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.