Strength Training – Lower Extremity

One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Yang et al., 2006) and one single case study (Sullivan et al., 2006) investigated the effect of lower extremity strength training on biomechanical gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
parameters in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that a progressive task-oriented resistance program for the lower extremity improved gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
cadence and stride length compared to no treatment.

The single case study (Sullivan et al., 2006) found that body-weight supported treadmill walking combined with limb loaded cycling improved hip and knee extension motions throughout stance and swing while walking, however ankle motion showed no noticeable change. As well, a strong correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
was found between gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
improvement and magnitude of paretic leg gluteus maximus and gluteus medius activation during gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
(measured by EMG).

Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that lower extremity strength training is more effective than no treatment in improving gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
cadence and stride length in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. One single case study also found an improvement for hip and knee extension while walking, but no change in ankle motion.

One fair quality RCT (Glasser et al., 1986) investigated the relationship between strength training and functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
(as measured by the Functional AmbulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
Profile) in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. No significant differences were found between a group of patients who received therapeutic exercise combined with isokinetic exerciseExercise performed with a specialized apparatus that provides variable resistance to a movement, so that no matter how much effort is exerted, the movement takes place at a constant speed. Such exercise is used to test and improve muscular strength and endurance, especially after injury.
therapy and a group who received therapeutic exercise alone. However, this study may not have been sufficiently powered to find significant between group differences.

Conclusion: There is limited evidence (level 2a) from one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that strength training is not more effective than therapeutic exercise alone in improving functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Note: The fair quality study may not have been sufficiently powered to find significant between-group differences.

One high quality RCT (Cooke et al., 2010) examined the efficacy of lower extremity strength training for improving temperospatial gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
parameters (as measured by symmetry of step length and step time) in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and found no significant difference at 6 weeks (outcome) or 18 weeks (follow-up) between patients who received physiotherapy and functional strength training using progressive resistive exercise vs. conventional physiotherapy alone.

Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that lower extremity functional strength training is not more effective than conventional physiotherapy alone in improving temperospatial gait parameters in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

One high quality RCT (Mead et al., 2007) studied the effect of lower extremity strength training on walking economy in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Immediately post intervention, there was a significant improvement in walking economy, as measured by oxygen uptake, in favour of the group of patients who received a progressive endurance and resistance training program for the lower extremity, compared to a group of patients who received relaxation training only (control). However, at a 4-month follow-up the difference was no longer significant.

Conclusion: There is moderate (level 1b) evidence from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that lower extremity strength training is more effective than control therapies (e.g. relaxation training) in improving walking economy immediately post intervention, but not at a 4-month follow-up, in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Five high quality RCTs (Moreland et al., 2003, Ouellette et al., 2004, Yang et al., 2006, Sullivan et al., 2007, Lee et al., 2008), two fair quality RCTs (Dean et al., 2000, Bourbonnais et al., 2002) and one single case study (Sullivan et al., 2006) have investigated the effectiveness of lower extremity strength training for improving walking endurance in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Moreland et al., 2003) reported no significant change in walking endurance, as assessed by the 2-minute walk test, following a program of progressive resistance exercises compared to the control group who performed the same exercises without resistance.

The second high quality RCT (Ouellette et al., 2004) found no significant change in walking endurance, as measured by the 6-minute walk test, between a group of patients who received lower-extremity progressive resistance training and a group who received upper extremity stretching (control).

The third high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Yang et al., 2006) found that a task-oriented endurance-resistance program did improve endurance as measured by the 6-minute walk test compared to no treatment.

The fourth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Sullivan et al., 2007) found no significant difference between non-gait-specific strength training of the lower extremity (limb loaded cycling) compared to gait-specific ambulation exercise that had no strength training component (body-weight supported treadmill walking), as measured by the 6-minute walk test.

The fifth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. by Lee et al. (2008) found no improvement on the 6-minute walk test, following progressive resistance training for the lower extremity compared to a sham strength-training program (control).

The first fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Dean et al., 2000), reported significant improvements in walking endurance, as assessed by the 6-minute walk test, following a program focused on strengthening the affected lower limb combined with practicing functional tasks involving the lower limbs, compared to practicing upper limb tasks only (control).

