Abstract
Although the benefits of exercise therapy in stroke rehabilitation are well-documented, the optimal amount remains a matter of debate. This study investigated the impact of the total amount of exercise therapy on clinical outcomes in adult patients with stroke. We conducted a comprehensive search of three major international databases (Medline, Embase, and the Cochrane Library) and included 18 randomized controlled trials that compared the effects of different amounts of exercise therapy on activities of daily living, upper limb function, lower limb function, and adverse events in stroke patients. We performed a risk of bias assessment, conducted a meta-analysis using a random-effects model, and evaluated the certainty of the evidence. The results indicated that more time spent in exercise therapy significantly improved activities of daily living compared to less time (standardized mean difference [SMD], 0.18; 95% confidence interval [CI], 0.06, 0.30; p = 0.002), with moderate evidence. Additionally, higher intensity of exercise therapy enhanced lower limb function compared to lower intensity (SMD, 0.66; 95% CI, 0.18, 1.13; p = 0.007), with a low level of evidence. No significant differences were found in the incidence of adverse events. Based on these findings, physicians may consider increasing the total amount of exercise therapy for stroke patients in order to improve their activities of daily living and motor function, while carefully considering each patient's neurological and medical condition.