Optimal exercise modalities for enhancing motor function recovery after stroke: a Bayesian systematic review with pairwise and network meta-analyses.

Background: This study aimed to compare the effectiveness of different exercise interventions in improving motor function recovery after stroke and to identify optimal rehabilitation strategies. Methods: A comprehensive search of five databases was conducted for randomized controlled trials (RCTs) up to March 13, 2025. Primary outcomes included the 6-min walk test (6MWT), 10-m walk test (10MWT), Berg Balance Scale (BBS), and FMA (total, UE, LE). Pairwise and Bayesian network meta-analyses were performed to compare the relative effects of different exercise modalities. Risk of bias was assessed using the RoB 2 tool, and evidence certainty was rated using CINeMA. This systematic review was prospectively registered in PROSPERO (CRD420251091242). Findings: A total of 317 RCTs involving 14,464 stroke patients were included. Network meta-analysis showed that, compared with routine care, electrical stimulation plus exercise (ESX) was associated with the largest improvement in walking endurance (MD = 53.4 m, 95% CI 14.27-92.58, p < 0.05, I Interpretation: Several structured exercise interventions were associated with improved motor outcomes after stroke. High heterogeneity was observed in some comparisons; however, meta-regression analyses suggested several potential sources of variability, and global network assessments indicated generally acceptable heterogeneity. These findings should therefore be interpreted cautiously, particularly for outcomes with substantial between-study variation. Funding: This study received no specific funding.