The second fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Bourbonnais et al., 2002), reported significant improvements in walking endurance, as assessed by the 2-minute walk test, in favour of a group of patients who received a force feedback program for the lower paretic limb compared to a group who received a force feedback program for upper paretic limb (control).

A single case study (Sullivan et al., 2006) found that body-weight supported treadmill walking combined with limb loaded cycling improved walking endurance, as measured by the 6-minute walk test, for one patient with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Conclusion: There is conflicting evidence (Level 4) regarding the effectiveness of lower extremity strength training in improving walking endurance in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. While four high quality RCTs found that lower extremity strength training is not more effective than control therapies (e.g. resistance-free exercises, upper extremity stretching program, exercises without strength training component or sham strength-training program) in improving walking endurance in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and two fair quality RCTs found that lower extremity strength training is more effective than control therapies (e.g. no treatment, the practice of upper limb tasks only and a force feedback program for upper paretic limb) in improving walking endurance in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Note: The one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that did find improvements in walking endurance used task-oriented strength training with some components that involved gait-related strength training movements (i.e. stepping exercises). Furthermore, one single case study found improvements in walking endurance for non-gait-specific strength training (limb loaded cycling) combined with gait-specific training that had no strength component (body-weight supported treadmill walking).

Seven high quality RCTs (Cooke et al., 2010, Kim et al., 2001, Lee et al., 2008, Mead et al., 2007, Ouellette et al., 2004, Sullivan et al., 2007, Yang et al., 2006), three fair quality RCTs (Bourbonnais et al., 2002, Dean et al., 2000, Teixeria-Salmela et al., 1999), two pre-post studies (Sharp & Brouwer, 1997, Cramp et al., 2006) and one single case study (Sullivan et al., 2006) have investigated the efficacy of lower extremity strength training for improving walking speed in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Cooke et al., 2010) reported no significant difference in walking speed (as measured by the 10 minute walking test or VICON movement analysis system) or community mobility (as measured by walking speed of 0.8m/sec) at 6 weeks (outcome) or 18 weeks (follow-up) between patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. who received physiotherapy and functional strength training using progressive resistive exercise vs. conventional physiotherapy alone.

The second high quality RCT (Kim et al., 2001) found no difference in habitual walking speed between a group of patients who received maximal isokinetic strength training compared to a group who received a program of passive range of motion exercises (control).

The third high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Lee et al., 2008) found no difference in maximal or habitual walking speed following progressive resistance training for the lower extremity compared to a sham strength-training program.

The fourth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Mead et al., 2007) found no difference in habitual walking speed between a group of patients who received a progressive endurance and resistance training program for the lower extremity compared to the control group who received a relaxation program only.

The fifth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Ouellette et al., 2004) found no difference in self-selected and maximal walking speed (as measured by maximal gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
velocities) between a group of patients who received lower-extremity progressive resistance training and a group who received upper extremity stretching (control).

Interestingly, the sixth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Sullivan et al., 2007) found that non-gait-specific strength training of the lower extremity (resistance cycling) was less effective for improving self-selected walking speed than ambulation exercise that had little or no strength training component (body-weight supported treadmill walking), and that when strength training of the lower-extremity was added to the gait-oriented training, there was no additional benefit.

The seventh high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Yang et al., 2006) found that a task-oriented endurance-resistance program for the lower extremity did improve habitual walking speed compared to no treatment (control).

The first fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Bourbonnais et al., 2002) reported a significant improvement in habitual walking speed in favour of a group of patients who received a force feedback program of the lower paretic limb compared to a group who received a force feedback program of the upper paretic limb (control).

The second fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Dean et al., 2000) found significant improvements in self-selected walking speed following a program focused on strengthening the affected lower limb combined with practicing functional tasks involving the lower limbs, compared to practicing upper limb tasks only (control).

The third fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Teixeria-Salmela et al., 1999) found an improvement in habitual walking speed following an aerobic-strength training program compared to no training.

The first pre-post study (Sharp & Brouwer, 1997) found a significant within-group improvement in habitual walking speed for a group of patients who received an isokinetic exerciseExercise performed with a specialized apparatus that provides variable resistance to a movement, so that no matter how much effort is exerted, the movement takes place at a constant speed. Such exercise is used to test and improve muscular strength and endurance, especially after injury.
program consisting of knee extension and flexion.

The second pre-post study (Cramp et al., 2006) found a significant within-group improvement in habitual walking speed for patients who received a low intensity progressive strength program.

