test consistently demonstrated lower scores in the exercise intervention cohort compared to the control cohort, suggesting substantial enhancement in the mobility among chronic stroke patients subjected to the exercise intervention.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e3.1.2 Effects of exercise intervention on 6MWT and 10MWT in chronic stroke patients\u003c/h2\u003e \u003cp\u003eAmong the eligible RCTs that evaluated the 6MWT, six RCTs were included in the meta-analysis of effect sizes \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan additionalcitationids=\"CR32 CR33 CR34\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e, comprising a sample size of 230 participants. As depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, there was no substantial heterogeneity observed across the selected studies, and a fixed-effects model was applied (\u003cem\u003eI\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.95; Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The meta-analysis results indicated that exercise intervention did not significantly improve the 6MWT among chronic stroke patients. The between-group difference was not significant [\u003cem\u003eMD\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;3.48, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05, 95% CI\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;27.34\u003c/em\u003e to \u003cem\u003e\u0026minus;\u0026thinsp;20.38\u003c/em\u003e]. These outcomes emphasize the necessity for further studies to comprehensively investigate the effects of exercise interventions on the 6MWT performances in patients who have undergone a chronic stroke.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eSix RCTs \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan additionalcitationids=\"CR35 CR36\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e with a total of 287 participants were included in the analysis of the 10MWT. The forest plot in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e revealed the presence of heterogeneity among the included RCTs, as indicated by an \u003cem\u003eI\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003evalue of 61% (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). To address the observed heterogeneity, a random-effects model was utilized. The findings from the meta-analysis revealed that the exercise intervention did not lead to a significant enhancement in the maximum walking speed (10MWT) among patients who have suffered a chronic stroke. The observed difference between the intervention and control groups was not significant \u003cem\u003e[MD\u0026thinsp;=\u0026thinsp;0.02, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05, 95% CI\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.09\u003c/em\u003e to \u003cem\u003e0.12].\u003c/em\u003e These findings underscore the need for further methodologically rigorous research to elucidate the potential benefits of exercise interventions on improving the 10MWT outcomes in post-stroke individuals.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e3.1.3 Impact of exercise intervention on BBS in chronic stroke patients\u003c/h2\u003e \u003cp\u003eAmong the included RCTs, three \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e investigated the influence of exercise intervention on BBS, as assessed by the BBS, in chronic stroke patients, encompassing a total of 95 participants. The absence of heterogeneity among the RCTs is evident from Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. The overall effect test model was used(\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008, \u003cem\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/em\u003e The meta-analysis results revealed a statistically significant enhancement in BBS balance scores attributable to exercise intervention, as evidenced by the positive MD in the combined effect size. In particular, the intervention group displayed significantly higher BBS scores compared to the control group \u003cem\u003e[MD\u0026thinsp;=\u0026thinsp;2.82, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, 95% CI\u0026thinsp;=\u0026thinsp;0.74\u003c/em\u003e to \u003cem\u003e4.90]\u003c/em\u003e, underscoring the significant effect of exercise intervention in improving the BBS balance measures.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e3.1.4 The subgroup mate-analyses of exercise modes on mobility, balance and gait\u003c/h2\u003e \u003cp\u003eThe subgroup meta-analyses conducted on exercise interventions in the 10 RCTs encompassed AT, RT and PRT. The meta-analysis for mobility is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e, which revealed a high heterogeneity (\u003cem\u003eI\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.42, \u003cem\u003ep\u0026thinsp;\u0026gt;\u003c/em\u003e\u0026thinsp;0.05). The fixed-effect size model showed that exercise intervention had a significant effect on mobility [MD = -5.10, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05,95% CI\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;8.78 to \u003cem\u003e\u0026minus;\u003c/em\u003e\u0026thinsp;1.42],the results showed that PRT could significantly improve the mobility (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).The meta-analysis for balance is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e. which revealed a high heterogeneity (\u003cem\u003eI\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.75, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The fixed-effect size model showed that exercise intervention had a significant effect on balance [MD\u0026thinsp;=\u0026thinsp;2.82, p\u0026thinsp;=\u0026thinsp;0.008, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, 95% CI\u0026thinsp;=\u0026thinsp;0.74\u0026ndash;4.90],the results showed that AT could significantly improve the balance (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The meta-analysis for gait is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e, which revealed a high heterogeneity (\u003cem\u003eI\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.96, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The fixed-effect size model showed that exercise intervention had no significant effect on gait [MD\u0026thinsp;=\u0026thinsp;0.16, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.06, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05, 95% CI\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.01 to 0.33].These findings suggest that interventions such as AT and RT do not significantly improve the gait ability of chronic stroke patients, which is in line with the meta-analysis by Amanzonw\u0026eacute; et al. Nevertheless, the subgroup analysis revealed significant enhancements in mobility index with PRT and notable improvements in BBS balance index with AT.