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The Foo Fighters Throw a Pop Party on ‘Medicine at Midnight’

By Kory Grow

Foo Fighters have been a reliable alt-rock institution for more than 25 years. A band with that kind of august track record could get bored or complacent with their job. But Dave Grohl and Co. just keep happily chugging along, putting out solid-to-great records, satisfying their enormous fan base with killer stadium shows, and keeping things fresh for themselves by coming up with interesting concepts (like their 2014 HBO doc series/album Sonic Highways ) and tossed-off collaborations with pals like Justin Timberlake, Rick Astley, or Serj Tankian.

The Foos’ 10th album is upbeat even by their uniquely well-adjusted standards, returning to their core Nineties alt-rock sound minus any gimmicks, detours, or shenanigans. 

From the first track, “Making a Fire,” the album is brighter and more optimistic than anything they’ve ever done. As Grohl commands a slippery guitar riff that ascends toward the heavens, a choir of women sings a sunny “na-na-na” refrain, leading to a foot-stomping, hand-clapping gospel breakdown and his latest lyrical confession, “I’ve waited a lifetime to live.” Then there are even more na-na-na’s, which, incidentally, aren’t by a choir at all, but the LP’s most notable guest, Dave’s teenage daughter, Violet, who recorded her own harmonies. Whether it’s a sense of paternal pride or sheer determination, Grohl sounds reinvigorated here, and that enthusiasm is the group’s guiding light on the record.

Although Grohl has spent much of his post-Nirvana career emulating his Seventies FM-radio rock idols, Medicine at Midnight evidences a pop streak that he’s only hinted at before. As with their last album, 2017’s Concrete and Gold, Foo Fighters teamed up with Adele and Kelly Clarkson producer Greg Kurstin, who has helped them hone their tuneful sensibilities. On the title track, they mix funky disco loops and acoustic guitar without losing their edge, and the serene ballad “Chasing Birds” has a melody that lingers well after its final chord.

Even the harder-rocking songs overflow with ear candy. The band tries its hand at some “Low Rider” cowbell on “Cloudspotter,” dabbles with video-game laser sounds and gospel vocals on the punky anti-war banger “No Son of Mine,” and attempts a Freddie Mercury-like vocal echo and quirky rhythms on “Holding Poison.” When Grohl swears “There’s got to be more to this . . . because I need more,” on the slow-building “Waiting on a War,” the record’s best rocker, it sounds like an arena singalong waiting to happen. 

The band finished Medicine before the Covid-19 pandemic, which may account for its upbeat mood. Only the album’s relatively mopey lead single, “Shame Shame,” feels out of place, and there’s more than enough good times to make up for it — just check the LP-ending ode to joy, “Love Dies Young.” It’s one of many reminders here that concepts and gimmicks have their place, but Grohl is at his best when he cuts loose and rocks out.

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The American Oasis? ... Foo Fighters.

Foo Fighters: Medicine at Midnight review – music for toilet breaks at their gigs

(RCA/Roswell Records) Dave Grohl’s band keep changing their methods but the results sound the same, even as they aim at David Bowie disco on their first LP since 2017

T here are artists who survive through perpetual reinvention, constantly surprising their audience at every turn, and then there are artists who trade in reliability. Twenty-six years into their career, Foo Fighters very much belong to the latter category.

Every two or three years a new album comes out, promoted by a tour of the world’s biggest venues, and magazine covers featuring Dave Grohl pulling the face he pulls on magazine covers: brow furrowed, teeth bared. It’s not a comparison you hear very often, but there’s a sense in which they’re the American version of Oasis: a putatively alternative band dealing in a punk-ish take on rock classicism and beloved of people who presumably want to know exactly what they’re getting before they shell out for, or at the very least stream, a new album.

A certain dependability might be the point – Dave Grohl presumably having had enough surprises to last him a lifetime while he was a member of Nirvana – although an itchiness seems to have manifested in recent years. “Complacency and feeling stagnant drives bands into the ground,” he told the Guardian, seven years ago . “It’s a priority that we continue to enjoy it and love it.” So there have been albums recorded in a garage ( Wasting Light ) or in different cities around America with local guest musicians ( Sonic Highways ). Concrete and Gold (2017) paired the band with pop kingpin Greg Kurstin, which, if nothing else, meant that the co-author of Adele’s Hello produced a song about Dave Grohl’s teenage love of controversial industrial experimentalists Whitehouse and Death in June.

Grohl had changed the methods by which Foo Fighters recorded albums without actually changing much about the music they contained: whether recorded in a garage, with the guy who produced Sia’s Chandelier or indeed New Orleans’ Preservation Hall Jazz Band , the results always sounded almost exactly like Foo Fighters. You thus might consider the pre-release publicity for Medicine at Midnight – another Greg Kurstin co-production, which Grohl has described as a “disco” album influenced by David Bowie’s Let’s Dance – with a jaundiced eye. In fairness, there are a handful of moments when you can just about hear the outline of this plan, most obviously on single Shame Shame, with its looped drums and pizzicato strings. Elsewhere, the title track and Chasing Birds definitely have a Bowie-ish lilt to the vocals, there’s a bit of dancefloor swing about the rhythm of Cloudspotter, and there are points on Holding Poison where the drums slip into a rough approximation of Earl Young’s patent open hi-hat disco beat, at least until the track slips into amiably hard-rocking bar-room boogie.

Foo Fighters: Medicine at Midnight album cover.

But these are gentle nods towards an idea, scattered sparingly around an album that otherwise sounds exactly like Foo Fighters. Their musical boundaries are marked at one extreme by No Son of Mine, a retooling of Motörhead’s Ace of Spades riff apparently intended as a tribute to Lemmy , and at the other by the surging pop-rock anthemics of Waiting on a War, a song clearly intended to rouse sports arena-sized audiences into singing along, then punching the air as it accelerates into its coda. Guitars chug as other songs build towards big choruses on which Grohl’s vocal roar sounds celebratory rather than anguished. Before Covid scuppered live music in 2020, Foo Fighters were supposed to be celebrating the 25th anniversary of their eponymous debut album in “world domination” style. You don’t get to do that if your new album is a sudden left-field turn that puzzles your fanbase: a line of thinking that seems to inform Medicine at Midnight, overriding any desire to experiment.

That thinking seems to inform the latterday Foo Fighters more broadly. They’re a band clearly in their element on stage, bringing out special guests, and slipping covers of everything from Prince’s Darling Nikki to Dead Kennedys’ Holiday in Cambodia into their sets. The albums are all expertly done, but making them seems to have become secondary to touring; the band have smartly instituted enough changes to the process of making albums to stop them feeling as if they’re merely going through the motions, but their contents are there to fill in the gaps between the big hits on stage without suggesting a drastic drop in quality. By those criteria alone, Medicine at Midnight – like its immediate predecessors, a solid but unspectacular album – is a success.

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Medicine at Midnight

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By Jeremy D. Larson

Roswell / RCA

February 8, 2021

A quarter-century after they rose from the ashes of grunge, climbed Billboard pop charts, vacuumed up Grammys, and conquered stadiums worldwide, the Foo Fighters return with another album of inconsequential music. When you’re a band of this size and tenure, new albums aren’t necessarily born of personal inspiration but out of a fraternal pledge to those around you: your band, your fanbase, your road crew, a new line of Ram trucks . The guys of the Foo Fighters—who have this wonderful shabby chic Venice Beach dad look now—continue to plow through albums with one thankless goal in mind: to keep the dying institution of rock alive. And with his cheerful indefatigability and his commitment to the primacy of guitars, Dave Grohl is the generational rock spokesperson the future deserves, Bruce Springsteen without the tunes.

Influence, legacy, and musical quality aside, Bruce and Dave might be the last two musicians still living inside of the remaining slipstream of monocultural rock’n’roll. They are both performers and entertainers above all, both icons of endurance; both give an outsized amount of themselves to their fans, on stage and off. Bruce performs four-hour shows and pulls a beaming crowd member up on stage every time; Grohl tours with a broken leg on a throne made of guitars and drum battles a 10-year-old . They both possess the innate ability to charm anyone who heaves into their view. And—as if by providence—both Bruce and the Foo Fighters played the inauguration afterparty of President Joe Biden, whose broad call for healing and unity was epitomized by two artists who call for healing and unity in the broadest possible terms.

Grohl’s lawful-good lifestyle presents an eternal conflict between being unable to hate the guy and being unable to enjoy the music he continues to make. Foo Fighters seem to approach their formative rock, hardcore, and punk influences with the prompt, “What would be fun to play on Guitar Hero ?” If the Guitar Hero reference feels dated, wait until you hear their new music. Their 10th album, Medicine at Midnight, adds very little to their extensive catalog of interchangeable power pop and hard-rock sing-alongs. But you can’t hang them on their own music, because Foo Fighters would never dare to give you enough rope to do it.

A Foo Fighters record rolls out in the same way Taco Bell rolls out a new menu item: A nominal twist on the same five or so ingredients. Produced once again by pop impresario Greg Kurstin, Medicine at Midnight is supposed to be the band’s party record, their dance record, their Bowie’s Let’s Dance record, even. Charitably, they could be talking about “Shame Shame,” a creeping acoustic number that signals a slinky new direction until Grohl rampages all over the chorus. Maybe they are referring to the title track, a geriatric, leathery blues anthem for men who love the feeling of a new John Varvatos jacket. Because every generation gets the “ Miss You ” it deserves, the song has a starchy groove and background chorus of women singing about “rain on the dancefloor.” You can try to fit Dave Grohl into a sparkly white suit, but underneath he’s always just wearing jeans and a T-shirt.

This is the issue with half-heartedly trying on a different costume every few years: All Foo Fighters songs exist in the same empty universe. There are no backdrops or scenes, no people, no roads, no cars—just a blank slate for anthemic oratory and rights-free guitar riffs. And because this blank slate is so predictable, and because there’s no dimension or interiority to any of Grohl’s songwriting, the songs become line items: ones you imagine working pretty good at their live show or ones that have no real reason to exist. Grohl has an expressive, agile voice, but it has only ever worked in the rock idiom, which should give “Waiting on a War,” “Love Dies Young,” and possible highlight “Holding Poison” a spot on setlists for the rest of the band’s time on Earth. The rest, truly, who cares?

When Bruce entered his mid-career doldrums in the early ’90s, he was off with his “Other Band,” not exactly minting hits or critically revered music—even going so far as to admit he was making “generic” songs to pad out his setlists. Grohl has ended up in a similar spot without ever leaving the comfort of the Foo Fighters. And while Bruce ranges freely and embraces darkness and doubt, Grohl keeps his rictus smile, holding on to the hand fate dealt him. “I just want to stay alive and play music, especially after Nirvana,” Grohl said in a recent interview with the New York Times . “When Kurt died, I truly woke up the next day and felt so lucky to be alive, and so heartbroken that someone can just disappear. I decided to take advantage of that, for the rest of my life.”

On the other side of every Foo Fighters song is a darker, wilder, more interesting world that Grohl has cordoned off out of self-preservation. Instead, he writes music out of a sense of duty and fear, knowing that choosing the wrong path could end the healthy, inspiring enterprise he has worked tirelessly to create. As the Foo Fighters’ legacy becomes tied with epic and communal live shows steeped in their long and narrow canon, it feels like a bellwether for rock’n’roll itself. Where rock once held limitless sway over pop culture, now the fate of traditional arena rock rests in a band whose music suggests they are terrified of seeing it die, gripping their songs so tight that they are strangling the life out of them. Foo Fighters’ greatest achievement, “ Everlong ,” still outshines every other song in their catalog, because it is their guiding principle: to remain in perpetual motion, to never stop feeling this good, to sing along with you forever. But everything dies, baby, that’s a fact.

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Foo Fighters Get Into the Groove on Blissfully Concise ‘Medicine at Midnight’: Album Review

By A.D. Amorosi

A.D. Amorosi

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Foo Fighters Medicine at Midnight

When Dave Grohl described the new Foo Fighters album as “our ‘Let’s Dance’,” referencing David Bowie’s hit-heavy 1983 smash, fans of the rock band known for its raw, crusty assault of guitar riffs and fist-pounding rhythms may have found themselves somewhat flummoxed. The Foos have always been a big-sounding band with a bigger-sounding bang, and while melodically, Grohl can match the best pop writers of today and yesteryear, pivoting towards that cosmopolitan gloss is not a direction anyone might have predicted for the stalwarts of arena rock.

Yet here it is on “ Medicine at Midnight ,” a blissfully concise 36 minutes of sprightly unabashed grooves led by a shaggy dog-eared leader who’s always eager to tease. Helping the Foos realize its sonic goals on this tenth album in a little over 25 years is producer Greg Kurstin (Adele, Maren Morris), who guides its boyish, biggest-ever beats into soulful, singalong territory, as well as “Let’s Dance” drummer-percussionist Omar Hakim, who appears liberally throughout “Medicine at Midnight.”

