Efficacy of combined nutrition and exercise interventions on muscle health and performance in patients after a stroke: protocol for a systematic review and meta-analysis

Introduction Stroke survivors experience profound skeletal muscle deterioration, typically losing 15%–20% of skeletal muscle mass in the affected limb within 4–6 months post-stroke. This deterioration accelerates functional decline, falls and secondary sarcopenia. While combined nutrition and exercise interventions have shown synergistic effects in other muscle-wasting conditions, the evidence for stroke remains fragmented. This systematic review and meta-analysis aims to evaluate the efficacy of combined nutrition and exercise interventions on muscle health and performance in patients after stroke. Methods and analysis We will systematically search PubMed, Scopus, Web of Science Core Collection and CNKI from inception without language or date restrictions. Randomised controlled trials evaluating combined structured exercise and nutritional interventions in adults (aged ≥18 years) with stroke will be included. Primary outcomes are muscle strength and muscle mass; secondary outcomes include functional performance, balance, daily living habits, neurological function and muscle composition. Two independent reviewers will conduct screening, data extraction and outcome-level risk-of-bias assessment using the Cochrane Risk of Bias tool for randomised trials. Hierarchical decision rules and robust variance estimation will be applied to address dependent effect sizes arising from multiple time points or concurrent outcome measures. Meta-analyses will be performed using random-effects models, with predefined criteria for switching to narrative synthesis under irreconcilable clinical or statistical heterogeneity. Pre-planned subgroup analyses will explore key moderators (eg, stroke chronicity, baseline nutritional status, exercise modality and supplement type). Certainty of evidence will be graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Ethics and dissemination Ethical approval is not required as this review involves secondary analysis of published data. Findings will be disseminated through peer-reviewed publications and conference presentations. Trial registration number PROSPERO, CRD420261335163.