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e3.1.5 Assessment of risk of bias\u003c/h2\u003e \u003cp\u003eThe summary of PEDro results (Table. 3) provides a methodological quality of the certainty of evidence assessment. Based on the PEDro evaluation, there are eight randomized controlled trials (RCTs) with PEDro scores ranging from 6 to 8, for which the certainty of evidence regarding the impact of exercise on chronic stroke patients is classified as 'high'. Additionally, two RCTs possessing PEDro scores of 5 have been assigned a 'moderate' certainty of evidence concerning the effects of exercise on chronic stroke patients.This distribution underscores the stringent selection criteria applied and reflects positively on the overall methodological quality of the studies included in the review.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eOur meta-analysis quantified the effects of different modes of exercise therapy on balance and gait in chronic stroke patients. Recent meta-analyses have suggested that AT \u003csup\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/sup\u003e and RT \u003csup\u003e[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/sup\u003e had no significant effects on improving balance. Saunders et al. \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e reported low-to-moderate quality evidence for improving balance through exercise therapy. However, our results showed that exercise interventions (AT, RT, and PRT) have a significant effect on BBS, but not on gait. Nevertheless, because of the small sample size, conclusions cannot be drawn for different stroke populations.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Impact of exercise intervention on TUG in chronic stroke patients\u003c/h2\u003e \u003cp\u003eOur meta-analysis revealed that exercise intervention could effectively improve the TUG index (MD\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;5.10, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The standing and walking test time in the experimental group was significantly lower than that in the control group, indicating that exercise intervention had a significant effect on improving the standing and walking test (TUG) index in chronic stroke patients, which is consistent with the previous findings of Flansbjer et al. \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. A related study by Fernandez-Gonzalo et al. \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e showed that after 12 weeks of muscle resistance training based on \u0026ldquo;wheel resistance training\u0026rdquo; of lower limbs, the muscle contraction activities of participants were less than 2 minutes each time, which improved executive function, attention, and information processing speed. Our analysis showed that the TUG increased significantly in the experimental groups by 2.16 s. This progressive isokinetic muscle strength training improved the TUG results in a consistent manner \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Impact of exercise intervention on 6MWT and 10MWT in chronic stroke patients\u003c/h2\u003e \u003cp\u003eOur meta-analysis suggests that exercise intervention does not lead to statistically significant differences in gait speed or endurance, as observed in the \u003cem\u003e6MWT (MD\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;3.48, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05)\u003c/em\u003e or the \u003cem\u003e10MWT (MD\u0026thinsp;=\u0026thinsp;0.02, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05)\u003c/em\u003e. This finding aligns with the outcomes reported by Takatori and colleagues in their experimental investigation involving the 10MWT \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. Both intervention and control groups exhibited improvements in gait performance, but only the TUG test showed significant improvement during follow-up. Furthermore, 6MWT and 10MWT test did not show significant changes. Consequently, further well-designed RCTs are warranted to explore the effects of exercise intervention on enhancing the 6MWT and 10MWT outcomes in chronic stroke patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Impact of exercise intervention on BBS in chronic stroke patients\u003c/h2\u003e \u003cp\u003ePost-stroke balance impairment is a major challenge \u003csup\u003e[\u003cspan additionalcitationids=\"CR42\" citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]\u003c/sup\u003eAdditionally, imbalance is a crucial risk factor for falls among individuals after stroke. The findings from the present meta-analysis demonstrated a statistically significant improvement in the BBS scores among chronic stroke patients following exercise intervention \u003cem\u003e(MD\u0026thinsp;=\u0026thinsp;2.82, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01)\u003c/em\u003e. Research indicates that gait performance serves as an accurate predictor of fall risk and actual falls \u003csup\u003e[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]\u003c/sup\u003e. The intervention group, which underwent 12 weeks of lower limb wheel resistance training, exhibited significant enhancements in the TUG test results (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with a notable increase of 3.77 points in BBS scores \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. Similarly, prolonged assisted walking training on a treadmill also yielded improvements in BBS scores among chronic stroke patients (33). Consequently, based on the synthesized findings from the meta-analysis, it can be postulated that a dedicated regimen of physical therapy, specifically directed toward the lower limbs, has the capability to improve balance in patients after cerebral vascular accidents.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Review limitations\u003c/h2\u003e \u003cp\u003eThe experimental group used a single form of exercise intervention, while the control group used camouflage training or daily activities. Combined training such as combined AT and strength training was not performed. Joint training can be conducted for comprehensive analysis in the future. Although we performed subgroup analyses of different exercise patterns, interpretation of the results remains challenging due to differences in intervention type and study design. In addition, the quality of studies and potential measurement errors or unmeasured/unreported factors may lead to increased heterogeneity. Due to the limited number of available studies, we were unable to conduct further meta-analyses and subgroup analyses, particularly on the effects of different types of stroke. Furthermore, we could not recommend the best exercise intervention to improve gait and balance in chronic stroke patients.