Recorded before the pandemic, the collection oozes positivity in the form of gang vocals by a trio of female backup singers (among them: Barbara Gruska, of the Belle Brigade fame and a fellow badass drummer) even when touching on such lyrical themes as loneliness and shame. Guitarists Pat Smear, Chris Shiflett and Grohl himself, along with Taylor Hawkins on drums, Rami Jaffee on keys and Nate Mendel on bass, help realize the no-muss, no-fuss, nine song tracklist which does indeed have good grooves and high kicks.

Starting with “Making a Fire,” which is adorned with na-na-nas that nod to Lenny Kravitz’s swaggering brand of fired up rhythm-rock-and-blues, the wildly contagious choruses and a gorgeous vocal bridge (“Are you afraid of the dark? I know a place we can start”) provide one powerful curtain raiser of a hip-shaking cut. “Shame Shame” follows. An oddball in the Foos canon of singles, as it shows off Grohl’s growl smoothed to a low croon, it strangely works with the track’s spare, slow shimmying vibe and supplely thumbed bass, all nestled into Kurstin’s moaning, bowing strings that land like a billowy pillow. Grohl eventually grouches it up with a crowd-baiting chant, making “Shame Shame” a chef’s kiss of a track two.

Further on, the ponderously atmospheric strings of “Waiting on a War” set less of a romantic table, while still provoking Grohl and Co. to action. Complimented by Smear’s rush of brushed denim acoustic guitars and deeply undulating rhythms, the singer opens and extends his baritone like never before, as he pulls lyric lines like taffy, and ruminates about a childhood waiting for the sky to fall, while toting toy guns by his side. As is the Foos’ want, the torrid track gets cold, loud, fast and screechy until it ends abruptly — and gloriously.

The Bowie-est of the songs is the title track, “Medicine at Midnight,” which finds a crooning Grohl uncomfortably slick at first, but multiple listens reveal Hakim’s clickity-clack percussion in the background as both satisfying and sensual. If it feels like a rip-off, it’s a really righteous one.

Kurstin, too, does a fascinating buff job of copy-catting the polished, hot wax sheen that producer Nile Rodgers gave Bowie’s sleek 1983 classic. Surely, it’s that chic feel that the Foos found so seductive. Yet, rather than utilize reeds, brass and horn arrangements, Kurstin uplifts the Foos bridges and choruses with opulently arranged chamber strings for an added layer of luster. To wit: closing track “Love Dies Young,” which might feel as at home on 1980s MTV as it would on a Big Star record.

Things take a bit of a mellow turn on “Chasing Birds,” on which Grohl uses his inside voice to soothing effect, along with amusing lyrical twists (“The road to hell is paved with broken parts, Bleeding hearts like mine”) and a Kurstin-fueled coda that bends at exactly the right place. But things only remain quiet for so long, as “Medicine” is blanketed by the urgency of songs like “No Son of Mine” and the pulsing “Holding Poison.”

Grohl promised a record you can groove to, and he delivered, while still maintaining a quintessential crunch that’s fitting for a Foo.

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Foo Fighters – ‘Medicine At Midnight’ review: an injection of joy from Grohl and the gang

It's slinky. It's shimmery. It gets a bit Bowie and boasts one of the best songs they've ever recorded. Album 10 is the soundtrack to the summer we all crave

Foo Fighters

While the songs that comprise Foo Fighters ’ 10th album may well be among the glossiest AOR that the band have ever put their name to, this is a record with old bones.

Drummer Taylor Hawkins has previously described ‘Medicine at Midnight’ as more “pop-orientated” than previous Foos releases, and he’s not wrong. But the record is more than that – it suggests the future of the Foo Fighters is more interesting than you might have anticipated. Thanks to the ongoing menace of COVID, the chassis of the record – its innards, its celebratory themes – are of the old world, the Before Times. Band main man Dave Grohl started demoing these songs as long ago as 2019; the record was meant to be released almost a year ago. Its emergence in 2021 feels a bit like finding a tenner in your jeans pocket after putting them through the wash: a nice surprise that’ll put a smile on your face.

A lot can happen in a year, as they say. Tonally, and through no fault of its creators, this is a record that has little in common with the era into which it finally enters – and if you know anything about the last 12 months, you’ll know what a blessed relief that is. Opener ‘Making A Fire’ is joyous stuff, a marriage of pop quirk and punchy barre chords, with a chorus that has as much in common as The Eagles as the alternative rock scene from which Foo Fighters emerged. There’s a universe somewhere where the song soundtracks a summer that never happened. You might read it as a reminder of what has been lost – or a NutriBullet of hope for a hopefully brighter future.

Grohl’s – and thereby the Foos’ – PMA continues throughout ‘Medicine At Midnight’: it’s a celebration of almost three decades of good times (and was meant to accompany a 25th anniversary world tour). The frontman’s songwriting template – essentially the soundtrack to trying to find your tent on the last night of Reading Festival – has served the band extremely well over the last decade. Grohl’s status as an everyman rock hero has grown with each Foo Fighters release.

Speaking to NME for this week’s digital cover story, Grohl emphasised the importance of the small venues that COVID has put in jeopardy. He’s the perfect spokesperson for the cause. “Those places are much more important than most people would imagine,” he said. “A lot of people will just look at them as watering holes, but those places are training grounds for the next generation of musicians that need somewhere to cut their teeth before they hit the next stage.”

What Drives Us , his documentary-cum-love-letter to touring in vans – subject matter as on-brand as flannel shirts and beard shampoo – was also curtailed by COVID, with a release date still pending. Everyman rock status aside, though, no-one expects a musical reinvention from the Foos at this stage.

And yet ‘Medicine at Midnight’ features a generous smattering of ingenuity throughout. Early single ‘Shame Shame’, is a slinky earworm of a tune; a song that – from mournful cello to a stuttering, awkward beat that is dying to have bars dropped atop – does everything you don’t expect it to, and at every turn. Elsewhere, ‘Cloudspotter’ recalls Queens of The Stone Age , a band Grohl formally thumped tubs for, at their most interesting. Later on, the title track recalls one of those shiny, colossal rock songs that big rock bands started making at their height of their ‘80s cocaine intake. David Bowie ’s ‘Let’s Dance’ is an obvious reference point for a song that is rarely obvious.

‘Waiting On A War’, a soft-rock plodder, is perhaps what your mate who doesn’t like Foos thinks the band sounds like (“ Never really wanted to be number one” , Grohl croons, “Just wanted to love everyone ”), but even this would likely hit different if sang in unison with thousands more voices at a music festival. And then along comes ‘No Son Of Mine’, a shuffling psychobilly-influenced stomper that explodes out of nowhere into a wild cacophony of breakneck guitar, psych-jam breakdown and – hold me – gospel backing vocals.

After a year that took so much, the return of the Foos feels like the culture getting back in credit. Consider the record’s closing track, ‘Love Dies Young’, which sparkles with effervescence that the last 12 months have lacked – it’s one of the best songs the band have ever put their name to.

Those who have followed Grohl through his days in DC hardcore – through Nirvana , the metallic ingenuity of Probot, his drumming to the stars and the rise and rise of the band that brings forth this record – will be enthused by the suggestion that this great songwriter is looking to expand his playbook. Even more will be delighted that an enduring force for good has returned.

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Foo Fighters' Medicine At Midnight spikes grunge ballast with pop panache

Foo fighters' medicine at midnight is dave grohl’s tightest set yet, with supernatural aid.

Foo Fighters: Medicine At Midnight

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Dave Grohl has spent the past decade scouring the US for his own spirit. He made 2011’s Wasting Light in his garage to try to recapture his teenage exuberance, 2014’s Sonic Highways in a variety of America’s most storied studios to try to borrow their mythology, and 2017’s Concrete And Gold in California’s spiritual Shangri-la Ojai, as if looking within himself for rock enlightenment. 

Along the way he’s worked with such luminaries as Justin Timberlake, Alison Mosshart and Ben Gibbard, with Eagles and Beatles and Cheap Tricks, in the hope of crossing the sonic streams. 

For tenth album Medicine At Midnight, recorded pre-lockdown, he’s even ventured beyond the physical realm, recording in a nearby haunted house with, he claims, poltergeists adjusting the pedalboard levels overnight.

Ironically, it’s injected new life into Foo Fighters . Where Concrete And Gold was an unspoken homage to the pivotal rock records of the late 60s and 70s (Motorhead’s Sgt Pepper , Grohl intended), Medicine At Midnight is his most future-facing album of recent years. 

Locked out of the singles charts in the streaming age, many rock acts have courted pop audiences of late, attempting to remain competitive (Smashing Pumpkins, The Killers). Foo Fighters are equally ambitious. They hired Sia and P!nk’s producer Greg Kurstin to add flecks of contemporary titanium to Concrete , and last April Grohl happily murdered Times Like These alongside Dua Lipa and Jess Glynne for charity. 

Medicine , however, melts modern pop textures into Grohl’s trademark grunge-pop ballast with panache, and inspires some of his most infectious choruses since the 90s. Shame Shame gilds a canyon rock core with piston R&B beats, hand claps and soulful asides; Making A Fire resembles a catchy collaboration between AC/DC and TLC; and the verses of the funksome title track could have fallen off Thriller.

As a result, the nine tracks (36 minutes) of Medicine At Midnight slip down easy. It’s the zippiest Foos album to date, and largely unburdened by the dark-times politicising that thickened Concrete . 

What’s more, it reassures its rock base as it goes; the pure fireball rock of No Son Of Mine and Holding Poison burn out the album’s early funk tendrils at the root, mid-paced ballad Chasing Birds couldn’t be more Imagine if it had an emotionless Yoko on vibes, and the record closes with one of the most euphoric anthems about the pointlessness of relationships ever recorded. 

As a modern rock melting pot, Medicine certainly sounds like a spirit rediscovered.

Mark Beaumont

Mark Beaumont is a music journalist with almost three decades' experience writing for publications including Classic Rock, NME, The Guardian, The Independent, The Telegraph, The Times, Uncut and Melody Maker . He has written major biographies on Muse, Jay-Z, The Killers, Kanye West and Bon Iver and his debut novel [6666666666] is  available on Kindle .

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Foo Fighters review, Medicine at Midnight: Robust rock’n’roll that stays in its lane

Dave grohl describes his band’s 10th album as a 'party record' – and while hardly full of bops, it would slot nicely into a stadium setlist, article bookmarked.

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Medicine at Midnight is Foo Fighters’ new ‘party record’

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Foo Fighters have never claimed to be reinventing the wheel. Nirvana, Dave Grohl ’s former band, already did that in the Nineties – so he’s spent the past 25 years hammering out what he readily admits is dad rock. “I think the reason why we’re still here is because we do disconnect ourselves from the popular stuff that’s going on,” he says, and it’s hard to resent him for that. Medicine at Midnight, the six-piece’s 10th record, is a perfectly perfunctory addition to a canon of robust rock’n’roll.

Grohl describes Medicine at Midnight as a “party record”, which does make me wonder what sort of parties he throws. But while hardly full of bops, it would slot nicely into a stadium setlist. The crunchy riffs of opener “Making a Fire” morph into syncopated beats, claps, and chants of “nah nah nah” that is forgivably cheesy. On “Cloudspotter”, which has a funky edge and hair-rock chorus, the meaningless refrain “sweet, sweet guillotine queen” feels factory-designed for a mass shout-along, while the acoustic ballad “Waiting on a War” practically begs you to put a lighter in the air. That track has strings, a rousing melody, and a vaguely defiant message – it was inspired by the moment Grohl’s 11-year-old daughter turned to him and asked if there was going to be a war.


  • Foo Fighters: ‘I’d go to Rock Against Reagan concerts and get beaten by police and rednecks’

“Shame Shame” gets off to a promising start – a minimalist, staccato intro and a chorus that sounds a little like Sleater-Kinney – but by the time the 38th “shame” comes around, the whole thing is dragging itself along like a sulky toddler. You can tell by the “Ace of Spades” riff that “No Son of Mine” was written in tribute to Motörhead’s Lemmy. And yet the trouble with drawing such blatant comparison is that the Foo Fighters are not Motörhead, while Grohl certainly doesn’t have Lemmy’s growl or grit. Other tracks try for something a little daring, like the title track with its husky, sinister funk. Soon, though, it’s turned into Tenacious D, and by the end, muscle memory has kicked in and it’s classic rock again.

If Dave Grohl went around proclaiming godlike genius, Foo Fighters’ lack of sonic development might be irksome. But there is something admirable about the fact they stay so firmly planted in their lane. Medicine at Midnight is unlikely to win over many new fans, but it will make the existing ones happy. During a pandemic, anything that can do that is to be celebrated.

