Key messages

• People with stroke can safely take part in programmes of exercise which involve muscle strength training.

• By engaging in muscle strength training, people with stroke can increase muscle strength and improve balance.

What is stroke?

Stroke occurs when the blood supply to part of the brain is interrupted, and this leads to damage in some areas of the brain. The impact of stroke can be life-changing and vary depending on the severity of damage and where this occurs in the brain. The impacts of stroke can be both physical and psychological, not only affecting the ability to move, but also the way someone thinks, behaves, and feels. These impacts can persist throughout life after stroke. One physical impact of stroke is that aerobic fitness and muscle strength can be low; this makes physical movement more difficult, and this may restrict a return to meaningful everyday activities.

What happens during rehabilitation after stroke?

After a stroke, many patients will receive rehabilitation, for example, from a physiotherapist or other health professional to help overcome physical problems with everyday activities. This therapy may involve different types of exercise and these may include strength training. This type of exercise, which is also called ‘resistance training’, can involve lifting weights or pulling against elastic resistance. Strength training can improve fitness by strengthening muscles important for activities like lifting objects, standing up, or walking. Patients may also be advised to do exercises at home. Therefore, the normal process of rehabilitation after a stroke may include elements of muscle strength training.

What did we want to find out?

Since muscle strength is often low after a stroke, strength training can improve fitness and reduce the impact of the post-stroke physical problems arising from this.

We wanted to find out whether muscle strength training is beneficial at any time after a stroke – whether earlier on, in hospital or later, after going home. Specifically, we wanted to determine whether strength training after stroke is safe, whether it improves muscle strength, improves movement (including walking and balance), changes the way people feel (including depression, quality of life) and whether it reduces the chance of having another stroke.

What did we do?

We searched for studies that tested strength training exercise in people after stroke. We only included studies if the exercise programme involved was based only on muscle strength training; we excluded studies if they involved any other types of exercise such as aerobic (exercise needing air) training. We compared and summarised the results of the studies and rated our confidence in the evidence, based on factors such as study methods and number of people included.

What did we find?

We found 27 studies that involved 1004 people with stroke, most of whom were able to walk independently. Most of the strength training programmes commenced more than six months after stroke, and most were short (less than 12 weeks). The strength training programmes could be successfully completed by most people; these programmes used different types of exercise equipment, such as exercise machines, elastic bands or simply bodyweight to provide resistance.

Main results

Participants could take part in strength training exercise programmes without this increasing the chance of injuries or health problems. We do not know whether strength training exercise protects against the chance of death or another stroke happening in the short or longer term.

Strength training clearly improved muscle strength in the legs and arms. Strength training can improve balance. This may be important as it is known to reduce the chance of falls in people with stroke. There was little or no effect on the preferred, comfortable walking speed, possibly because, although the exercises might strengthen the legs, they do not involve the act of walking. We could not draw conclusions about the effects of strength training on overall measures of disability (how we complete activities of daily living).

Little is known about the psychological benefits despite these being important to people with stroke. However, our data do hint that strength training might reduce depression.

What are the limitations of the evidence?

Most studies involved people who could walk. This means little is known about many people with stroke who have more limited mobility.

Most studies took place in high-income, industrialised countries. This means little is known about other regions of the world.

There are lots of uncertainties and not enough evidence about the effects of strength training.

How up-to-date is this evidence?

This review updates evidence from a previous version of this review (which was in a different format combining three separate programmes). The evidence is up-to-date to January 2024.