Do Trials of Resistance Training to Improve Mobility After Stroke Adhere to the American College of Sports Medicine Guidelines? A Systematic Review.

OBJECTIVE: To determine whether resistance training to improve mobility outcomes after stroke adheres to the American College of Sports Medicine (ACSM) guidelines, and whether adherence was associated with better outcomes.

DATA SOURCES: Online databases searched from 1975 to October 30, 2016.

STUDY SELECTION: Randomized controlled trials examining the effectiveness of lower limb strength training on mobility outcomes in adult participants with stroke.

DATA EXTRACTION: Two independent reviewers completed data extraction. Quality of trials was determined using the Cochrane Risk of Bias Tool. Trials were scored based on their protocol's adherence to 8 ACSM recommendations. To determine if a relation existed between total adherence score and effect size, Spearman ρ was calculated, and between individual recommendations and effect size, Mann-Whitney U or Kruskal-Wallis tests were used.

DATA SYNTHESIS: Thirty-nine trials met the inclusion criteria, and 34 were scored on their adherence to the guidelines. Adherence was high for frequency of training (100% of studies), but few trials adhered to the guidelines for intensity (32%), specificity (24%), and training pattern (3%). Based on the small number of studies that could be included in pooled analysis (n=12), there was no relation between overall adherence and effect size (Spearman ρ=-.39, P=.21).

CONCLUSIONS: Adherence to the ACSM guidelines for resistance training after stroke varied widely. Future trials should ensure strength training protocols adhere more closely to the guidelines, to ensure their effectiveness in stroke can be accurately determined.