Physical Exercise Reduces Fall-Related Outcomes Among People With Stroke: A Systematic Review and Meta-Analysis.

Abstract

Importance Stroke markedly increases fall risk. Physical exercise is a potential approach to reducing falls poststroke. Objective The objective was to evaluate the effect of physical exercise on falls in people with stroke, and to examine participant and exercise protocol characteristics that may affect treatment response. Design This was a systematic review and meta-analysis of randomized controlled trials. Setting Following the PRISMA guidelines, PubMed, CINAHL, Cochrane Database, PsycINFO, Embase, and Web of Science databases were systematically searched. Participants People with stroke were studied. Intervention Physical exercise training was the intervention examined in this systematic review. Main outcomes and measures Number of falls/injurious falls/fallers were the outcomes examined. Results Eighteen studies (1536 participants) were included. Overall, physical exercise significantly reduced the number of falls by 39% (incidence rate ratio (IRR = 0.61, 95% CI = [0.47, 0.78]). The effect on the number of injurious falls (IRR = 0.63, 95% CI = [0.37, 1.05]) and fallers (IRR = 0.88; 95% CI = [0.73, 1.0]) was less apparent. Exploratory subgroup analyses revealed that programs focusing on balance training and those integrating physical exercise with cognitive components (eg, dual-task training/mind-body exercise) were most effective, compared with walking training, combined balance/walking training, and strength training. People in the chronic stage of stroke and with mild to moderate disability may benefit more from exercise. Conclusions Physical exercise is effective in improving fall-related outcomes among people with stroke, particularly for people in the chronic stage with mild/moderate disability levels may gain more benefits. Physical exercise programs incorporating balance training and cognitive components may be more effective for fall prevention. Relevance This results of this systematic review provide insight into exercise training for fall prevention in stroke rehabilitation.