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Foo Fighters’ Medicine at Midnight Fittingly Caps 25 Years of Rock Triumphs: Review

A tight, focused record calibrated to show off their strengths and reconfirm their pep

Foo Fighters’ Medicine at Midnight Fittingly Caps 25 Years of Rock Triumphs: Review

  • Foo Fighters

Release Date

  • February 5, 2021

Record Label

  • RCA / Roswell

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  • Apple Music

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review medicine at midnight

The Lowdown: During the Foo Fighters livestream show at the Roxy in November, Dave Grohl spent a little time wondering what could’ve been. “2020 was gonna be the best year ever!” he said to the audience-free club. “We had plans, man!” That show, while good, wasn’t the ending to a triumphant 25th anniversary year that Grohl had in mind. COVID-19 upended most of the celebrations, including tours of Europe and America (one of which retraced the itinerary of the band’s first tour from 1995), the Foo-curated D.C. Jam Festival, and the release of the band’s 10th studio album, Medicine at Midnight . While the tours are still grounded and the festival a post-social-distancing dream, the album has finally arrived. Described by Grohl as a “Saturday-night party album,” Medicine at Midnight also serves as a capstone to the band’s quarter-century ascent to the top of American rock and roll.

Dave Grohl and Foo Fighters' Accidental Rise to Rock Royalty

Dave Grohl and Foo Fighters’ Accidental Rise to Rock Royalty

The Good: Although it was recorded before the pandemic, Medicine at Midnight hits with the urgency of a record conceived in a quarantine haze. Kicked in by crunchy guitars and the crisp drums of Taylor Hawkins, opener “Making a Fire” builds up the record’s momentum with a maximalist glee; as Grohl sings about shooting your shot and making up for lost time, the band heaves out a heady mix of handclaps and woos and nah-nahs and stomping drums all at once. Keeping up that pace for an entire record would be exhausting, for performer and listener alike, a fact that makes the album’s change-ups all the more refreshing. Taut with the atmospheric interplay between Hawkins and guitarist Chris Shiflet, “Shame Shame” was the best of the record’s advanced singles and remains a highlight here. Later, “Cloudspotter” chugs with classic-rock simplicity, powered by riffs that could’ve been recorded at any point in the last 40 years. Credit here often goes to producer Greg Kurstin, who once again delivered a crisp, sharp-focused sound that never tips over into sterility.

As a reflection on the band’s first 25 years, Medicine at Midnight spends much of its time in a ruminative mood; in addition to “Making a Fire,” there are also tracks reflecting on the spectre of conflict (“Waiting on a War”), hypocrisy (“No Son of Mine”), and the unerring flight of time’s arrow (“Chasing Birds”). Like any good showmen, the Foo Fighters save the best of these for last; powered by “Barracuda”-grade guitars and a well-based kit, “Love Dies Young” closes things out with a rollicking sky-high anthem about living life while there’s life left to live. It’s probably the purest distillation of the album’s stated goal and a likely contender for set closer whenever the band hits the road next.

The Bad: There’s an obvious drawback that comes with the Foo Fighters’ “Oops! All Anthems!” approach: if you’re always aiming for the cheap seats, you’d better be sure that your ammo has the oomph to really reach them. Unfortunately, that’s not always the case on Medicine at Midnight, where more than a few songs fail to reach the heights that Grohl has in mind. The deficit between intention and effect is most apparent on the record’s ballad; both “Waiting on a War” and “Chasing Birds” suffer from dulled, imprecise lyrics that present pathos without the feeling or details needed to back it up. It’s not limited to the slow stuff, either; “No Son of Mine” wants to invoke righteous fury, but is hamstrung by bloodless generalities that don’t live up to the cyclonic swirl of guitars and drums around them. There’s also the issue of the record’s backing singers: while they wail like wraiths on “No Son of Mine” and provide a balm on “Chasing Birds”, their voices hamper otherwise excellent solos on “Medicine at Midnight” and “Holding Poison” that would’ve been far more powerful unaccompanied. It’s not the end of the world, but it’s something you’ll definitely notice.

The Verdict: Though it arrives in a very different world than the one it was intended for, Medicine at Midnight is a fitting commemoration for the Foo Fighters’ belated anniversary year. Rather than indulge in excess or (as Grohl put it) “making some acoustic record, where we’re riding off into the sunset of our career,” the band marks the latest milestone with a tight, focused record calibrated to show off their strengths and reconfirm their pep. An essential listen for fans and a fair introduction for newcomers, Medicine at Midnight feels like the rare late-career release that genuinely earns its spots within the legacy setlist. Now, if we could just get those tours rebooked…

Essential Tracks: “Making a Fire”, “Shame Shame”, and “Love Dies Young”

Pick up a copy of Medicine at Midnight here …

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review medicine at midnight

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Medicine at Midnight

  • Record Label: RCA
  • Release Date: Feb 5, 2021

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Generally favorable reviews - based on 23 Critic Reviews What's this?

Generally favorable reviews - based on 101 Ratings

  • Summary: The 10th full-length studio release for the alternative rock band led by Dave Grohl was produced with Greg Kurstin.
  • Genre(s): Pop/Rock
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  • Positive: 18 out of 23
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Is the Foo Fighters’ new pop-oriented album a triumph or a turd?

Foo Fighters

Tomorrow, the new Foo Fighters album, Medicine At Midnight , will be released. On one  hand, you probably already know if this is of interest to you or not: The Foo Fighters aren’t exactly the most sonically or stylistically adventurous band on the planet, so if you’ve historically enjoyed their particular brand of pop-infused hard rock, there’s a decent chance you’ll be curious to give the new one a spin. On the other hand, this isn’t quite the same collection of songs you’d normally expect from the band. That divergence in sound makes itself known right out of the gate; after opening track “Making A Fire” introduces a stomping mid-tempo drum pattern, followed by a typically classic-rock-inspired riff, the shift comes abruptly—a chorus of “Nah nah na-na-na-na nahh!” voices erupt over the song, leading the casual listener to wonder if maybe they’ve accidentally thrown on late-period Queen by accident. One By One Part II , this is not.

The rest of the record follows suit. Here, a Motörhead-meets-Meat Loaf barnburner with choral arrangements in the background (“No Son Of Mine”); there, a Captain And Tennille-level acoustic ballad (“Chasing Birds”). There’s still the occasional old-school Foo Fighters track (“Waiting On A War,” “Holding Poison”), but even those have been generously leavened with new levels of synths and ’80s-rock flourishes. It didn’t come out of nowhere: The group’s 2017 record, Concrete And Gold , began tentatively pushing in this direction. Still, it’s enough to make a Foo Fighters fan pause, take stock of the group, and wonder if this is a band they have an interest in continuing to follow. Two A.V. Club staffers, assistant editor Alex McLevy and editorial coordinator Gwen Ihnat, are longtime listeners of Dave Grohl and company; they had notably different reactions to Medicine At Midnight , and decided to sit down and hash out their opposing views to determine just what, if anything, this new record has to offer.

Gwen Ihnat : I will never quit the Foo Fighters: My love of the first two records still knows no bounds (I would put on The Colour And The Shape tomorrow) and they’ve given me some of the greatest live-show experiences—yes, even in arena rock —that I’ve ever had. In fact, it’s the opening bands (Naked Raygun, Cheap Trick) and the live covers (“Under Pressure,” “Miss You,” “School’s Out”) that indicate the unbreakable tie between Dave Grohl and fans like me: We all grew up on the same classic rock radio. The band is never better than when Dave and company just dive into that unabashed love for bell-bottoms-era rock ’n’ roll.

So I was disappointed when the Foos debuted their new song “Shame Shame” on their recent Saturday Night Love appearance . A snoozier song has scarcely been released; when people say that the Foo Fighters have no new sound to offer, this track, so somnambulant as to appear to actually be running backward, is exactly what they’re talking about. It’s not the worst song on Medicine At Midnight (that would be the execrably schmaltzy “Chasing Birds,” which aimed for “Walking After You” territory and failed miserably). But since “Shame” was the first song I heard, I approached the rest of these new MAM songs tenuously—and was greatly surprised (and relieved). Kickoff “Making A Fire” is a triumphant ’70s-sounding anthem aided by the chorus mentioned above, bringing to mind sun-scorched convertible seats and the smell of Coppertone. I love the smoky percussion that brings the title track to life, evoking a dramatic Eagles saga circa The Long Run. (Taylor Hawkins is having a ton of fun on this record, you can tell.) And even though the sentiment of closing track “Love Dies Young” is a downer, it’s bolstered by the glossy ’80s-sounding guitars driving the track.

“Shame Shame” doesn’t even belong on this album. And yet, Alex, you apparently like that song. What gives?

Alex McLevy: I understand why you grabbed “Shame Shame” like a cudgel to beat me with, Gwen. I think your reaction was shared by a lot of people that night on SNL , but I also think current events colored that perception. Joe Biden had just been declared the official victor of the 2020 presidential election, and the country was in a celebratory mood. “Shame Shame” went over like a fart in church—a dispiriting, downbeat number when people were looking for a “Times Like These” anthem. But had Trump won, I think it probably would’ve played very aptly; more importantly, it was just the kind of left turn, stylistically speaking, the band needed. It’s a bleak, minor-key dirge with some interesting vocal melodies, and I admire the attempt at something new—I’d venture to say it’s one of my favorite tracks on the new record, which should tell you something significant about the dim light in which I hold the rest of it.

Like you, I was a fan from the start; hell, even more so, considering Grohl actually reached out to me as a young punk kid to offer words of encouragement when I needed them. I’ll always be curious to hear what he’s up to. But a funny thing happened over the past few years. First, there was the Sonic Highways documentary and accompanying album, which was the first time I realized that Grohl wasn’t exactly a world-class lyricist. That was a great music doc series that unfortunately ended each episode with a new Foo fighters song, the lyrics prominently displayed on the screen—a genuine mistake, if the show wanted people to come away with a newfound admiration for Grohl’s words. Similarly, I could never really get into Concrete And Gold , which sounded a little too much like a bar band playing covers of old classic-rock B-sides—amusing at times, but hardly inspiring.

But good god, does this latest album crap the bed. You call “Making A Fire” triumphant; I burst out laughing the first time I heard those opening “nah nah nah”s, and I have a hard time imagining anyone taking it seriously, let alone finding it awesome. It’s an attempt to bust out some of that old FM radio flavor you mention, but frankly, the band doesn’t have the songwriting chops to incorporate such ambitious flourishes. Just as the acoustic half of In Your Honor always felt like a misguided detour away from Grohl’s strong suits as a musician (i.e. loud-as-fuck guitars and booming rock choruses), Medicine At Midnight ’s efforts to bring in synth-heavy and orchestral retro-rock influences play like someone’s uncool uncle who used to gig in a hair-metal band discovering Pro Tools and thinking, “Sweet, I always wanted to make Bat Out Of Hell IV !” While I admire Grohl’s proud embrace of the “dad rock” label , it doesn’t mean he needs to actually transform into one of those dads trying to relive glory days that were never really his; other people already made that music, and made it very well, so seeing him do a substandard gloss on it just feels like a bummer. It’s Homer Simpson explaining the competent drum work of Grand Funk Railroad’s Don Brewer to his kids.

But maybe I’m being churlish to the rest of the album. Gwen, we haven’t discussed some of the other tracks yet; aside from your favorites (which, again, hard “agree to disagree”), is the record as a whole really delivering all these awesome riffs and throwback pleasures for you?

Gwen Ihnat : Wow, that is some straight-up vitriol from an alleged fan, Alex (you passed churlish a while back with “uncool uncle”; c’mon, Dave would always be the coolest uncle). Granted, I believe my bar is (much) lower than yours; at this point in their career, with album number 10, I’m happy just to have Foo songs I want to hear more than a few times. To that end, while thoughtful rock song “Waiting On A War” just sounds like a more muted “Times Like These” or “The Best Of You,” it still manages to grab me at the end. Although I totally get what you’re saying about the lyrics: The “Is there more to this than that?” refrain is banal enough to slip far below even my Foo Fighters limbo bar. I welcome the bared musical teeth displayed in “No Son Of Mine,” which is a fun hard-rocker I can already picture witnessing live. But in a fairly compact (nine-track) album, there are a few, like “Cloudspotter” and “Holding Poison,” that just aren’t sticking with me no matter how many times I’m listening to them. (Meanwhile, I’ll probably never get “Shame Shame”’s plodding melody line out of my brain, and I really want to.) If I was grading, I would put this in the C+ range, hoping that by album number 11 the band might discover more of those infectious rock hooks I love.

But at this point, they don’t really have to. The next record could be all covers, or acoustic, or live. The Foo Fighters have built up enough rock (to read: “rawk”) goodwill to get a lifetime pass from me, and I’ll keep going to see them live until they actually resemble those octogenarians in the “Run” video . At this point, a good Foo song—and yes, I would put “Making The Fire” and “Love Dies Young” in that category, I enjoyed those backing vocals and ’80s riffs you mock so fiercely—is just gravy. It’s been a long year. Let’s let the Foos have their fun.

