Effects of cardiorespiratory physiotherapy on balance and gait in stroke: a network meta-analysis of randomised controlled trials

To investigate effects of various cardiorespiratory physiotherapy interventions on balance and gait in patients with stroke. This systematic review and network meta-analysis searched PubMed, EMBASE, Cochrane Library, and Web of Science for articles from 2000 to 2023. Twenty-nine RCTs on stroke patients were selected, involving interventions like ground-based aerobic training (GBAT), resistance training (RT), aquatic training (AT), robot-assisted training (RAT), inspiratory training (IT), combined aerobic and resistance training (CART), and combined aerobic and breathing training (CABT). Outcome variables were Berg Balance Scale (BBS), 6-minute walk test (6MWT), and 10-meter walk test (10MWT) scores. The analysis included 29 articles with 1,370 participants. On the BBS, RT was the most effective (99.66%), significantly more than conventional training (CT) (mean, 95% CI: 1.538, 0.771–2.304). For the 6MWT, CABT ranked highest (85.39%), with all interventions except AT showing significant effects compared to no intervention (N). For the 10MWT, GBAT ranked highest (81.71%), with significant effects for N versus GBAT (0.744, 0.308–1.180) and CART (0.732, 0.257–1.207). Comparisons of CT versus CART and N versus IT in the 6MWT had moderate evidence quality. The findings emphasise the importance of incorporating aerobic, strength, and respiratory exercises alongside conventional physical therapy for optimal outcomes. CRD42023387282. Resistance training is recommended over other interventions to improve balance in stroke patients.Interventions including aerobic, strength, and respiratory training are recommended over conventional training or non-interventions to improve gait in stroke patients.Rather than relying on conventional training to improve balance and gait, interventions that focus on cardiopulmonary physiotherapy should be considered. Resistance training is recommended over other interventions to improve balance in stroke patients. Interventions including aerobic, strength, and respiratory training are recommended over conventional training or non-interventions to improve gait in stroke patients. Rather than relying on conventional training to improve balance and gait, interventions that focus on cardiopulmonary physiotherapy should be considered.