title: Strengthening to promote functional recovery poststroke: an evidence-based review.
abstract: BACKGROUND
  Following stroke, patients/clients suffer from significant impairments. However, weakness is the predominant common denominator. Historically, strengthening or high-intensity resistance training has been excluded from neurorehabilitation programs because of the concern that high-exertion activity, including strengthening, would increase spasticity. Contemporary research studies challenge this premise.
  
  
  METHODS
  This evidence-based review was conducted to determine whether high-intensity resistance training counteracts weakness without increasing spasticity in persons poststroke and whether resistance training is effective in improving functional outcome compared to traditional rehabilitation intervention programs. The studies selected were graded as to the strength of the recommendations and the levels of evidence. The treatment effects including control event rate (CER), experimental event rate (EER), absolute risk reduction (ARR), number needed to treat (NNT), relative benefit increase (RBI), absolute benefit increase (ABI), and relative risk (RR) were calculated when sufficient data were present.
  
  
  RESULTS
  A total of 11 studies met the criteria. The levels of evidence ranged from fair to strong (3B to 1B).
  
  
  CONCLUSIONS
  Despite limited long-term follow-up data, there is evidence that resistance training produces increased strength, gait speed, and functional outcomes and improved quality of life without exacerbation of spasticity.
authors.affiliation: John Muir Rehabilitation Center, Walnut Creek, CA, USA.
authors.forename: Sang
authors.initials: S
authors.lastname: Pak
authors.forename: Carolynn
authors.initials: C
authors.lastname: Patten
mesh_terms: D019317:Evidence-Based Medicine; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation