Exercise timing after stroke influences functional recovery outcomes
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Key Takeaway
Earlier post-stroke exercise training significantly improves motor and balance outcomes compared to later interventions.
A systematic review and meta-analysis of 5,254 stroke patients examined how the timing of exercise training affects functional recovery. The study compared acute, subacute, and chronic phase interventions, focusing on outcomes like the Fugl-Meyer Assessment (FMA) and Berg Balance Scale (BBS). The analysis revealed that acute-phase exercise training (ASETG) consistently outperformed subacute (SSETG) and chronic (CSETG) training in improving motor function and balance.
Key results showed that ASETG led to significantly greater improvements in total FMA scores (WMD = 7.95, 95% CI 6.73–9.16) and FMA-upper extremity scores (WMD = 4.26, 95% CI 3.09–5.44) compared to SSETG. Similar benefits were observed for lower extremity function and balance, with ASETG also outperforming CSETG in overall FMA scores (WMD = 5.31, 95% CI 3.89–6.72).
Secondary outcomes, including the Modified Barthel Index and Action Research Arm Test, further supported these findings. However, heterogeneity and the inclusion of observational studies limit the certainty of these results. The authors caution that while earlier exercise appears beneficial, high-quality randomized controlled trials are needed to confirm optimal timing.
In practice, clinicians should consider initiating exercise training as soon as medically feasible after a stroke to maximize functional recovery. This approach aligns with the study's emphasis on early intervention for better outcomes.
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View Original Abstract ↓
ObjectiveThis systematic review and meta-analysis aimed to compare the effectiveness of exercise training initiated in the acute, subacute, and chronic phases after stroke.MethodsThe Wanfang, CNKI, VIP, PubMed, Web of Science, Cochrane Library, and EMBASE databases were comprehensively searched for relevant articles from their inception to December 2025. Studies comparing outcomes among the acute stage exercise training group (ASETG), subacute stage exercise training group (SSETG), and chronic stage exercise training group (CSETG) for stroke patients were included. The outcomes assessed were improvements in the Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS), Action Research Arm Test (ARAT), Modified Barthel Index (MBI), and Modified Ashworth Scale (MAS) after treatment. Meta-analysis of comparable data was performed using Review Manager 5.3 software provided by the Cochrane Collaboration.ResultsA total of 16 randomized controlled trials (RCTs) and 22 observational studies involving 5,254 patients were included. The meta-analysis indicated that the ASETG showed significantly greater improvements in FMA scores compared to the SSETG [WMD = 7.95, 95% CI (6.73, 9.16)]. This trend was also observed in the FMA-UE [WMD = 4.26, 95% CI (3.09, 5.44)] and FMA-LE [WMD = 4.57, 95% CI (3.73, 5.41)] subscales when compared to the SSETG. Furthermore, the ASETG outperformed the CSETG in FMA scores [WMD = 5.31, 95% CI (3.89, 6.72)]. In addition, the ASETG exhibited significantly greater improvements in BBS scores compared to the SSETG [WMD = 3.64, 95% CI (1.14, 6.15)] and in MBI scores [WMD = 10.66, 95% CI (9.55, 11.77)]. Moreover, the SSETG showed a greater improvement in ARAT scores compared to the CSETG [WMD = 2.70, 95% CI (1.81, 3.59)].ConclusionThis review suggests earlier post-stroke exercise may improve functional outcomes (FMA, BBS, MBI, ARAT). However, due to heterogeneity and inclusion of observational studies, findings should be interpreted cautiously. High-quality RCTs are needed to confirm the optimal timing.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42024519257, identifier PROSPERO (CRD42024519257).
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