AM : Hey, I only begrudge someone fun when it’s substandard material nonetheless offered up to fans as something they should pay money to own! Oh, wait. Look, you’re right that I’ve been mocking some of these tracks fiercely, but in my defense, they mostly deserve it. “Love Dies Young,” for example, is an album closer that sounds more like a Journey or Heart outtake than a 21st-century Foo Fighters song, and “Cloudspotter”—a track you smartly omit from your defense, lest it make my argument for me—comes across like a tune Ace Frehley would’ve set aside for being too corny. When Grohl covered Frehley’s “Ozone” for the B-side of the “Big Me” single way back when, it seemed like a good-natured goof; now I worry he wanted to write songs that dumb all along. (I’m being kind by not just excerpting large blocks of lyrics from “Cloudspotter” here; let’s just include the refrain “Callin’ on someone else’s dime / put your 2 cents where the sun don’t shine” and leave it at that.)

I really wanted to like Medicine At Midnight . As you rightly point out, Dave Grohl will always be the cool uncle, even when he puts out misbegotten mistakes like this one. I’ll still probably call myself a fan, and will still absolutely crank the speakers whenever “The Pretender” comes on. I used to have a theory that every other record the Foos made was good to great, somewhat akin to the “even-numbered Star Trek movies” concept. Wasting Light, In Your Honor, Colour And The Shape (I know I’m cheating a little here, but you get the idea)—all delivery systems for a more-than-half-full glass of great rawk. But I’m worried they might have settled into a groove I’m no longer that excited about: rewriting old genres and past-their-prime styles, rather than distilling what they’ve done into badass new flavors. Grohl can deliver great hits, but he seems to have backslid into being a little too comfortable goofing on the hard rock of his youth. At least “Shame Shame” was different in a way that didn’t feel like an attempt to ape something else; I don’t expect a revelatory new phase of the band—but are a couple catchy singles too much to ask?

  • Cover Story

Album review: Foo Fighters – Medicine At Midnight

No Van Tour, but Foo Fighters still deliver a dose of the good stuff on Medicine At Midnight…

Album review: Foo Fighters – Medicine At Midnight

Foo Fighters had an idea for the release of their new album. To celebrate the band’s quarter-century, Dave Grohl hit upon a wheeze: the subsequent U.S. tour would follow the route of their very first jaunt around America in an old Dodge van. Indeed, so sentimental a side does Dave have, he actually bought back the same van in more recent years. It’s a rather cool bit of Foo history, although presumably they can’t work out how to get it into a Hard Rock Café. When you hear the story, you can feel the romance in the memory: the lads, piling around in a van, having it. Yeah, do that.

As has become the normal order of things, this hasn’t been able to happen. Like Weezer , who pushed the release of Van Weezer back to a point at which gigs can happen and a stadium rock album is actually appropriate, instead releasing the more homey OK Human (itself pushed back for originally being inappropriate for the stadiums they would be playing with Green Day ), Foos have had their grand design for Medicine At Midnight forcibly changed. Boo and hiss. For Dave, who says that the place where his band make the most sense and their largest point, is onstage. Any stage. But in a time of no stages, needs must.

In some ways, though, being introduced to Medicine At Midnight at home, rather than in a football stadium, isn’t such a drag when it comes to getting acquainted with the material. For all the talk of old tours, being onstage, and Foos essentially being a “garage band” who just happen to play massive shows, these aren’t the most immediate songs Foo Fighters have ever written. The excitable energy of Monkey Wrench or All My Life doesn’t really make much of an appearance, nor do any real trace of the band’s love of really heavy music that so often straps a rocket to their songs live.

But this is no problem at all because, like Weezer with OK Human, this does indeed have a sense of nostalgia to it, but it’s more in line with the great American radio-rock of the ‘70s and ‘80s, and the works of people like Peter Frampton and The Eagles, than you might have been expecting. On opener Making A Fire, there’s a groove like Aerosmith , while Shame Shame has a loose, jammed feel, built around a finger-clicking beat that swells into a slowly rising chorus. The title-track almost sounds like something that could have been on David Bowie’s The Next Day comeback, understated, but sharp as a razor, while Chasing Birds is entirely laid-back, strummy cool. The power of Waiting On A War, meanwhile, comes from its strings, rather than volume, even at the end, when they deliver the most striking part of its final crescendo.

On No Son Of Mine and Holding Poison, the tempo does pick up, and Dave does some shouting on Cloudspotter, but things never topple into anything that’ll give you beer hair. But what this album is, it isn’t really about those moments. Instead, it’s an exhibition of just what a simply, fundamentally good band Foo Fighters are, and how skilled with a tune and a melody Dave Grohl is. You couldn’t call it stripped back as such, but its less hectic nature throws things into slightly sharper focus.

The plan may have been iced, and nobody actually knows when anything will kick off again, but that takes nothing away from things here. Rather than ruing the fact that we won’t get to hear these songs live for a long time yet, we’re instead gifted the opportunity to live with them and feel some of their joy right now . And, as Dave Grohl himself agrees, that’s something worth putting out there.

Verdict: 4/5

For fans of: Biffy Clyro , Bob Mould , Weezer

Medicine At Midnight is released on February 5 via Roswell Records/Columbia Records.

Read this: “Music gives people hope. And we desperately need that now”: Foo Fighters take us inside Medicine At Midnight

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Medicine at Midnight

Album review of medicine at midnight by foo fighters..

Medicine at Midnight by Foo Fighters

Foo Fighters

Release Date: Feb 5, 2021

Genre(s): Pop/Rock

Record label: RCA

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Album Review: Medicine at Midnight by Foo Fighters

Great, based on 8 critics.

Right before its release in early 2021, Dave Grohl called Medicine at Midnight the Foo Fighters' "Saturday Night party album" -- a self-evaluation that turns out to be pretty accurate. It also functions as an acknowledgment of an open secret within the band's catalog: for all their attributes, the Foos have rarely been "fun. " Foo Fighters fix that deficit by diving head on into disco and dance, the syncopations and polyrhythms so dominating Medicine at Midnight that the four-on-the-floor rock & roll ravers almost seem diminished in comparison.

Full Review >>

Pairing up with Adele and Sia songwriting sidekick Greg Kurstin for a second time following 2018's 'Concrete and Gold', Foo Fighters unhatch a new groove on LP10 that expands their sound into - gulp - funk and dance territory. A move which on paper spells trouble, but in practice pays off. While its predecessor was indebted to Motorhead and pulled in classic hard rock influences, 'Medicine At Midnight' takes its cues from 'Let’s Dance'-era Bowie.

The main thing that comes to mind when one thinks of American rock band Foo Fighters is stability. You know who their name, you know their history, you know some of their hits, you know their instantly-recognisable blend of honey and grit. And that's because they have been an omnipresent force in the music business, having been around now for just shy of 25 years.

Think back on the past decade of Foo Fighters' career -- what stands out? Maybe it's that time frontman Dave Grohl broke his leg and performed while sitting on a giant throne. Perhaps it's his viral drum-off challenge with a 10-year-old kid. Or it might be the band's seemingly endless parade of festival headlining slots and SNL appearances. Most recently, it was likely their performance at Joe Biden's presidential inauguration. What probably doesn't stand out, however, is that the band have continued to release albums at a steady clip.

Foos are back! (kinda) Way back in 2011, just before the turning of Wasting Light, I thought Foo Fighters were well and truly spent. At that point Foo Fighters was their only really great album, with Foos' follow-up, The Colour and the Shape, riding on the coattails of the eponymous debut as a decent alternative. Yet, even with my praises for both of those records, they aren't entirely cohesive in the "album experience" sense.

At this point, fans are either leaning into Foo Fighters' sonic turns in recent years or remain content with spinning The Colour and the Shape indefinitely. While the Foos always tipped a proverbial cap to various genres while standing atop their grunge-turned-modern rock foundations, Dave Grohl and company have embraced long-held influences tighter than ever in recent years, allowing prog and pop flavors to dominate multiple songs. The result is a more vibrant sonic bouquet—or a polarizing direction.

The aim to stay fresh and exciting when you have been together for twenty-five years is not one alternative rock legends Foo Fighters need to worry about. The tenth studio album from Dave Grohl and his cohorts marks a glorious depiction of the band's successful career in music. While each track inserts its own stroke of rock and roll lightning, they also work as a combined unit.

The Lowdown: During the Foo Fighters livestream show at the Roxy in November, Dave Grohl spent a little time wondering what could've been. "2020 was gonna be the best year ever!" he said to the audience-free club. "We had plans, man!" That show, while good, wasn't the ending to a triumphant 25th anniversary year that Grohl had in mind. COVID-19 upended most of the celebrations, including tours of Europe and America (one of which retraced the itinerary of the band's first tour from 1995), the Foo-curated D.C.

'Medicine at Midnight'

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Foo Fighters Release 10th Studio Album: Medicine At Midnight Review


New Dose of Foo

Foo Fighters released an amazing album in 2017’s Concrete & Gold . The anticipation for a follow-up album has been ever-growing throughout their past few years of touring. Now that touring is out of the situation, fans received new music through Medicine At Midnight . The band’s tenth studio album is satisfying, but not to its full potential. 

Track Reviews

“making a fire”.

“Making A Fire” lacks the energy of previous opening tracks. It’s not on the level of “This Is A Call”, “All My Life” and “Bridge Burning”. Those set the bar for their respective albums with adrenaline-filled riffs. “Making A Fire” did not deliver like such. Once the “na-na’s” started, the song lost some of its potential. 

“Shame Shame”

The eerie instrumentals put the band in a new territory of sound. It’s a bit mopey for a Foo album but will make its way up the charts. This was made purely for political commentary and is not a fitting style for the Foo. 


Where was this song the entire time? “Cloudspotter” is the track that should have opened the album. It has the familiarity to Concrete & Gold ’s track “Make It Right”. 

“Waiting On A War”

It’s a softer and upbeat song. It’s an attempt at another “Times Like These” or “Best Of You”, but it does not live up to those classics. Yet it will be the album’s leading radio hit. However, the last minute is a nice surprise of built-up rock. It’s reminiscent of “Walk” but with an acoustic guitar. 

“Medicine At Midnight”

The titular track feels like an homage to David Bowie seasoned with Eric Clapton. This isn’t the first time the Foo have thrown it back; they also paid homage to Pink Floyd in the psychedelic track “Concrete & Gold”.  The echoes of guitar chords and backup vocals are filled with classic rock vibes. The guitar solo is the cherry on top. It’s a different style of rock that suits them surprisingly well. An entire album with this vibe would be a great opportunity for them in the future. 

“No Son Of Mine”

“No Son Of Mine” is the best example of the band’s chemistry. This is quintessential Foo Fighters. Counting the notes for the verse is a challenge itself, nevermind how fast they play it. Also, Grohl is a better vocalist when he is not trying to be a good one. In this case, he’s just having fun screaming into the mic and it works. It sounds like it was left on the cutting board of Wasting Light but finally made its way to the public three albums too late.  

Read our full review of the track here .

“Holding Poison”

Again, another track that was lost in the archives of Wasting Light . This song progressively gets better and will be an amazing jam live. 

“Chasing Birds”

Foo slows down the pace with this mellow, unplugged track. It’s the calm after the rock storm. The lyrics are quite poetic but it could have been a minute shorter. Unfortunately, it fails to live up to previous lighter tracks like “Walking After You” and “Dirty Water”. 

“Love Dies Young”

This is heavily influenced by glam-rock. It’s not the best way to end the album.

Overall Review

Medicine At Midnight experiments with a shift of tone that doesn’t fit the Foo Fighters. Dave Grohl and Co. embody the dad-rock of our generation and it sounds awkward. The tracks that try to replicate the glam-rock genre are unsettling. Meanwhile, the tracks where they return to their roots are enjoyable. Songs like “Cloudspotter” and “No Son Of Mine” prove that age is just a number. They can still jam better than most younger bands. Even the pleasant surprise of “Medicine At Midnight” should receive some respect. It’s an album that has hints of The Colour And The Shape and Wasting Light , but overall feels like an underwhelming delivery in the vein of In Your Honor . 

Miss the old Foo after hearing Medicine At Midnight ? We can help:

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Album Review: ‘Medicine at Midnight’ by Foo Fighters

Grunge rock made for the dancefloor, foo fighters' tenth album overflows with crisp production and relentless positivity..

By Sean Maunier on February 18, 2021

Foo Fighters

A band two and a half decades into their career and as comfortably situated as Foo Fighters usually has two options. More than a few bands at similar points have chosen to double down on their strengths, do what they’re good at, and deliver something that pleases, albeit doesn’t really excite, their fans.