A single case study (Sullivan et al., 2006) found that body-weight supported treadmill walking combined with limb loaded cycling improved habitual walking speed for one patient with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Conclusion: There is conflicting evidence (level 4) regarding the effectiveness of lower limb strength training in improving walking speed in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Six high quality RCTs report that lower limb strength training (conducted during functional strength training, maximal isokinetic strength training, progressive endurance and/or resistance training programs, resistance cycling, gait-oriented training or body-weight supported treadmill training) is not more effective than control therapies (e.g. conventional physiotherapy, passive range of motion exercises, sham strength-training programs, relaxation programs or upper extremity stretching) in improving self-selected, maximal or habitual walking speed in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. However, one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and three fair quality RCTs found that lower limb strength training (conducted during aerobic strength training programs or force-feedback programs) was more effective than control therapy (e.g. upper limb programs) or no therapy in improving habitual or self-selected walking speed. Furthermore, two pre-post studies and one case study also reported improved habitual walking speed following lower extremity strength training programs.
Note: Programs that were successful in improving ambulation skills often included elements such as gait-related training tasks.

Three high quality RCTs (Mead et al., 2007, Lee et al., 2008, Cooke et al., 2010) investigated the effects of strength training on self-reported functional mobility in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Mead et al., 2007) found no significant between-group differences in self-reported functional mobility, as measured by the Rivermead Mobility Index, between a group of patients who received a progressive task-oriented resistance program for the lower extremity compared to the control group who received a relaxation program.

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Lee et al. (2008), found no improvement in perceived self-efficacy in functional mobility (measured by the Ewart Self-Efficacy Scales for stair climbing and walking) following a progressive strength-training program, compared to a sham strength-training program.

The third high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Cooke et al., 2010) found no significant differences in functional mobility (as measured by the Rivermead Mobility Index) at 6 weeks (outcome) or 18 weeks (follow-up) between patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. who received physiotherapy and functional strength training using progressive resistive exercise vs. conventional physiotherapy alone.

Conclusion: There is strong evidence (level 1a) from three high quality RCTs that lower extremity strength training is not more effective than other control treatments (e.g. relaxation program, sham strength-training or conventional physiotherapy) for improving self-reported measures of functional mobility in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Two high quality RCTs (Yang et al., 2006, Mead et al., 2007), one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Bourbonnais et al., 2002) and one pre-post study (Sharp & Brouwer, 1997) investigated the effect of lower extremity strength training on ability to transition from sitting to ambulating in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCT (Yang et al., 2006) found a significant between-group difference in transition from sitting to ambulating (as measured by the Timed Up and Go test) immediately post treatment in favour of a group of patients who received an endurance-resistance program compared to a group that received no treatment (control).

The second high quality RCT (Mead et al., 2007) also found a significant between-group difference in transition from sitting to ambulating (as measure by the Timed Up and Go test) immediately post treatment for participants who received a progressive task-oriented resistance program for the lower extremity compared to the control group who received a relaxation program (control), however the difference was no longer significant at a 4-month follow up.

The fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Bourbonnais et al., 2002) found no significant difference for the Timed Up and Go test between a group of patients who received a force feedback program of the lower paretic limb compared to a group who received a force feedback program for the upper paretic limb (control).

The pre-post study (Sharp & Brouwer, 1997) found no improvement in transition from sitting to ambulating (as measured by the Timed Up and Go) following an isokinetic exerciseExercise performed with a specialized apparatus that provides variable resistance to a movement, so that no matter how much effort is exerted, the movement takes place at a constant speed. Such exercise is used to test and improve muscular strength and endurance, especially after injury.
program consisting of knee extension and flexion.

Conclusion: There is strong evidence (level 1a) from two high quality RCTs that lower extremity strength training is more effective than control therapies (e.g. no treatment, relaxation) in improving the time it takes to transition from sitting to ambulating in patients post stroke. However, one fairquality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and one pre-post study found no improvement following a strength training program.

One fair quality RCT (Dean et al., 2000 ) investigated the effect of lower extremity strength training on force production during sit-to-stand in patients with stroke. This fair quality RCT found a significant increase in force production through the affected leg during sit-to-stand, following a program focused on strengthening the affected lower limb combined with practicing functional tasks involving the lower limbs compared to a program of upper limb tasks only (control).

