Cycling with or without functional electrical stimulation (FES) is an effective way to rehabilitate patients with lower limb disability. The purpose of this systematic review and meta-analysis was to quantify the effectiveness of different protocols of cycling with/without FES on lower limbs after stroke.

The following databases were searched: PubMed, Cochrane Central Register of Controlled Trials, Ovid Medline, EBSCO Cumulative Index of Nursing and Allied Health Literature, Ovid EMBASE, Physiotherapy Evidence Database (PEDro), and Occupational Therapy Systematic Evaluation of Effectiveness, by means of words relevant to randomized and stroke, cycling and lower limbs disability. Randomized-controlled trials from 1990 to July 2017 were included following predetermined search and selection criteria. Data extraction was performed using a predetermined data collection form.

A total of 15 trials satisfied eligibility criteria for this review. Cycling had a positive effect on 6 meter walking test performance [30.4 s; −1.9 to 62.6 (standardized mean difference; 95% confidence interval)] compared with no or placebo intervention (control). Cycling had a positive effect on walking speed (0.10 m/s; 0.1–0.2), based on the results of 10 meter walking test, compared with control. Cycling had a positive effect on balance based on Berg score (0.25; −0.44 to 0.94) compared with control. Cycling with FES had a positive effect on balance (1.95; 1.33–2.52) compared with cycling alone.

Although cycling alone has a positive effect on walking ability, walking speed, and balance the effects are small and variable. In terms of balance, positive effects substantially smaller when compared with concurrent effect of FES with cycling with low evidence. It appears that cycling with or without functional electrical stimulation has positive effects on walking ability walking speed and balance, but further research is needed to confirm the clinical utility of these modalities for stroke patients.