Shin 2011.

Study characteristics
Methods	Study design: RCT Method of randomisation: "subjects were randomly allocated to one of into two groups"
Participants	Number of participants: n = 21 Inclusion criteria: "Subjects who were between 6 months and 5 years since diagnosis of stroke, subjects with hemiplegia of the lower extremities" Exclusion criteria: "subjects who could not ride a bicycle or perform functional exercise due to arthritis, low‐back pain, or degenerative joint disease; subjects who were receiving medical treatment due to other symptoms; and subjects who could not follow the instructions due to low perceptive abilities, cognitive disorder, or communication disorder"
Interventions	(1) Combined exercise training group (n = 11) "Exercise combined with aerobic and functional strengthening exercises for balance" "The first exercise was 30 min of functional strength training, consisting of six sub‐categories: bridge exercise, lifting toes, and ankles, sitting and standing, stretching out the arms while standing, step exercise, and stairs exercise. Bridge exercise is lifting pelvis using the legs, from bending hips and knees with supine. Lifting toes and ankles is dorsiflexion and plantar flexion of the hemiplegic leg in the sitting position. Sitting and standing is standing from sitting and sitting again until the hip touches chair. Stretching out the arms while standing is stretching out the arms upward, downward, right‐side, left‐side and diagonally. Step exercise is shifting of weight bearing to a leg on a step. The hemiplegic leg and non‐hemiplegic leg are placed in turn on the step and the location of step alternates from the front to one side of the subject. Stairs exercise is walking up stairs with the hemiplegic leg supporting the body weight and walking down stairs with the non‐hemiplegic leg support body weight. Before exercise, 5 minutes warming‐up exercise of breathing exercise and stretching were conducted. Each exercise was repeated at medium intensity without fatigue ten to fifteen times. The second exercise for the combined exercise training group was aerobic exercise. Treadmill walking and riding a bicycle were conducted for fifteen minutes each. Treadmill walking started at 0.5 m/s and the initial 5 minutes was on adaption period. In the next 10 minutes walking velocity increased or walking was done with less support from the hand‐rail. A stationary bicycle was used for the bicycle riding exercise. At the beginning a patient started with a velocity which he/she could feel comfortable with. As time went by the velocity was increased. The intensity of the two aerobic exercises was determined by checking the heart rate" The individual components delivered are listed in Table 6. Based on the individual components, this intervention is categorised as comprising cardiopulmonary intervention, functional task training and musculoskeletal intervention (active) Length of intervention period: four weeks Number of sessions and length of individual sessions: 60 minutes per day, five times a week Intervention provider: physical therapist ("aerobic exercise was conducted with the assistance of a caregiver or family member under the supervision of a physical therapist") (2) Conventional exercise group (n = 10) "Special instructions were not given to the physical therapist in charge, and the conventional training was done as usual. The therapist focused on re‐educating normal movement during functional activities that were meaningful to the patients. Training was composed of balance exercise, posture control exercise, and gait exercise. Keeping normal movement of the pelvis for balance and posture control was emphasized. The therapist judged that working on increasing anterior and posterior pelvic tilt would improve weight transfer and hip extension during gait, leading to improvements in selective distal control of the knee and the foot. Trunk control and alignment can affect muscle tone, range of motion, and control of the limb. For the upper limbs, treatment was conducted focusing on movement of the scapular. For balance exercise, weight transfer exercise and reaching exercise were alternately performed on the affected side and the unaffected side in the sitting or standing position. Bridging exercise was performed to strengthen the trunk muscles. Selective movement of each joint of the shoulder, elbow, knee and ankle joint was performed to facilitate upper and lower limb movement. For gait exercise, training in weight transfer during gait was conducted by planting the unaffected side foot at the front and back of the body. Gait training was divided between the stance phase and the swing phase, and exercises for each phase were performed. In addition, stair climbing practice and gait training for crossing obstacles were conducted. Patients did not do the same exercise every training day but suitable exercises were selected according to the goals of each patient and the therapist. The intensity of each exercise was decided by the therapist considering each patient’s capacity for exercise" The individual components delivered are listed in Table 6. Based on the individual components, this intervention is categorised as comprising functional task training, musculoskeletal intervention (active) and neurophysiological intervention Length of intervention period: four weeks Number of sessions and length of individual sessions: 60 minutes per day, five times a week Intervention provider: physical therapist This study is classified as active intervention one (functional task training, musculoskeletal (active)) versus active intervention two (functional task training, musculoskeletal (active), neurophysiological) (Table 9). Active intervention group one also received cardiopulmonary intervention
Outcomes	Measures of postural control and balance: Berg Balance Scale (dynamic balance), force platform (static balance) Time points when outcomes were assessed: "start of the intervention..and after completion of the 4‐week intervention"
Notes	Note: The conventional exercise group was categorised as comprising 'neurophysiological' components, as a description of facilitation of 'normal movement' was provided. However, this was referenced to Bobath/Davies
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	"subjects were randomly allocated to one of two groups"
Allocation concealment (selection bias)	Unclear risk	No information provided
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	No information provided
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	No dropouts described
Free of systematic differences in baseline characteristics of groups compared?	Low risk	"the pre‐intervention dynamic balance of the two groups was not significantly different"
Did authors adjust for baseline differences in their analyses?	Low risk	No information provided
Other bias	Unclear risk	No information provided