Conclusion: There is limited evidence (level 2a) from one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that lower extremity strength training is more effective than upper limb exercises in improving force production during sit-to-stand in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Two high quality RCTs (Ouellette et al., 2004, Mead et al., 2007) investigated the effect of lower extremity strength training on the time it takes to transition from sitting to standing in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Ouellette et al., 2004) found no significant difference in ‘repeated chair rise time’ between a group of patients who received lower extremity progressive resistance training compared to a group who received upper extremity stretching (control).

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Mead et al., 2007) found no significant differences immediately post-intervention (3 months) or at follow-up (4 months) for ‘timed sit to stand’ between a group of participants who received a progressive endurance and resistance training program (that involved a sit-to-stand strength exercise) for the lower extremity, and the control group who received a relaxation program.

Conclusion: There is strong evidence (level 1a) from two high quality RCTs that lower extremity strength training is not more effective than control therapies (e.g. upper extremity stretching or relaxation program) in improving the time it takes to transition from sitting to standing in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Three high quality RCTs (Kim et al., 2001, Ouellette et al., 2004, Lee et al., 2008), one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Teixeria-Salmela et al., 1999) and one pre-post study (Sharp & Brouwer, 1997) studied the effect of lower extremity strength training on stair climbing in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCT (Kim et al., 2001) found that maximal isokinetic strength training did not improve stair climbing speed compared to a program of passive range of motion exercises (control).

The second high quality RCT (Ouellette et al., 2004) found no significant difference for stair climbing speed between a group of patients who received lower-extremity progressive resistance training and a group who received upper extremity stretching (control).

The third high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Lee et al., 2008) found a significant improvement in stair climbing power following progressive resistance training for the lower extremity compared to a sham strength-training program.

The one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. by Teixeria-Salmela et al. (1999) found an improvement in stair climbing following a strength training program compared to no training.

The pre-post study (Sharp & Brouwer, 1997) found no improvement in stair climbing following an isokinetic exerciseExercise performed with a specialized apparatus that provides variable resistance to a movement, so that no matter how much effort is exerted, the movement takes place at a constant speed. Such exercise is used to test and improve muscular strength and endurance, especially after injury.
program consisting of knee extension and flexion.

Conclusion: There is conflicting evidence (Level 4) regarding the effectiveness of lower extremity strength training in improving parameters of stair climbing in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. While two high quality RCTs and one pre-post study found that lower extremity strength training is not more effective than control therapies (e.g. passive range of motion exercises or upper extremity stretching program) in improving stair climbing in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. reported an improvement in stair climbing power and one fair quality RCTs reported an improvement in rate of stair climbing following strength training.

One high quality RCT (Mead et al., 2007) and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Inaba et al., 1973) examined the ability to resume activities of daily living (ADL)Basic tasks that involve bodily issues (bathing, dressing, toileting, transferring, continence, eating and walking) that are done on a daily basis. following strength training in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The high quality RCT (Mead et al., 2007) found that lower-extremity strength training does not improve the ability to perform ADLs, as measured by the Nottingham Extended ADL Scale, for a group of patients who received an endurance-resistance training program compared to a group of patients who received relaxation training (control).

The fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Inaba et al. 1973) found that patients who received progressive resistance training combined with selective stretching significantly improved their ability to perform ADL tasks, as measured by 8 items representing functional ability, compared to a group of patients who received functional training and selective stretching only (control) and a group of patients who received active exercises combined with functional training and selective stretching.

Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that strength training is not more effective than control therapies (e.g. relaxation training) in improving performance of ADLs in patients with stroke. However, one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that a progressive resistance program may be effective in improving ADL performance in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

One high quality RCT (Lee et al., 2008) found that strength training had no effect on peak VO2Blood oxygen level.
or peak heart rate in patients with stroke following progressive strength training, compared to sham strength training.

Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that lower extremity strength training is not more effective than sham treatment in improving aerobic capacity in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

One high quality RCT (Mead et al., 2007) studied the effects of lower extremity strength training on anxiety and depression in patients with stroke. The study found no significant differences for anxiety and depressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
as measured by the Hospital Anxiety And DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
Scale between a group of patients who received an endurance-resistance training program and a group of patients who received relaxation training (control).