Foo Fighters could have chosen to release a low-stakes album, but they have opted to take the other, bolder route available to them. Medicine at Midnight (★★★☆☆) is a slicker, glossier take on the band’s normal raw, post-grunge sound, one that dials down the rock in favor of crisp production and relentless positivity.

At just 9 tracks that clock in at 36 minutes, Medicine at Midnight is a tightly contained album. Nothing on it feels superfluous or out of place, a timely reminder that despite the rawness and carefree abandon that Foo Fighters’ music usually exudes, there is always a meticulous thoughtfulness behind the songwriting. At its best, their approach results in some genuinely great moments, such as the tense buildups of “All My Life,” the addictive nah-nah-nahs of “Making a Fire,” and the stunning controlled chaos of standout single “Shame Shame.”

As tight and focused as it is, the album would have benefitted from some breathing room. Having the metal-inflected “No Son of Mine” coming in right after the funky, ponderous “Medicine at Midnight” is not so much jarring as slightly disorienting. The mellowness and retro shimmer of “Chasing Birds,” on the other hand, feels like it was written for a different album entirely. Medicine at Midnight is certainly full of well-crafted songs that mostly hold up well on their own, but taken together, they leave the impression that Dave Grohl and company were trying to do too much in too little time.

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Some unevenness is more than forgivable when a band is in uncharted waters, but even their new musical direction is far from the risk it has been hyped up as. For better or worse, despite the new direction in writing and production, Foo Fighters still sound very much like themselves. Despite all that has been made of their in interviews and publicity around the album, the unfamiliar elements come off as window dressing over the familiar grungy riffs and Grohl’s unmistakable vocals.

With that said, Foo Fighters deserve credit for making a bold, if slight late-career shift in the direction of a more pop-rock sound. The album was recorded before the pandemic and had it been released last year as scheduled, its release would have been perfectly timed to ride 2020’s wave of dancefloor-ready pop-rock. It’s clearly an album that would shine at a big summer festival.

Medicine at Midnight might be an uneven work, but as we collectively face down another quiet year for live music, its tracks might just be the pick-me-up we all need.

Medicine at Midnight is currently available for streaming, download, and physical purchase. For more information visit .

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Foo Fighters, ‘Medicine at Midnight’ Review – Track-by-Track Review of New Album

Foo Fighters, "Medicine at Midnight," album cover. Track-by-Track Review: Foo Fighters infuse pop into their rock sound with the band's new album, "Medicine at Midnight."

Foo Fighters, ‘”Medicine at Midnight,” album cover – Story by Anne Erickson, courtesy photo

Review: Foo Fighters are back with their new album, “Medicine at Midnight,” which infuses a dose of pop into the band’s straight-ahead rock sound. Here’s Audio Ink’s track-by-track review of the album.

Foo Fighters are the kind of rock band that pretty much any generation of music fan can appreciate, from kids to their grandparents. Choc it up to Dave Grohl and company’s mainstream blend of melodic rock ‘n ‘roll that’s simply likeable, never offensive, and pleasing to the ears.

Now, Foo Fighters are back with their 10th studio album, “Medicine at Midnight,” out Friday (Feb. 5) via Roswell Records/Columbia Records, and the set presents an even more likeable sound, as the band goes more pop than they ever have before. Don’t let the word “pop” cause alarm, though, as “Medicine at Midnight” still features a bevy of rockers with deep riffs and rhythms.

Foo Fighters ‘Medicine at Midnight’ Track-by-Track Look

Out the gate, Foo Fighters gives listeners what they’ve come to expect from the band with opening track, “Making a Fire.” The song is the Foo at their best, with a huge, melodic hook and super-catchy chorus. This is a more pop-infused song than many Foos jams, though, complete with clapping and cheesy “na-nas” that add a feel-good vibe.

The following track, “Shame Shame,” is a full-fledged rock anthem, with big guitars and warm sonics. The song also marks the Foos’ lead single off “Medicine at Midnight,” and it’s been another hit for the band. Counting 9.3 million audience impressions, the song marked the fastest rise to the top of the Billboard Rock Airplay chart in four years. “Another splinter under the skin / Another season of loneliness / I found a reason and buried it / Beneath the mountain of emptiness,” Grohl sings.

Next up is “Cloudspotter,” which offers funky guitars with an almost ’70s-psychedelic character. This is one of the most unique tracks on the album, complete with cowbell, syncopated beats and an upbeat, dance-worthy rhythm section.

“Medicine at Midnight” gets dramatic with the next track, “Waiting on a War,” which stars as an acoustic ballad and builds to a massive arena rocker that’s one of the strongest songs on the set. “There’s got to be more to this… because I need more,” Grohl begs in the swelling track.

The album’s title track follows, “Medicine at Midnight,” offering one of the more adventures selections on the set. With a raw, funk-infused character, disco loops and unplugged guitar, the song brings an experimental feel to the album. While it might not be anyone’s favorite Foo Fighters jam, it’s certainly one of the most musically diverse.

From there, the album launches into “No Son of Mine,” one of its more uptempo, punk-fueled tracks. The song, which carries an anti-war theme, incorporates a dirty, edgy riff that recalls bands such as Motorhead and Thin Lzzy. giving this a true classic rock feel.

While all of the tracks on the album are strong, “Holding Poison” is probably the most difficult to digest. Grohl sings with an strong vocal echo over choppy rhythms and riffs, and while the song is an upbeat listen, it probably won’t be a classic. Still, this is the Foos, and so the album’s weakest songs are strong.

The album continues with one of its strongest songs, “Chasing Birds,” a peaceful ballad that has possibly one of the best Foo Fighters melodies of all time. Think “Everlong” 2.0. While “Chasing Birds” wasn’t picked as an early single, we’re guessing it will top that charts down the road.

If fans think “Medicine at Midnight” doesn’t sound, well, Foo Fighters enough, then the album’s closing track, “Love Dies Young,” is here to save the day. The song features the band’s classic, straight-ahead rock style and sounds like it could have come from any era of the Foos. Call it a comforting cap to the record.

Clocking in at just over 36 minutes, “Medicine at Midnight” is on the short side, but Foo Fighters more than make up for that with the musical diversity apparent on the album. By the time the album kicks off to the final notes, it truly feels like a musical journey, going from the styles of Bowie to Motorhead and beyond. With solid songwriting and a passionate delivery, “Medicine at Midnight” is worth the buzz, and it shows why Grohl is considered one of a handful of kingpins of rock ‘n’ roll.

Ink rating: 9/10. Essential songs: “Shame Shame,” “Chasing Birds,” “Love Dies Young,” “Making a Fire.” For fans of: The Seattle sound brought into the modern day, with chunky riffs and rhythms, but also a love for experimentation. Online: .

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Our Take: With ‘Medicine at Midnight’, Foo Fighters’ Album Total Cracks the Double Digits in Grand Style

Foo Fighters © Danny Clinch

Josh's Take

The music is all a year old at this point, but ‘Medicine at Midnight’ still proves to be a fresh and worthy tenth entry to Foo Fighters’ expansive and impressive catalogue. 

Stream: ‘medicine at midnight’ – foo fighters.

I magine a scenario in which Dave Grohl, heartbroken by the loss of Nirvana bandmate Kurt Cobain, decides to retire from music out of respect for his dear companion in 1994. He’d still be remembered and talked about to this day for his contributions to one of the most iconic rock bands of all time.

So just how imagine how worthy of remembrance Grohl will be now that he has proven to be a key figure to not one, but two such iconic bands– the second of which, Foo Fighters, is now a quarter-century old and still going strong. Their 10th album, Medicine to Midnight , is an increasing rarity these days: A new release that was recorded outside of the isolation conditions imposed by COVID-19. The album received its finishing touches last February, only to be repeatedly delayed as the band waited in vain for the pandemic to end. Despite the lull time, the music still sounds as fresh as it would have had it been released early last year as planned, a testament to the enduring skills and chemistry of these six veteran rockers.

Medicine at Midnight - Foo Fighters

Medicine to Midnight is notable for being one of the first instances of Foo Fighters openly incorporating disco and dance in their music, a revitalized sound they liken to the 1983 album Let’s Dance by David Bowie.

One of the songs that most readily evokes that attribution is lead single “Shame Shame,” which Grohl describes as possessing “a dynamic and a vibe and a tone unlike anything we’ve ever done before.” As much as the track is influenced by party music genres, “Shame Shame” does come with a pretty ominous music video– one that Grohl says was inspired by a memorable nightmare he’d had as a teenager — and lyrics which bemoan, “ Another splinter under the skin. Another season of loneliness .” The album may have been recorded before the lockdown began, but those particular lines sure seem to have predicted the prevalent moods of that upcoming period.

If you want to I’ll make you feel something real just to bother you Now I got you Under my thumb like a drug, I will smother you

I’ll be the one, be the moon, be the sun be the rain in your song, go put that record on if you want to i’ll be the one, be the tongue that will swallow you, shame, shame, shame, shame another splinter under the skin another season of loneliness i found a reason and buried it beneath the mountain of emptiness, – “ shame shame ,” foo fighters.

Much of the rest of Medicine at Midnight strikes a similar, effective balance between upbeat music and more subdued thematic fair.

“Waiting on a War,” for instance, features a dramatic second-half shift from gradual acoustics to electric guitars and crazy-intense drum work by Taylor Hawkins, resulting in what is sonically one of the album’s most exciting moments. Yet the situation painted in the lyrics is far less celebratory: it describes a sense of impending doom inspired by both the Cold War paranoia Grohl experienced as a child, as well as sentiments expressed far more recently by his own daughter, Harper. Given everything that’s gone wrong in the world since this album was recorded, plenty of us can certainly relate to the line regarding how “Everyday [I’m] waiting for the sky to fall / Big crash on a world that’s so small.”

On top of these new themes and sounds, there are plenty of other ways in which the Foo Fighters have brought an innovative twist to their music on Medicine at Midnight . It’s always a major moment for a rock band when one of their offspring who hadn’t even been born when the group was first formed joins them in the studio for the first time. In this case, Dave Grohl’s older daughter, Violet, contributes some delightful “na-na-na’s” to the uplifting album opener, “Making a Fire.” It’s also nice to see the group dabble not just in disco, but also soul music: “Chasing Birds” serves as the record’s sole slow-burner, as the band decides to chill out for a bit, although not without excluding some of solemn feelings that has previously surfaced on the album (“ Say goodbye, I’m never coming back. Here comes another heart attack. “)

Foo Fighters © Danny Clinch

For all of the experimentation featured on Medicine at Midnight , Foo Fighters still return to their straight-up rock roots on “Love Dies Young.” You might not expect a man who’s been steadily married for close to 20 years describe love as “ a bitter kiss that’ll make you wish you never had a taste ,” but Grohl delivers a convincing vocal performance of these lines all the same. The song winds up being a glorious album closer that channels all the high-octane energy the band has been celebrated for throughout their career.

Love dies young and there’s no resuscitation Once it’s done, no regeneration It’s a losing game that’ll make you play Your hand against your chest Love dies young

Love dies young and there’s no reanimation once it’s gone, no regeneration it’s a bitter kiss that’ll make you wish you never had a taste, love dies young, oh please don’t take my breath don’t take my breath away love dies young.

With any luck, Medicine to Midnight will get the accompanying world tour it was denied and still deserves– something Grohl, for once, is evidently looking forward to. Yet no matter how the vaccine rollout pans out, Foo Fighters can still take plenty of pride in having pulled off such a great later-career success, a record brimming with some of their liveliest and most party-ready music ever.

:: stream/purchase Medicine at Midnight  here ::

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Album review: Foo Fighters – Medicine at Midnight

  • March 24, 2021

review medicine at midnight

Foo Fighters have established themselves as a household name and continue to sell out arenas all over the world, but after playing together for over 25 years, the question needs to be asked; do you stick with a tried and true sound or go down the experimental route for the latest album? The answer the Foo Fighters have given with their latest album is why not try and do both?

Having been formed initially as a solo project in 1995 by former Nirvana drummer Dave Grohl, Foo Fighters have been one of the biggest acts in not just rock, but music in general. The Colour and the Shape in 1997 saw the band make their break and established Dave Grohl as a viable artist, finally losing the moniker of ‘that guy from Nirvana’. ‘Everlong’, from The Colour and the Shape, continues to be one of the band’s enduring anthems and is still the regular closer at their live shows. With nine albums under their belts before the release of ‘Medicine At Midnight’, some critics and even fans said that the band had very much established their sound and were sticking to it, with flashes of experimentation, particularly on 2017’s Concrete and Gold, but nothing like a full on departure. That was until ‘Shame Shame’, the lead single from the 10 th and latest album ‘Medicine At Midnight’ was released, which saw the band rock the boat completely.

