Combined exercise training to improve gait in older stroke patients: a systematic review and network meta-analysis.

OBJECTIVE

This study aimed to evaluate the effects of different combined exercise modalities on gait function and related outcomes in middle-aged and older adults with stroke using a network meta-analysis.

METHODS

This review was conducted in accordance with PRISMA guidelines and prospectively registered in PROSPERO (CRD42024558927). Five databases (Web of Science, PubMed, Cochrane Library, Embase, and SPORTDiscus) were systematically searched up to April 1 2025. Additional studies published between 2020 and 2024 were identified through manual reference screening. The search strategy incorporated MeSH terms and followed the PICO framework.

RESULTS

The network meta-analysis revealed modality-specific benefits across outcome domains. Electrical nerve stimulation combined with gait training was most effective for improving postural control (SMD = 1.45 [0.21, 2.69]). Integrated aerobic training with motor control training produced the greatest improvements in gait parameters (SMD = 1.66 [0.63, 2.68]). Functional rehabilitation combined with motor control training yielded the best outcomes in functional mobility (SMD = 0.99 [0.57, 1.41]). Functional electrical stimulation combined with motor control training demonstrated the highest efficacy in enhancing standing and walking ability (MD = 6.63 [1.66, 11.60]).

CONCLUSIONS

Combined exercise modalities outperform single modality interventions in improving gait related outcomes in patients with stroke. Tailored exercise prescriptions based on individual characteristics including age, stroke duration, intervention type, and training period are recommended to maximize rehabilitation efficacy.