Effect of Eccentric Versus Concentric Strengthening on Functional Mobility in Subacute Stroke Patients: A Randomized Parallel-Group Comparative Study

Abstract

Background: Stroke is the foremost cause of acquired neurological disability globally. Lower
limb hemiparesis during the subacute phase (1-6 months post-onset) is the primary barrier to
functional independence. Eccentric and concentric strengthening differ substantially in
neuromuscular and metabolic profiles, comparative evidence in subacute stroke rehabilitation
is scarce.
Objective: To compare the effects of eccentric versus concentric lower limb strengthening on
functional mobility in subacute stroke patients using the Timed Up and Go (TUG) test and 2-
Minute Walk Test (2MWT).
Design: Randomised, single-blind, parallel-group comparative interventional study.
Setting: Department of Physiotherapy, Yenepoya Ayurveda Medical College and Hospital,
Mangaluru, India.
Participants: Thirty-four subacute stroke patients (aged 40-75 years, Modified Rankin Scale
2-3, Modified Ashworth Scale ≤2, Brunnstrom Stage 3–5, MoCA >24) allocated by block
randomisation: Group A (eccentric strengthening + general neurophysiotherapy, n = 17) and
Group B (concentric strengthening + general neurophysiotherapy, n = 17).
Intervention: Eight sessions over four weeks (two sessions/week, 45 min/session: 25 min
strengthening + 20 min neurophysiotherapy). Both protocols employed weight-cuff resistance
targeting five lower limb muscle groups with biweekly progression.
Main Outcome Measures: TUG (seconds) and 2MWT (metres), assessed pre and post-
intervention by a blinded assessor.
Results: Both groups demonstrated statistically significant within-group improvements (all
p < 0.001). Group A achieved a mean TUG reduction of 8.88 s versus 4.65 s in Group B
(Mann-Whitney U, p < 0.001, r = 0.870). Mean 2MWT improvement was 37.88 m (Group A)
versus 17.82 m (Group B) (t = 22.191, p < 0.001, Cohen's d = 7.612). Between-group
differences were statistically significant with very large effect sizes.
Conclusion: Eccentric strengthening produces statistically and clinically superior
improvements in functional mobility compared with concentric strengthening in subacute
stroke patients and may be considered a first-line strengthening strategy where patient
tolerance permits.