‘Shame Shame’ is not the thumping rock anthem you would expect from Foo Fighters to announce their return, but rather a delicate, genre-crossing track where a driving drum beat and soaring violins are the centrepiece. It also allows Grohl to showcase his vocal range a lot more than usual, jumping between speaking to full blown ‘ooh’s’ that you can already hear fans emulating when arenas can be filled again. The track was met with mixed reception from fans and critics, but there was more excitement for a Foo Fighters’ album than there had been for over a decade as this was the most different the band had sounded in its entire history.

So, after months of waiting, what does ‘Medicine At Midnight’ actually sound like? Truthfully, it’s the Foo Fighters you expect with hints of experimentation here and there once again. That’s not to say it’s a bad thing, just not the total departure we were expecting. The band has fully embraced it’s influence and love of classic rock by emulating bands like Motorhead on tracks like ‘No Son of Mine’, a roaring and storming guitar driven beast that is sure to become a live staple like ‘All My Life’. Opening track ‘Making A Fire’ is another 70’s rock influenced song featuring a crescendo of powerful licks and drums, but is the first instance where we see this experimentation kick in, with the inclusion of a full backing choir that gives the song an almost gospel like quality.

There are a couple of hidden gems on the album that stand out as some of the strongest writing the band has done in years. ‘Chasing Birds’ is a laid back song that combines a few sounds and genres, emulating both the Beatles and Bee Gees in its dreamy melody and soft vocals that could be the Foo’s attempt at ‘How Deep Is Your Love’. There’s something beautifully simple about the song that makes it work. Eponymous track ‘Medicine At Midnight’ is a funk/blues crossover track that is straight off David Bowie’s 1983 album ‘Let’s Dance’, with a sultry grove that makes the track infectious.

However, it isn’t all smooth sailing. Tracks like single ‘Waiting on a War’, a mid tempo anthem that have become common on Foo Fighters’ albums throughout their career, and ‘Cloudspotter’, a lively but safe track, feel like filler which on an album that has nine songs and clocks in at just over 36 minutes, is disappointing. There also feels like a slightly missed opportunity from the band to have followed the route they had with ‘Shame Shame’ and completely departed from their sound altogether, just to shake things up a bit.

All in all, ‘Medicine At Midnight’ is a solid record, if not still a little bit too safe. However, if you’re a Foo Fighters fan, there’s definitely enough of the band you know to keep you entertained as it’s the sound of a group that have been playing for 25 years and are still having a good time doing it.

review medicine at midnight

Author: James, Bath store

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  • Aerobic exercise interventions for promoting cardiovascular health and mobility after stroke: a systematic review with Bayesian network meta-analysis
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  • Kevin Moncion 1 ,
  • Lynden Rodrigues 2 , 3 ,
  • Elise Wiley 1 ,
  • Kenneth S Noguchi 1 ,
  • Ahmed Negm 4 ,
  • Julie Richardson 1 , 5 ,
  • Maureen Jane MacDonald 6 ,
  • Marc Roig 2 , 3 ,
  • Ada Tang 1
  • 1 School of Rehabilitation Sciences , McMaster University Faculty of Health Sciences , Hamilton , Ontario , Canada
  • 2 School of Physical and Occupational Therapy , McGill University , Montreal , Quebec , Canada
  • 3 Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR) , Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital , Laval , Quebec , Canada
  • 4 University of Calgary Cumming School of Medicine , Calgary , Alberta , Canada
  • 5 Department of Health Research Methods Evidence and Impact , McMaster University Faculty of Health Sciences , Hamilton , Ontario , Canada
  • 6 Department of Kinesiology , McMaster University Faculty of Science , Hamilton , Ontario , Canada
  • Correspondence to Dr Ada Tang, School of Rehabilitation Sciences, McMaster University Faculty of Health Sciences, Hamilton, Canada; atang{at}

Objective To determine the superiority of aerobic exercise (AE) interventions on key outcomes of stroke recovery, including cardiorespiratory fitness (V̇O 2 peak, primary outcome), systolic blood pressure (SBP) and mobility (6 min Walk Test (6MWT) distance and 10 m Usual Gait Speed) after stroke.

Data sources MEDLINE, EMBASE, Web of Science, CINAHL, CENTRAL, SPORTDiscus, PsycINFO and AMED Allied and Complementary Medicine were searched from inception to February 2023.

Eligibility criteria Randomised controlled trials were included that compared the effects of any AE interventions (low-intensity, moderate-intensity, high-intensity continuous training (HICT), high-intensity interval training (HIIT)) to no exercise, usual care or other AE interventions in individuals poststroke.

Analyses Systematic review with Bayesian network meta-analysis (NMA) methodology was employed. Surface under the cumulative ranking curve (SUCRA) values were used to rank interventions. The Grading of Recommendations, Assessment, Development and Evaluation minimally contextualised framework for NMA was followed.

Results There were 28 studies (n=1298) included in the NMA for V̇O 2 peak, 11 (n=648) for SBP, 28 (n=1494) for 6MWT and 18 (n=775) for the 10 m Usual Gait Speed. The greatest effect on V̇O 2 peak, 6MWT and 10 m Usual Gait Speed was observed after HIIT and HICT. No differences between interventions were found for SBP. SUCRA values identified HIIT as the superior AE intervention for all outcomes of interest. HIIT was the most effective intervention for improving V̇O 2 peak (2.9 mL/kg/min (95% credible interval 0.8 to 5.0) moderate certainty) compared with usual care.

Conclusion This NMA suggests that higher-intensity AE is superior to traditional low-intensity to moderate-intensity AE for improving outcomes after stroke.

  • Rehabilitation
  • Physical fitness
  • Exercise Therapy
  • Risk factor

Data availability statement

Data are available on reasonable request.

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Aerobic exercise (AE) training is an effective and recommended intervention for promoting cardiorespiratory fitness (V̇O 2 peak), cardiovascular health and mobility after stroke.

There is debate regarding the most effective AE intervention for promoting stroke recovery, and a new superiority analysis with more novel AE prescriptions, including high-intensity interval training (HIIT), is needed to guide clinical practice.


This large-scale systematic review and network meta-analysis of 47 randomised controlled trials identified that HIIT and high-intensity continuous training significantly improve V̇O 2 peak, 6 min Walk Test distance and 10 m Usual Gait Speed among people poststroke compared with lower-intensity and usual care exercise programmes.

HIIT appears to be the top ranked intervention across all outcomes of interest. We have moderate certainty evidence that our findings are clinically significant and eclipse the minimal clinical important difference (MCID) for V̇O 2 peak (3.2 mL/kg/min vs MCID=3.0 mL/kg/min) and 10 m Usual Gait Speed (0.34 m/s vs MCID=0.13 m/s) after HIIT.


These findings suggest that healthcare and exercise professionals should encourage the adoption of high-intensity AE, whether performed in intervals or continuously, in clinical practice and community settings to enhance stroke recovery. These findings also provide current and comprehensive data to update clinical practice guidelines for AE after stroke.


Stroke is the leading cause of disability and the third-leading cause of death worldwide 1 accounting for over 6.5 million deaths and 143 million disability-adjusted life-years lost in 2019. 2 The burden of stroke-related death and disability can be attributed to a rise in the prevalence of modifiable cardiovascular disease risk factors, 3 low cardiorespiratory fitness (V̇O 2 peak), 4–6 and lack of physical activity 7 and exercise participation among stroke survivors. 8 These factors contribute to a physiological environment rich in oxidative stress, inflammation and vascular dysfunction, which are associated with vascular cognitive impairment and stroke recurrence. 9

Aerobic exercise (AE) training, commonly prescribed as moderate-intensity continuous training (MICT), 10 11 is recommended for secondary stroke prevention and cardiovascular risk factor management. This prescription is individualised, but typically involves targeted exercise at 40%–60% of heart rate reserve (HRR) for 20–60 min, 3–5 times per week. 10 11 Previous meta-analyses, primarily comprised MICT interventions, have reported significant benefits of AE training for improving V̇O 2 peak, 12 mobility (6 min Walk Test distance (6MWT), 10 m Usual Gait Speed), 12 and other cardiovascular risk factors such as systolic blood pressure (SBP), 13–15 when compared with usual care or non-exercise control interventions. As such, MICT remains the primarily recommended exercise intervention for stroke. 11 However, mounting evidence suggests that novel interventions, such as high-intensity interval training (HIIT), may stimulate distinct physiological mechanisms, leading to superior improvements in cardiovascular health outcomes and mobility among individuals poststroke. 16–18

A limitation of previous meta-analyses is that prescriptions of AE interventions are often overlapping and combined to facilitate one direct pairwise comparison between exercise and control. 12–15 18 However, in the context of exercise, there are many competing AE interventions that are likely to lead to differing treatment effects. 16 Thus, a single effect estimate derived from pooled exercise interventions may lack precision and lead to inadequate dosing of AE after stroke. 19 Network meta-analyses (NMA) can bridge this knowledge-implementation gap by examining the comparative effectiveness of competing AE interventions, developing precise effect estimates, and establishing a rank order of treatments from least to most effective. 20 This will help healthcare professionals and community exercise specialists effectively determine which AE intervention provides the greatest treatment effects to guide AE prescription for individuals poststroke.

To date, no large-scale synthesis has examined the comparative effectiveness and superiority of different AE interventions for improving cardiovascular health or mobility outcomes following stroke. The purpose of this systematic review and NMA was to establish the effects and superiority of different AE interventions for improving V̇O 2 peak (primary outcome) and SBP (secondary outcome) as a key cardiovascular risk factor, 3 as well as mobility outcomes (6MWT and 10 m Usual Gait Speed, tertiary outcomes) in individuals poststroke. Given the anticipated intensity-dependent response, 16 it is hypothesised that higher-intensity exercise interventions, whether performed in intervals or continuously, will lead to superior health outcomes after stroke.


Study design.

This systematic review with Bayesian NMA was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for NMA 21 and was registered with PROSPERO (Protocol #303297). The established protocol plan was followed without significant deviations.

Search strategy

An electronic literature search was conducted in eight databases, MEDLINE, EMBASE, Web of Science, CINAHL, CENTRAL, SPORTDiscus, PsycINFO and AMED Allied and Complementary Medicine, from journal inception to 27 February 2023, with restriction to articles published in English. The search strategy was developed, piloted and refined in collaboration with a research librarian and used keywords related to stroke, AE and randomised controlled trials (RCTs). Grey literature, trial registries (eg, ), reference lists of included articles and relevant systematic reviews were handsearched to identify any additional potentially relevant literature. All search results were imported into Covidence software for study selection procedures. The full search strategy is provided in online supplemental appendix 1.0 .

Supplemental material

Inclusion and exclusion criteria.

Studies were included in this review if they were a published RCT that examined the effect of any AE intervention on cardiorespiratory fitness (V̇O 2 peak, primary outcome), SBP as a key cardiovascular risk factor (SBP, secondary outcome), other modifiable cardiovascular risk factors (eg, diastolic blood pressure (DBP), fasting glucose, fasting insulin, glycosylated haemoglobin, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol; secondary outcomes), anthropometric measurements (body mass index, hip-waist ratio, waist circumference; secondary outcomes) or mobility outcomes (eg, 6MWT distance and fast and usual 10-metre gait speed, tertiary outcomes) in individuals with stroke. Several control interventions were eligible for inclusion in the network of evidence including no exercise treatment (eg, no prescribed intervention, relaxation exercises, passive treatment including passive range of motion or mobilisations), usual care (eg, usual stroke rehabilitation typically includes gait training, active range of motion, stretching, light resistance training, balance or functional training), and AE interventions featuring different intensity parameters were compared (eg, low vs moderate intensity AE).

Participants were adults over 18 years old, with no restrictions on the type (eg, ischaemic, haemorrhagic, transient ischaemic attack) or timing poststroke. Studies were excluded from this review if they (1) were editorials, theses, poster or conference abstracts or presentations, or opinion pieces; (2) did not report exercise prescription parameters according to the FITT principle: frequency, intensity, time, and type of AE; (3) included robot-assisted, exoskeleton, exergame or virtual rehabilitation technologies as either an intervention or control; (4) examined outcomes not related to V̇O 2 peak, mobility or cardiovascular risk factors in individuals with stroke and (5) were preclinical animal studies.

Study selection procedure

Two independent reviewers (reviewer 1: KM (all studies), reviewer 2: one of LR, EW and KSN (divided equally) independently conducted title and abstract screening and full-text evaluation. All reviewers (KM, LR, EW and KSN) first piloted the screening template by independently screening a predetermined set of abstracts (n=50) and full-text articles (n=5). After piloting the screening template for abstracts and full-text screening, study reviewers deliberated, compared results and resolved any discrepancies to ensure the screening criteria and data extraction sheets were clear and consistently applied. A third reviewer (AT) was consulted as needed to resolve any conflicts.

