The effectiveness of group exercise for improving activity and participation in adult stroke survivors: a systematic review

Published:January 19, 2019DOI:



      Following post stroke rehabilitation, group exercise interventions can be used to continue improving cardiovascular fitness, activity levels, balance, gait, movement efficiency, and strengthening. However, little is known of the effectiveness of group exercise for improving activity and participation in stroke survivors.


      This review aims to assess the effectiveness of group exercise for improving activity and participation in adult stroke survivors.

      Data sources

      Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, and the Cochrane Library.

      Study eligibility criteria

      Randomised controlled trials (RCTs) of group exercise using validated outcome measures of activity and participation for post stroke rehabilitation. Two independent reviewers assessed all abstracts, extracted data, conducted a narrative synthesis and assessed the quality of all included articles. The Cochrane Risk of Bias Tool assessed methodological quality and included outcome measure quality was assessed.


      14 RCTs were included (n = 624 chronic stroke survivors collectively). Studies ranged between 12 and 243 stroke participants with an average of left:right hemisphere lesions of 32:39 and average age was 66.7 years. Although intervention and control groups improved, no significant difference between group differences were evident.


      and implications of key findings: The review found improvements are short-term and less evident at long-term follow up with little improvements in participation after 6 months. However, this review was limited to the standard of intervention reporting. Further research should consider consistency in measuring underpinning mechanisms of group exercise interventions, which may explain the lack of activity changes in long-term follow-up.

      Systematic review registration number PROSPERO



      RCT (randomised controlled trial), UK (United Kingdom), NHS (National Health Service), ICF (International Classification of Functioning Disability and Health), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis), CVA (Cardiovascular Accident), TIA (Transient Ischemic Attack), HIIT (High Intensity Interval Training), MeSH (Medical Subject Heading), EBRSR (Evidence Based Review of Stroke Rehabilitation), MCID (Minimally Clinically Important Difference), TUG (Timed Up and Go Test), 6MWT (6 Minute Walk Test), MAS-arm (Motor Assessment Scale upper lib-arm), MAS-hand (Motor Assessment Scale upper limb-hand), WMFT (Wolf Motor Function Test), SIS (Stroke Impact Scale), FAI (Frenchay Activities Index), RMI (Rivermead Mobility Index), NHP (Nottingham Health Profile), SF36 (Medical outcomes study 36-item short form questionnaire, version 2), FIM (Functional Independence Measure), GHQ (General Health Questionnaire), HADs (Hospital Anxiety and Depression Scale), SRD (Smallest Real Difference), BBS (Berg Balance Scale)


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