Effects of exercise-based interventions on balance and functional mobility in adults with chronic stroke: a systematic review and meta-analysis

ObjectiveTo systematically evaluate, using the GRADE framework, the effects of exercise-based interventions on Berg Balance Scale, Timed Up and Go, and Functional Reach Test outcomes in adults with chronic stroke.MethodsWe systematically searched PubMed, Embase, Web of Science, Scopus, and the Physiotherapy Evidence Database from inception to 29 June 2025 for randomized controlled trials investigating structured exercise-based interventions in adults with chronic stroke. Eligible studies enrolled adults at least 6 months after stroke onset and reported at least one validated balance or functional mobility outcome. Methodological quality was assessed using the Physiotherapy Evidence Database scale, and the certainty of evidence was rated using the GRADE approach. Meta-analyses were performed using random-effects models and expressed as mean differences (MDs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs); exploratory univariable random-effects meta-regression was used to examine intervention duration and training frequency.ResultsSixty-nine randomized controlled trials involving 2,314 adults with chronic stroke were included. Exercise-based interventions improved Berg Balance Scale scores [MD = 2.54, 95% CI (1.83–3.26)], reduced Timed Up and Go test completion time [MD = −2.68 s, 95% CI (−3.72 to −1.65)], and improved Functional Reach Test performance [SMD = 0.65, 95% CI (0.25–1.05)]. The certainty of evidence was moderate for BBS, high for TUG, and moderate for FRT, with the degree of heterogeneity differing across outcomes.ConclusionExercise-based interventions were associated with improvements in BBS scores, TUG performance, and FRT outcomes in adults with chronic stroke, although the certainty and consistency of evidence varied across these measures. These findings support the potential role of exercise-based interventions in improving these selected outcomes. Larger pragmatic trials with standardized intervention reporting and longer follow-up are needed to clarify optimal training components, dose, delivery, and durability of effects.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42020156992, identifier CRD42020156992