Data extraction procedures

Two independent authors (reviewer 1: KM and reviewer 2: LR or EW) conducted data extraction. Extracted data included study and participant characteristics, AE intervention parameters and control group details, and outcome measurements. A comprehensive list of extracted data can be found in online supplemental appendix 1.1 . In the event of disagreements, they were resolved by consensus between authors and a third reviewer (AT) in case of conflict. Pilot testing of the data extraction sheets was performed with a small number of articles (n=5) to ensure consistency between reviewers.

Exercise prescriptions of interest

AE was defined as the specific set of interventions of direct interest for the present NMA and is referred to as the decision set. 22 Each intervention was categorised using the FITT principle: frequency, intensity, time and type of AE. Per the AEROBICS 2019 guidelines 11 and the American College of Sports Medicine, 23 AE intensity was based on the reported per cent heart rate max (HRmax) or HRR or ratings of perceived exertion (RPE) and defined as low (<54% HRmax, <40% HRR, <11/20 RPE), moderate (55%–69% HRmax, 40%–59% HRR, 12–15/20 RPE) or high (>70% HRmax, >60% HRR, >15/20 RPE) and included in the decision set. HIIT interventions were also included in the decision set and adapted using previous definitions. 16 24 A decision-making algorithm was developed by KM and AT to assist with group allocation in the decision set. Briefly, if the exercise programme had a clearly described intensity level, it was grouped as defined (eg, moderate, 40%–59% HRR). If an exercise programme had overlapping intensity levels with a clear progression plan to achieve a given intensity (eg, 12 weeks of 40%–80% HRR, with 10% increase in %HRR every 4 weeks), it was grouped as the highest target intensity. An exercise programme with overlapping intensity levels without a clearly described progression plan was grouped conservatively as the lowest defined target intensity. Lastly, if an exercise programme had overlapping or unclear intensity levels but included a patient-reported intensity target value (eg, RPE), the participant-reported target value guided the exercise grouping for the present analysis. The decision-making algorithm was also used to assist with group allocation for AE control groups. The decision-making algorithm was implemented by KM and verified by consensus with LR and with consultation with AT in the event of disagreement.

Data analysis

Where applicable, descriptive data extracted was analysed descriptively, including mean±SD, mode and median (IQR). Data were organised and summarised in tables and figures and narratively described in the text.

Effect measures and data transformations

The number of participants, mean value and the SD of the outcome measurements in each group were used in the meta-analysis using mean differences. All extracted outcome data were converted into means and SDs. SDs were converted from the reported SE or CI. 25 If SDs of change scores were not reported, they were imputed using a correlation coefficient derived from similar studies. 26 Means and SDs were estimated following procedures outlined by Wan et al if medians, IQRs or ranges were reported. 25 If METs were reported as an outcome of V̇O 2 peak, they were converted to stroke adjusted V̇O 2 peak since 1 MET=3.0 mL/kg/min in individuals poststroke. 27

Pairwise meta-analysis

Pairwise meta-analyses were performed using a random-effects model, given that studies differed methodologically and clinically, resulting in between-study heterogeneity. 28 Between-study heterogeneity of the treatment effects within each treatment comparison was assessed using the I 2 statistic 29 and its 95% CI and the magnitude of the between-study variance (τ 2 ) and its 95% CI, as estimated using the restricted maximum likelihood estimator and the Q-profile approach. 30 31

Network meta-analysis

A Bayesian random-effects NMA was conducted using Markov Chain Monte Carlo simulations. This analysis included outcomes from a network of at least 10 studies to ensure network connectedness and allow for meaningful comparisons. A common within-network between-study variance (τ 2 ) was assumed since no clinically important differences in the heterogeneity were expected across treatment comparisons. Vague informative priors were assumed for all Bayesian NMA model parameters. The models were run for 100 000 iterations after discarding the first 10 000 iterations and thinning of 10. To evaluate the convergence of the model, 3 chains were used, and models were assessed using the trace plots of leverage vs Bayesian deviance residual, Gelman-Rubin and Geweke convergence diagnostics. 32 Convergence was assumed using a combination of the Potential Scale Reduction Factor for each parameter (≤1.05), and if z -scores from the Geweke diagnostics are reported as larger than 1.96 or smaller than −1.96. 33 For each NMA, the assumptions of consistency and transitivity were assessed a priori. 34 35

To examine consistency at the global level, the deviance information criterion (DIC) was compared between an inconsistency model and a model in which consistency was assumed. The node-splitting method was used to examine local inconsistency between direct, indirect and network estimates, and statistical inconsistency was considered when p≤0.05. 36 If significant inconsistency was detected, data were checked for potential abstraction errors, and in the absence of errors, significant inconsistency was explored by conducting meta-regression analysis using the potential effect modifiers. The plausibility of intransitivity was assessed via visual observation of scatterplots and box and whisker plots of the distribution of effect modifiers across studies. Effect modifiers included the proportion of females in each study arm, mean age and exercise intervention volume, which was calculated as the product of time (minutes per week), intensity (eg, 80%) and intervention duration (weeks). 37

Network meta-regression was conducted for the primary outcome (V̇O 2 peak), considering potential treatment effect modifiers. The fit of the meta-regression model was carried out using a plot of the leverage values and the corresponding effective number of parameters (pD), total residual deviance (D res ) and the DIC. A larger DIC suggests a worse model fit, and a D res value close to the total number of arms included in the analysis suggests a good fit. A combination of the pD, D res and DIC values was used to help determine model choice when considering competing models. A difference in DIC≤3 suggests no significant difference between the competing models. 38 This approach was used to compare the fixed versus random effects, consistency versus inconsistency and meta-regression versus random effect models.

Interventions of each outcome were ranked using the surface under the cumulative ranking curve (SUCRA). 39 40 SUCRA values range from 0 to 100%, with higher SUCRA values indicating the higher likelihood that a treatment is in the top rank or one of the top ranks. 41 Network diagrams were created to represent the available evidence in a figure. Each node represents the different interventions and comparators. The size of each node and the weight of the lines visually represent the proportional number of studies comparing two connected nodes within the network. Network estimates were reported in league tables, including posterior mean differences and 95% credible intervals (CrI). Forest plots were generated to present network estimates compared with usual care.

All statistical analyses were conducted within R statistical software (V.4.2.2). Random effects pairwise meta-analyses were conducted using the meta package, 42 Bayesian NMAs were conducted using the BUGSnet package 43 and the node-splitting method was conducted using the gemtc package. 36

Sensitivity analyses

Comparison-adjusted funnel plots were examined for extreme and small study effects and potentially outlying studies for the primary outcome (V̇O 2 peak). When potential outliers were identified, they were excluded in a sensitivity analysis to assess the robustness of the results.

Risk of bias

Study quality and risk of bias of each study and outcome were independently assessed by two independent authors (reviewer 1: KM and reviewer 2: LR or EW) using the Cochrane Risk of Bias 2 assessment. 44 Briefly, this assessment included rating the risk of bias (low, high or some concerns) of the following domains: random sequence generation; allocation concealment; blinding of participants and personnel; blinding of outcome assessment; incomplete outcome data; and selective reporting bias. 44 Disagreement was resolved by consensus or with a third reviewer (AT). Risk of Bias 2 summary plots were generated using robvis. 45

Grading the quality of evidence

One reviewer (KM) evaluated the quality of evidence by using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) for NMA using the direct, indirect and network estimates from the node splitting analysis. 46–48 The certainty for each comparison and outcome was rated as high, moderate, low or very low, based on considerations of risk of bias, inconsistency, indirectness, publication bias, intransitivity, 49 incoherence 50 and imprecision. 51 Judgements of imprecision were made using a minimally contextualised approach, with a null effect as the threshold of importance. 52 For the primary outcome, treatments were then classified in groups from the most to the least effective using the minimally contextualised framework, 52 which focuses on the treatment effect estimates and the certainty of the evidence. The GRADE assessment was then discussed with the authors to ensure consensus on the interpretation of findings.

Equity, diversity and inclusion statement

Our study included all identified RCTs of AE training after stroke, with no exclusion criteria on sex, gender, race, ethnicity and socioeconomic level. Our research team consisted of individuals working in three provinces across Canada and included four women and five men from different ethnicities, disciplines (rehabilitation, physiology, medical research, exercise science and population health) and stages across academic careers.

Study selection

The flow of the systematic review is presented in figure 1 . The database search yielded 7463 records. The examination of titles and abstracts resulted in the retrieval of 160 full-text records. Following full-text evaluation, 46 studies were included in the review (V̇O 2 peak NMA (n=28 studies, primary outcome), SBP NMA (n=11 studies, secondary outcome), 6MWT NMA (n=28 studies, tertiary outcome), 10 m Usual Gait Speed NMA (n=18 studies, tertiary outcome)). A complete list of studies, demographic information and post-intervention outcomes are reported in online supplemental appendix 2.0 . NMAs of other outcomes including DBP (n=11 studies), resting heart rate (n=10 studies) and fast gait speed (n=18 studies) are reported in online supplemental appendix 3.0 . Few studies reported on vascular risk factors which restricted meaningful NMAs, including body mass index (n=7 studies), LDL and HDL cholesterol (n=5 studies), fasting insulin (n=3 studies) and glucose (n=3 studies), glycosylated haemoglobin (n=3 studies), total cholesterol (n=5 studies) and waist circumference (n=2 studies).

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Flow chart of studies identified and included in the systematic review and network meta-analysis. 6MWT, 6 min Walk Test ; FITT, frequency, intensity, time and type; SBP, systolic blood pressure.

Network geometry

Figure 2 displays the network plot detailing the treatment comparisons for V̇O 2 peak ( figure 2A ), SBP ( figure 2B ), 6MWT ( figure 2C ) and 10 m Usual Gait Speed ( figure 2D ). The V̇O 2 peak NMA (28 studies, n=1298 participants) included 6 interventions, 15 total pairwise comparisons and 10 direct pairwise comparisons ( figure 2A ). The SBP NMA (11 studies, n=648 participants, figure 2B ) included 5 interventions, 10 total pairwise comparisons and 6 direct comparisons. The 6MWT NMA included 28 studies, n=1494 participants, 6 interventions, 15 total pairwise comparisons and 7 direct pairwise comparisons ( figure 2C ). The 10 m Usual Gait Speed NMA (18 studies, n=775 participants) included 6 interventions, 15 total pairwise comparisons and 7 direct pairwise comparisons ( figure 2D ).

Network geometry for (A) peak oxygen uptake (V̇O 2 peak), (B) systolic blood pressure (SBP), (C) 6 min walk test (6MWT) and (D) 10 m Usual Gait Speed. Each node indicates an aerobic exercise intervention and is weighted according to the number of participants who received the intervention. Each line connecting the nodes is weighted according to the number of studies which contain pairwise comparisons. HICT, high-intensity continuous training; HIIT, high-intensity interval training; Low, low-intensity continuous training; MICT, moderate-intensity continuous training.

Study characteristics

Characteristics of included studies are detailed in online supplemental appendix 2.0 . A total of 2517 participants were included in this review. The common aerobic intervention groups included MICT (n=22 arms), 17 53–73 high-intensity continuous training (HICT) (n=23 arms), 61 68 74–94 HIIT (n=8 arms) 17 54 60 65 67 95–97 and low (n=5 arms). 63 69 74 80 88 The most common comparator was usual care (n=31 arms) 53 55 57–59 62 64 65 70–73 75 78 79 81–87 89–93 95–98 which commonly included components of stroke rehabilitation such as gait retraining, active or passive range of motion, stretching, light resistance training, balance, functional training or education on physical activity, lifestyle and medication modifications and no exercise (n=4 arms). 56 66 76 94 Briefly, sample size ranged from 5 to 105 participants (mean age range, 48–76 years; one study did not report the mean age of participants 76 ), and study duration ranged from 3 to 24 weeks. The majority of studies were conducted in either North America (n=14 USA, n=3 Canada, n=1 Jamaica) and Europe (n=4 Denmark, n=3 Germany, n=2 Norway, n=2 Sweden, n=1 Belgium, n=1 Italy, n=1 Ireland, n=1 Hungary), followed by Asia (n=3 Taiwan, n=2 China, n=2 Israel), Oceania (n=4 in Australia, n=1 in New Zealand) and South America (n=1 Brazil). The proportion of females ranged from 0% to 65%, and three studies did not report sex distributions. 64 83 85 Most studies were conducted with participants at least 6 months poststroke (n=41 studies, 87%), followed by the participants between 7 days and 3 months poststroke (6 studies, 13%).

For the primary outcome, most studies were rated as having an unclear (n=15, 54%) or a high risk of bias (n=12, 43%). One study was rated as a low risk of bias (n=1, 3%). Missing outcome data due to participant dropouts and selection of the reported result due to unblinded outcome assessments were the most frequently identified sources of high risk of bias. A summary of the risk of bias assessment is presented in online supplemental appendix 2.1 .