Conclusion: There is moderate (level 1b) evidence from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that lower extremity strength training is not more effective than control treatments (e.g. relaxation training) in improving depressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
and anxiety in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Two high quality RCTs (Yang et al., 2006, Mead et al., 2007), one fair quality RCT (Dean et al., 2000), one fair quality randomized crossover study (Page et al., 2008), one pre-post study (Weiss et al., 2000) and one single case study (Sullivan et al., 2006) studied the effect of lower extremity strength training on balance in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Yang et al., 2006) found no significant difference in balance (as measured by a step test) between a group of patients who received a progressive task-oriented resistance program for the lower extremity and a group that received no treatment (control).

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Mead et al., 2007) found no significant difference in balance (as measured by the Functional Reach Test) between a group of patients who received an endurance-resistance training program and a group of patients who received relaxation training (control).

The one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Dean et al., 2000) found an improvement on the step test following a program focused on strengthening the affected lower limb combined with practicing functional tasks involving the lower limbs (including stepping exercises), compared to practicing upper limb tasks only.

The one fair quality randomized crossover study (Page et al., 2008) found a marked pre-post improvement in balance (as measured by the Berg Balance Scale), following resistance-based locomotive training. In contrast, following a home exercise program that had no strength-training component, there was no improvement on the Berg Balance Scale. No statistical analysis was done between groups for this measure.

The pre-post study (Weiss et al., 2000) found that lower extremity strength gains from a resistance program were correlated with increases in balance as measured by the Berg Balance Scale.

The single subject study (Sullivan et al., 2006) found lower extremity strength training had no effect on balance as measured by the Berg Balance Scale.

Conclusion: There is strong evidence (level 1a) from two high quality RCTs and one single subject study that strength training is not more effective than control therapies (e.g. no treatment or relaxation training) in improving balance in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. However, one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and one fair quality crossover study (without between-group analysis) reported an improvement in balance following a strength-training program, and one pre-post study suggests that lower limb strength improvement is associated with balance improvement.

One high quality RCT (Mead et al., 2007) investigated the effects of strength training on functional independence (as measured by the Functional Independence Measure) in patients with stroke. The study found no significant difference between a group of patients who received an endurance-resistance training program as compared to a group of patients who received relaxation training (control).

Conclusion: There is moderate (level 1b) evidence from one high quality study that lower extremity strength training is not more effective than control therapies (e.g. relaxation training) in improving functional independence in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Five high quality RCTs (Cooke et al., 2010, Ouellette et al., 2004, Yang et al., 2006, Mead et al., 2007, Lee et al., 2008,), three fair quality RCTs (Inaba et al., 1973, Teixeria-Salmela et al., 1999, Bourbonnais et al., 2002) and three pre-post studies (Sharp & Brouwer, 1997, Badics et al., 2002, Cramp et al., 2006) examined the effect of strength training on lower extremity strength in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Cooke et al., 2010) found no significant difference in knee flexion or knee extension peak torque (as measured by an isokinetic dynamometer) at 6 weeks (outcome) or 18 weeks (follow-up) between patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. who received physiotherapy and functional strength training using progressive resistive exercise vs. conventional physiotherapy alone.

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Ouellette et al., 2004) found a significant improvement in lower extremity strength, as measured by leg press strength and knee extension strength, in favour of a group of patients who received lower-extremity progressive resistance training program compared to a group who received upper extremity stretching (control).

The third high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Yang et al., 2006) found a significant between-group difference in leg strength as measured by a hand-held dynamometer in favour of a group of patients who received a progressive task-oriented resistance program for the lower extremity compared to no treatment (control).

The fourth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Mead et al., 2007) found no significant improvement in lower extremity strength as measured by leg extensor power between a group of patients who received an endurance-resistance training program compared to a group of patients who received relaxation training (control).

The fifth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Lee et al., 2008) found an improvement in peak power output on a cycle ergometer, as well as lower extremity strength (1 rep max, power and endurance tests) in both legs following progressive strength training compared to sham strength training (control).

The first fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Inaba et al., 1973) found a significant improvement in lower extremity strength in favour of a group of patients who received progressive resistance training combined with selective stretching compared to a group who received functional training combined with selective stretching (control) and a group who received active exercises combined with selective stretching.

