BACKGROUND: Chronic stroke patients often experience muscle weakness, reduced mobility, and impaired physical function. Eccentric contraction-based resistance exercise has been proposed as an effective intervention to improve neuromuscular function and mobility; however, its effects remain unclear. This study compared the effects of eccentric overload resistance training using a flywheel device and traditional resistance training on physical performance and muscle strength in chronic stroke patients. METHODS: This 8-week, randomized controlled trial included chronic stroke patients who were assigned to either an intervention group (INT; eccentric flywheel-based resistance exercise) or a control group (CON; conventional resistance training). Physical function was assessed based on the timed up-and-go test, 6-minute walk test, 5-times sit-to-stand test, gait speed, and isokinetic muscle strength before and after the intervention. RESULTS: Of the 40 participants enrolled, 36 completed the study (INT group: n = 18; CON group: n = 18). Both groups showed improvements in physical function outcomes, such as gait speed, balance, and functional mobility, postintervention. Muscle strength also improved in both groups, with no significant between-group differences in functional or muscle strength outcomes. Subgroup analysis revealed additional benefits of eccentric training for participants with limited walking ability. CONCLUSION: Both resistance training approaches improved physical performance in chronic stroke patients. However, eccentric overload resistance training offered additional advantages in functional mobility, particularly for patients with severe impairments. Both eccentric overload and traditional resistance training significantly improved physical performance in chronic stroke patients, highlighting the importance of structured exercise in rehabilitation.

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