Objectives To systematically evaluate the intervention effects of four different exercise modes including aerobic exercise, resistance exercise, aquatic exercise and traditional fitness exercise on balance function, lower limb motor function and quality of life of stroke patients.

Methods A comprehensive search of publicly available randomized controlled trials of the effects of exercise on stroke patients in databases, such as Cochrane Library, PubMed, Embase, Web of Science, EBSCO, China Citation Database of Biomedical Journals (CMCI) and so on. RevMan 5.3 software and Stata 16.0 software were used to analyze the outcome indicators of the included literatures.

Results A total of 2881 patients were included in 60 articles, including 1458 in the experimental group and 1423 in the control group. Meta-analysis showed that compared with conventional physical therapy, exercises significantly improved Berg Balance Scale (BBS) scores in stroke patients (SMD=0.88, 95%CI: 0.71, 1.04, P<0.05), 6-minute walking distance (6MWT) (SMD=0.39, 95%CI: 0.22, 0.57, P<0.05), timed standing-walking test score (TUGT) (SMD=−0.63, 95%CI: −0.82, −0.44, P<0.05), Fugl-meyer Motor Function Scale (FMA-L) (SMD=0.87, 95%CI: 0.63, 1.10, P<0.05), functional walking rating (FAC) (SMD=0.68, 95%CI: 0.47, 0.90, P<0.05) and quality of life (SMD=0.76, 95%CI: 0.61, 0.90, P<0.05). Four different exercise methods can effectively improve the BBS score, TUGT score, FMA-L score and quality of life score of stroke patients. In addition, aerobic exercise and traditional fitness exercises had a good effect on the improvement of 6MWT. For FAC, the improvement effect of aerobic exercise and resistance exercise was more obvious.

Conclusions Aerobic exercise, resistance exercise, aquatic exercise and traditional fitness exercise have positive significance for the rehabilitation of stroke patients, effectively improve the balance function of patients as well as the lower limb motor function, and improve the quality of life of patients. Furthermore, the improvement effect of aerobic exercise is more comprehensive.