The second fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Teixeria-Salmela et al., 1999) also found a significant improvement in lower extremity strength following a lower limb-training program compared to no intervention.

The third fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Bourbonnais et al., 2002) found a significant improvement in lower extremity strength following a force feedback program for the lower paretic limb compared to a force feedback program for upper paretic limb.

The first pre-post study (Sharp & Brouwer, 1997) found a significant improvement in paretic muscle strength following an isokinetic exerciseExercise performed with a specialized apparatus that provides variable resistance to a movement, so that no matter how much effort is exerted, the movement takes place at a constant speed. Such exercise is used to test and improve muscular strength and endurance, especially after injury.
program consisting of knee extension and flexion.

The second pre-post study (Badics et al., 2002) found a significant within group increase in leg extensor and supporting strength of the legs following a strength-training program aimed at restoring the extensor strength of the legs and the supporting strength of the arms.

The third pre-post study (Cramp et al., 2006) found a significant within-group improvement in isometric and concentric strength of knee extensor muscles in patients who received a low intensity progressive strength program. However, no improvement in knee flexor muscle strength was found.

Conclusion: There is conflicting evidence (level 4) as to whether lower extremity strength training is more effective than various control treatments (e.g. relaxation, upper extremity programs, no treatment, sham strength training and conventional physiotherapy) in improving lower extremity strength in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. While three high quality RCTs, three fairquality RCTs and three pre-post studies found an improvement in lower extremity strength following lower extremity strength training, two high quality RCTs did not find an improvement.
Note: The studies used different methods for evaluating strength.

Two high quality RCTs (Moreland et al., 2003, Ouellette et al., 2004), one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Bourbonnais et al., 2002), one fair quality randomized crossover study (Page et al., 2008), two pre-post studies (Nugent et al., 1994, Weiss et al., 2000) and one single case study (Sullivan et al., 2006) have investigated the effectiveness of strength-training interventions for the improvement of motor function in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Moreland et al., 2003) found no significant differences in motor function between patients who received strength training and patients who received conventional therapy (control), as assessed using the disability inventory of the Chedoke-McMaster Scale Assessment (CMSA).

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Ouellette et al., 2004) found a significant difference in motor function (as measured by self-reported changes in function and disability using the Late Life Function and Disability Instrument) in favour of patients who received a lower-extremity progressive resistance training program as compared to patients who received an upper extremity stretching program (control).

The one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Bourbonnais et al., 2002) found no significant difference in motor function (as measured by the lower extremity section of the Fugl-Meyer Assessment) between a group of patients who received lower extremity strength training and a group of patients who received upper-extremity strength training.

The one fair quality randomized crossover study (Page et al., 2008) found a marked pre-post improvement in motor function (as measured by lower extremity section of the Fugl-Meyer Assessment), following resistance-based locomotive training . In contrast, following a home exercise program that had no strength training component, there was only a negligible improvement on the lower extremity section of the FMA. No statistical analysis was done between groups.

Two pre-post studies used the Motor Assessment Scale (MAS) as a primary outcome measure to explore the relationship between strength-training interventions and motor function. Nugent et al. (1994) reported a significant improvement in MAS score following a set regimen of weight bearing leg extensor exercise (WBE). Similarly, Weiss et al. (2000) noted significant improvements in MAS scores following a 12-week program of resistance training.

The single case study by Sullivan et al. (2006) found an improvement in motor ability as measured by the lower extremity section of the Fugl-Meyer Assessment immediately post intervention, however this difference was no longer notable 6 months after baseline.

Conclusion: There is conflicting evidence (level 4) as to whether strength training improves motor function in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. While one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness., one fair quality crossover (without between-group analysis) and two pre-post studies reported improved motor function, another high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that strength training was not more effective than control therapies (e.g. conventional therapy, upper extremity strength training) in improving motor function in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Further, while the single case study found an improvement immediately post intervention, the improvement was no longer notable 6 months post intervention.
Note: Because of the variations in the intervention times and exercise programs, future studies are warranted to better understand the effect of the different strength training regiments on motor function. It should also be noted that all studies used different functional assessments.

One fair quality RCT (Teixeria-Salmela et al., 1999) examined the use of strength training to improve physical activity (as measured by the Human Activity Profile and the Adjusted Activity Scale) in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Significant improvements were found for those who had received the intervention compared to those who had not received strength training.

