Comparing Effect of Mat Exercise and Gym Ball Exercise Regime on Trunk Control and Functional Balance in Patients with Chronic Stroke

Abstract

Persistent impairment of trunk control is an important constraint on balance, mobility and independence after stroke. Selective trunk exercise performed on a stable mat or plinth and on an unstable gym ball has therefore been proposed to extend task-specific practice beyond conventional limb-focused rehabilitation. This critical narrative review evaluates the comparative effects, plausible mechanisms, methodological quality and clinical applicability of mat- and gym-ball-based trunk exercise for adults with chronic stroke. Searches of PubMed/MEDLINE, the Cochrane Library and the Physiotherapy Evidence Database were supplemented by citation searching and verification through publisher, PubMed and Digital Object Identifier records; eligible evidence available up to 23 April 2026 was considered. Direct comparative evidence remains limited. In an acute pilot trial, the between-group change favoured physio-ball training by 3.06 points on the total Trunk Impairment Scale. In a 108-participant chronic-stroke trial, plinth- and Swiss-ball-based programmes produced mean improvements of 3.6 and 4.1 points, respectively, relative to standard physiotherapy, with similar benefits between the two active surfaces. A subsequent 84-participant chronic-stroke trial likewise found that stable- and unstable-support core programmes improved trunk control, strength, weight-bearing symmetry and balance confidence relative to standard physiotherapy, without significant differences between active conditions. Meta-analytic evidence supports trunk training for trunk-specific outcomes and standing balance, although certainty is commonly low and transfer to activities of daily living is attenuated in dose-matched comparisons. The most defensible interpretation is that repeated selective movement, multidirectional weight shift, feedback, progression and sufficient active practice account for much of the benefit, whereas surface instability is an optional method of grading task demand rather than a necessary therapeutic ingredient. Surface selection should therefore reflect impairment, goals, tolerance, supervision and setting. Independent, adequately powered, dose-matched comparative trials with objective biomechanics, prospective falls, participation, fidelity, adverse-event and economic outcomes are required before surface-specific superiority can be established.