Exercise intervention improves the modified Barthel index, Berg balance scale, and Fugl-Meyer assessment of upper limb motor function in stroke patients: a systematic review and meta-analysis.

BACKGROUND AND

OBJECTIVE

Exercise is a core approach in stroke rehabilitation, yet updated evidence on its effects on the Berg balance scale (BBS), modified Barthel index (MBI), and Fugl-Meyer assessment of upper extremity motor function (FMA-UE) remains limited. This study systematically evaluated the effects of exercise interventions on these three outcomes.

METHODS

PubMed, Web of Science, Cochrane Library, and China National Knowledge Infrastructure (CNKI) were searched from January 2015 to March 2025 for randomized controlled trials. Meta-analysis was performed using RevMan 5.4, and a meta-regression analysis was performed to explore the dose‒response relationship between exercise dose and improvements in FMA-UE scores. The minimal clinically important difference (MCID) was used to derive an optimal dose threshold.

RESULTS

Nineteen RCTs involving 1,041 participants were included. Exercise significantly improved the MBI (SMD = 0.95, 95% CI: 0.42-1.49), BBS (SMD = 0.73, 95% CI: 0.24-1.22), and FMA-UE (SMD = 0.62, 95% CI: 0.16-1.07) scores. The meta-regression analysis revealed a linear relationship (MD = 1.5252 + 0.0003 × total dose). The optimal dose threshold for achieving an MCID of 5 points was approximately 11,580 min (193 h).

CONCLUSIONS

Exercise improves balance, daily activities, and upper limb function in stroke patients. The proposed "193-hour concept" provides a preliminary cumulative dose target for clinically meaningful upper limb recovery, pending prospective validation. PROSPERO registration: CRD420251272336.