Conclusion: There is limited (level 2a) evidence from one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that strength training interventions may be effective in increasing physical activity in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Four high quality RCTs (Cooke et al., 2010, Kim et al., 2001, Mead et al., 2007, Lee et al., 2008, ) and one single case study (Sullivan et al., 2006) investigated the effects of lower extremity strength training on quality of life in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Cooke et al., 2010) found no significant difference in health status or health-related quality of life (as measured by the EuroQuoL) at 6 weeks (outcome) or 18 weeks (follow-up) between patients with subacute stroke who received physiotherapy and functional strength training using progressive resistive exercise vs. conventional physiotherapy alone.

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Kim et al., 2001) found no improvement on the mental or physical health items of the Medical Outcomes Short Form-36 (SF-36) for patients who received a maximal isokinetic strengthening program compared to patients who received a passive range of motion intervention (control).

The third high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Mead et al., 2007) found that lower extremity strength training significantly improved the role-physical items of the SF-36 for patients who received an endurance-resistance training program compared to a group of patients who received relaxation training (control). However, no significant between-group difference was found for the physical functioning, general health, vitality and mental health items of the SF-36.

The fourth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Lee et al., 2008) found no improvement in quality of life, as measured by the SF-36, following a progressive strength training of the lower extremities compared to a sham strength training program.

The single case study (Sullivan et al., 2006) found that a patient who received lower extremity strength training improved on the strength, mobility, emotion, and social participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. sub-scales of the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Impact Scale (SIS), however no improvement was found for the hand function, activities of daily living (ADL)Basic tasks that involve bodily issues (bathing, dressing, toileting, transferring, continence, eating and walking) that are done on a daily basis., communication, memory and thinking subscales of the SIS.

Conclusion: There is strong evidence (level 1a) from three high quality RCTs that lower extremity strength training is not more effective than a variety of control treatments (e.g. conventional physiotherapy, passive ROM, or sham strength training) in improving quality of life in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Note: However, one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found a significant difference in the role-physical items of the Medical Outcomes Short Form-36 (SF-36), in favour of patients who received the lower extremity strength training program as compared to the control group who received relaxation training. As well, one single case study found an improvement in some aspects of quality of life following strength training post-stroke.

One high quality RCT (Moreland et al., 2003), two fair quality RCTs (Teixeria-Salmela et al., 1999, Bourbonnais et al., 2002) and three pre-post studies (Sharp & Brouwer, 1997, Badics et al., 2002, Cramp et al., 2006) examined the effect of strength training on spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The one high quality RCT (Moreland et al (2003), found no change in spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
(as measured by the Ashworth Scale) following progressive resistance exercises compared to the control group who performed the same exercises without resistance.

The first fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Teixeria-Salmela et al., 1999) found no change in spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
, as measured by the pendulum testThis is a test for spasticity. The patient sits on a table and the examiner holds the patient’s foot with the knee as fully extended as possible. The examiner drops the leg, and a computer records the motion and vibration.
for the knee and controlled resistance to passive stretch for the ankle, following a lower limb training program compared to no intervention. However this study may not have been sufficiently powered to find significant results.

The second fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Bourbonnais et al., 2002) found no change in spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
(no measure specified) following a force feedback program for the lower paretic limb compared to a force feedback program for the upper paretic limb.

The first pre-post study (Sharp & Brouwer, 1997) found no change in spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
, as measured by the pendulum test, following an isokinetic exerciseExercise performed with a specialized apparatus that provides variable resistance to a movement, so that no matter how much effort is exerted, the movement takes place at a constant speed. Such exercise is used to test and improve muscular strength and endurance, especially after injury.
program consisting of knee extension and flexion.

The second pre-post study (Badics et al., 2002) found no change in spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
, as measured by the Ashworth scale, following an exercise program aimed at restoring the extensor strength of the legs and the supporting strength of the arms, possibly due to an unusually high level of spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
at baseline.

The third pre-post study (Cramp et al., 2006) found no change in lower extremity spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
, as measured by the Ashworth scale, in patients who received a low intensity progressive strength program.

Conclusion: There is moderate evidence (level 1b) from one high quality RCT, two fair quality RCTs and three pre-post studies that lower extremity strength training is not more effective than control therapies in improving lower extremity spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..