\u003c/p\u003e \u003c/div\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eOur systematic review and meta-analysis revealed that exercise training interventions significantly increased mobility and balance scores in chronic stroke patients. However, they had no effect on gait scores. The subgroup analysis revealed significant enhancements in mobility index with PRT and notable improvements in BBS balance index with AT.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConflict of Interest\u003c/h2\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e\n\u003ch2\u003eDeclarations of Human Ethics\u003c/h2\u003e\n\u003cp\u003eHuman Ethics and Consent to Participate declarations: not applicable\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eYang Liu and Xueting Pan contributed equally to this work, sharing first authorship. They were involved in study design, data extraction, and manuscript drafting.Mi Jiang performed the statistical analysis and contributed to the interpretation of results.Jiaxian Geng, the corresponding author, supervised the study, revised the manuscript critically, and ensured the integrity of the work.All authors read and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003e\u0026nbsp;\u003c/h2\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe original data generated and analyzed during the current study are available from the corresponding author upon reasonable request. Please contact the corresponding author at [corresponding author's email address] for data access.\u003c/p\u003e\n\u003ch2\u003eData Availability Statement\u003c/h2\u003e\n\u003cp\u003eThe original contributions presented in the study are included in the article; further inquiries can be directed to the first author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBLUM, L. N. \u0026amp; KORNER-BITENSKY Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review[J]. \u003cem\u003ePhys. Ther.\u003c/em\u003e \u003cb\u003e88\u003c/b\u003e (5), 559\u0026ndash;566 (2008).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePRAMODHYAKUL, W., WATTANAPAN, P. \u0026amp; SIRITARATIWAT, W. W. EUNGPINICHPONG.S. AMATACHAYA. Immediate effects of obstacle crossing training in independent ambulatory patients with spinal cord injury[J].Spinal Cord. \u003cb\u003e51\u003c/b\u003e(5):379\u0026ndash;383. 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(2019).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"stroke, exercise training, gait, balance ability, meta-analysis","lastPublishedDoi":"10.21203/rs.3.rs-6124658/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6124658/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eAlthough exercise interventions are recommended after a stroke, their effects on mobility,balance and gait are still unclear.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: The aim of this research was to evaluate the effects of exercise training on mobility、balance and gait parameters, with a particular emphasis on the Timed Up and Go test (TUG), the Berg Balance Scale (BBS),the 6-Minute Walk Test (6MWT), and the 10-Meter Walk Test (10MWT).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA systematic search was conducted across several databases, namely Web of Science, Embase, PubMed, and the Cochrane Library for randomized controlled trials (RCTs), to evaluate the effects of exercise interventions on mobility, balance and gait in chronic stroke patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAfter rigorous screening, 10 RCTs with both experimental and control groups (183/152 participants) were found eligible for inclusion. The meta-analysis demonstrated significant improvement in the mobility ability, as measured by TUG test after exercise intervention (mean difference [MD] = −5.10, p \u0026lt; 0.01, 95% confidence interval [CI] = −8.78 to −1.42). Furthermore, exercise effectively enhanced the balance ability, as measured by the BBS, among chronic stroke patients (MD = 2.82, p \u0026lt; 0.01, 95% CI = 0.74–4.90). However, no statistically significant impact of exercise training was observed on the 6MWT (MD = −3.48, p \u0026gt; 0.05, 95% CI = −27.34 to 20.38) or 10MWT (MD = 0.02, p \u0026gt; 0.05, 95% CI −0.09 to 0.12).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion：\u003c/strong\u003eExercise training interventions significantly increased mobility and balance scores in chronic stroke patients. However, they had no effect on gait scores. The subgroup analysis revealed significant enhancements in mobility index with PRT and notable improvements in BBS balance index with AT.\u003c/p\u003e","manuscriptTitle":"Effects of Exercise on Mobility , Balance and Gait in Patients with the chronic Stroke: A systematic review and meta-analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-14 06:02:55","doi":"10.21203/rs.3.rs-6124658/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-23T11:59:28+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-17T23:47:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-14T08:03:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"133037539411560413610533896273374076390","date":"2025-04-07T14:33:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"102831680136870819261417691575656571646","date":"2025-04-07T05:47:27+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-07T05:38:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-07T05:32:11+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-03-12T12:00:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-12T09:19:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-02-28T02:24:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0568a333-e023-4bc8-9df1-b14786c5f0b8","owner":[],"postedDate":"March 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":45579385,"name":"Health sciences/Health care/Public health"},{"id":45579386,"name":"Health sciences/Health care/Quality of life"}],"tags":[],"updatedAt":"2025-07-14T16:09:54+00:00","versionOfRecord":{"articleIdentity":"rs-6124658","link":"https://doi.org/10.1038/s41598-025-09458-1","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-07-07 15:57:14","publishedOnDateReadable":"July 7th, 2025"},"versionCreatedAt":"2025-03-14 06:02:55","video":"","vorDoi":"10.1038/s41598-025-09458-1","vorDoiUrl":"https://doi.org/10.1038/s41598-025-09458-1","workflowStages":[]},"version":"v1","identity":"rs-6124658","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6124658","identity":"rs-6124658","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}