Network estimates of all AE prescriptions

The posterior mean difference and 95% CrI from all network comparisons are displayed in table 1 for V̇O 2 peak ( table 1A ), SBP ( table 1B ), 6MWT ( table 1C ) and 10 m Usual Gait Speed ( table 1D ). For the primary outcome, treatments were classified from the most to the least effective using the minimally contextualised framework 52 in table 2 . A GRADE table for each outcome and comparison is outlined in online supplemental appendix 2.2 .

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League table for all mean differences and 95% credible interval (CrI) by outcome and aerobic exercise intervention

Final classification of all aerobic exercise interventions, based on network meta-analysis of interventions for aerobic exercise and cardiorespiratory fitness in people poststroke

Cardiorespiratory fitness

The effect of each AE prescription compared with usual care on V̇O 2 peak is displayed in figure 3A . The posterior mean difference for all interventions ranged from 0.04 to 3.2 mL/kg/min. The largest network estimates were observed after HIIT (3.2 mL/kg/min, 95% CrI (0.7 to 5.6), moderate certainty), followed by HICT (2.4 mL/kg/min, 95% CrI (0.3 to 4.5), moderate certainty) and MICT (2.3 mL/kg/min, 95% CrI (0.3 to 4.4), moderate certainty). There were no significant differences between HIIT, HICT and MICT pairwise comparisons. Compared with usual care, the effect of low (0.08 mL/kg/min, 95% CrI (−2.0 to 1.9), low certainty) and no exercise (0.2 mL/kg/min, 95% CrI (−2.3 to to 2.8), low certainty) were the only non-significant comparisons.

Forest plots of the posterior mean difference and 95% credible intervals of each aerobic exercise intervention compared with usual care for outcomes (A) peak oxygen uptake (V̇O 2 peak), (B) systolic blood pressure, (C) 6 min Walk Test and (D) 10 m Usual Gait Speed. HICT, high-intensity continuous training; HIIT, high-intensity interval training; Low, low-intensity continuous training; MICT, moderate-intensity continuous training.

Systolic blood pressure

The effect of each AE intervention compared with usual care on SBP is displayed in figure 3B . The posterior mean difference for all prescriptions ranged from 0.2 to –7.1 mm Hg. The largest network estimates were observed after HIIT (−7.1 mm Hg, 95% CrI (−18.6 to 3.9), low certainty), followed by HICT (−6.3 mm Hg, 95% CrI (−19.2 to 3.0), low certainty), MICT (−2.8 mm Hg, 95% CrI (−10.5 to 5.9), low certainty) and no exercise (2.2 mm Hg, 95% CrI (−7.1 to 11.6), low certainty). There were no significant differences observed for any pairwise comparison.

6 min Walk Test distance

The effect of each AE intervention compared with usual care on 6MWT distance is displayed in figure 3C . The posterior mean difference for all prescriptions ranged from −2.3 to 41.9 m, with the largest significant network estimate following HICT (39.4 m, 95% CrI (16.1 to 66.5), low certainty). Compared with usual care, the effect of HIIT (41.9 m, 95% CrI (−12.1 to 94.9), low certainty), MICT (24.1 m, 95% CrI (−1.4 to 48.9) very low certainty) and low (12.4 m, 95% CrI (−32.9 to 54.2) very low certainty) were non-significant comparisons.

10 m Usual Gait Speed

The effect of each AE prescription compared with usual care on the 10 m Usual Gait Speed is displayed in figure 3D . The posterior mean difference for all prescriptions ranged from 0.05 to 0.34 m/s, with the largest significant effect from HIIT (0.34 m/s 95% CrI (0.13 to 0.55), moderate certainty), followed by MICT (0.20 m/s, 95% CrI (0.05 to 0.35), low certainty). Compared with usual care, the effect of no exercise (0.09 m/s, 95% CrI (−0.04 to 0.23), very low certainty), HICT (0.04 m/s, 95% CrI (−0.04 to 0.12), very low certainty) and low (−0.07 m/s, 95% CrI (−0.21 to 0.07), very low certainty) were non-significant comparisons.

Additional outcomes

Additional outcomes of DBP (n=11 studies), resting heart rate (n=10 studies) and fast gait speed (n=18 studies) are reported in online supplemental appendix 3.0 . Briefly, HIIT interventions consistently ranked as the most superior intervention for improving DBP (SUCRA 79%), resting heart rate (49%) and fast gait speed (48%). There were no significant differences between any pairwise comparisons.

Superiority of ranking

Figure 4 displays the SUCRA curves, which indicate the percent probability that each intervention would rank in the top interventions for V̇O 2 peak ( figure 4A ), SBP ( figure 4B ), 6MWT ( figure 4C ), 10 m Usual Gait Speed ( figure 4D ). For V̇O 2 peak, the top three ranking interventions included HIIT (72%), followed by HICT (18%) and MICT (9%). For SBP, the top three interventions included HIIT (49%), HICT (44%) and MICT (4%). For 6MWT, the top three interventions included HIIT (48%), HICT (44%) and MICT (4%). For 10 m Usual Gait Speed, the top three interventions included HIIT (96%), MICT (2%) and no exercise (2%). SUCRA figures for additional outcomes are reported in online supplemental appendix 3.0

Probability of ranking for each intervention for outcomes (A) peak oxygen uptake (V̇O 2 peak), (B) systolic blood pressure, (C) 6 min Walk Test and (D) 10 m Usual Gait Speed. HICT, high-intensity continuous training; HIIT, high-intensity interval training; Low, low-intensity continuous training; MICT, moderate-intensity continuous training.

Model fits and network inconsistency

All model fit outputs and node-splitting analyses are provided in online supplemental appendix 2.3 . For the V̇O 2 peak NMA, the random effects and consistency model (DIC=102, Dres=57) was superior fitting to the fixed effects model (DIC=128, Dres=95) and the inconsistency model (DIC=106, Dres=60). No meaningful differences were found between all model fit parameters for SBP, 6WMT and 10 m Usual Gait Speed. The node-splitting analyses for the primary outcome revealed no local inconsistency, as evidenced by no statistically significant differences between direct, indirect and NMA evidence (Bayesian p>0.05).

Sensitivity analyses of the primary outcome and their results are reported in online supplemental appendix 2.5 . For the V̇O 2 peak NMA, eight studies 17 60 63 65 67 68 76 88 were identified as potentially outlying through visual inspection of funnel plots. Overall, the effects for all AE interventions versus usual care remained statistically significant, such that posterior mean differences ranged from 0.14 to 3.04 mL/kg/min, with the largest from HIIT 3.0 mL/kg/min (95% CrI 1.0 to 5.0), followed by HICT 2.5 mL/kg/min (95% CrI 1.5 to 3.5) and MICT 2.1 mL/kg/min (95% CrI 1.1 to 2.9). The effectiveness and ranking of interventions remained consistent with the non-adjusted random effects model.

Network meta-regression

Network meta-regression model fits are for the primary outcome of V̇O 2 peak are in for online supplemental appendix 2.6 . Model fit was not meaningfully different compared with the unadjusted random effects model for all potential effect modifiers. Age, sex and training volume did not yield any apparent modifying effect on the effect for each AE prescription.

The present NMA represents the most extensive synthesis of AE data from randomised trials in stroke rehabilitation to establish the superiority of different AE interventions. In this systematic review and NMA, we analysed all relevant RCT data involving 47 trials and 2517 participants after stroke to establish the superiority and effectiveness of AE prescription for improving V̇O 2 peak, mobility and resting SBP. Compared with usual care, most AE interventions resulted in beneficial physiological and clinical adaptations relevant to stroke recovery, namely through improved V̇O 2 peak and mobility (6MWT distance and 10 m Usual Gait Speed). As hypothesised, we identified an intensity-dependent response such that higher-intensity AE (ie, HIIT and HICT) ranked as the most superior and effective across all outcomes of interest followed by MICT. Clinical decision-making by healthcare professionals and community exercise specialists should adopt a nuanced approach that balances exercise intensity and format, individualised needs and abilities, and specific clinical contexts. Nonetheless, our findings are relevant and may be used to inform updates to clinical practice guidelines.

HIIT, HICT and MICT were, in this order, the three most effective AE interventions for improving V̇O 2 peak, with effects ranging from 3.2 to 2.1 mL/kg/min. Using the minimally contextualised GRADE framework, we are moderately confident that our HIIT effect estimate is among the most effective intervention for improving V̇O 2 peak such that the true effect is likely to be close to the estimate of effect. However, due to some concerns with the risk of bias, there is a possibility that the effect estimate is substantially different. Nonetheless, when considering the mean differences for HIIT, HICT and MICT, V̇O 2 peak increased by at least 1.0 mL/kg/min compared with usual care and other typical interventions (ie, low and no exercise). Our findings are clinically significant given that V̇O 2 peak changes as low as 1 mL/kg/min are associated with a 10% reduction in cardiovascular mortality, 99 and an increase of 1 MET (values in stroke=3.0 mL/kg/min) 27 is associated with a 7% risk reduction in stroke hospitalisation 100 and 9% lower risk for ischaemic stroke. 4 Given the prognostic strength of V̇O 2 peak for stroke, cardiovascular disease, and all-cause mortality, and that it is often considered the fifth vital sign, 101 the addition of V̇O 2 peak testing in stroke rehabilitation as routine care can be beneficial. However, it is important to acknowledge the clinical feasibility of cardiopulmonary exercise testing and potential for limited testing resources, 19 particularly across various practice and low-resource settings. Nonetheless, exercise professionals are encouraged to follow an individualised approach for improved risk stratification, personalised exercise prescription and effective patient management to promote cardiovascular health and fitness after stroke.

The physiological mechanisms underpinning changes in V̇O 2 peak after HIIT among people poststroke have yet to be fully elucidated. Evidence from non-stroke populations suggests intensity-dependent peripheral and central cardiometabolic adaptations that may contribute to clinical improvements in V̇O 2 peak. 102–107 From a peripheral perspective, an acute bout of HIIT activates signalling pathways involved with mitochondrial biogenesis and repeated activation of these pathways through HIIT may drive adaptations such as increased mitochondrial density, capacity and respiration in skeletal muscle, 102–106 associated with increased V̇O 2 peak. 107 While these mechanisms for the poststroke population are unclear, emerging evidence suggests that MICT is more effective than usual care for improving mitochondrial bioenergetics that has been positively correlated with V̇O 2 peak. 59 Further research is needed to examine the intensity-dependent mechanisms underpinning mitochondrial adaptations after AE training among people poststroke.

The effects of AE on central cardiovascular adaptations and arterial function remain poorly understood after stroke. However, in adults with cardiovascular and cardiometabolic conditions, HIIT is superior to MICT for improving measures of cardiac contractility and systolic function, 108 and endothelial function. 109 In stroke, preliminary evidence suggests that higher intensity AE can improve diastolic function (eg, right atrial emptying fraction) compared with usual care, 71 and that HIIT is more effective than MICT for improving systolic function (eg, cardiac output). 60 HIIT can also elicit acute increases in novel arterial biomarkers, including insulin-like growth factor one and vascular endothelial growth factor, compared with MICT. 110 111 While preliminary, this research highlights the potential for HIIT to elicit superior central cardiovascular adaptations compared with MICT after stroke and emphasises emerging areas of vascular research regarding the potential effects of exercise for improving novel cardiovascular and cerebrovascular biomarkers after stroke. 112

Arterial hypertension is widely regarded as the most important modifiable cardiovascular risk factor for stroke; identifying effective non-pharmaceutical interventions, such as exercise, which can reduce SBP after stroke is particularly important. 3 In the present NMA, we found that HIIT and HICT may reduce blood pressure by up to 7 mm Hg when compared with usual care and non-exercise interventions. When considering the lower CrI limit, HIIT and HICT may reduce blood pressure by up to 19 mm Hg. While this overall effect estimate is not statistically significant and of low certainty evidence, it may be clinically significant given that a 10–12 mm Hg reduction in SBP is associated with a 30% lower primary stroke risk. 113 Our findings are novel, providing updated evidence from previous pairwise analyses (MD=−0.2, 95% CI −4.0 to 5.6) that did not demonstrate potential clinically important reductions in SBP. 12 Our findings are the first to disaggregate the effects and superiority of several AE interventions for blood pressure management poststroke.

Importantly, our review determined the superiority of various AE interventions for improving clinical markers of stroke recovery, including the 6MWT distance and 10 m Usual Gait Speed. We identified a dose-response effect, whereby higher-intensity AE tended to be superior for improving 6MWT distance. HIIT demonstrated the greatest effect compared with usual care, although this finding was not significant (41.9 m (95% CI −12.1 to 94.9)). This was followed by significant improvements after HICT (39.4 m (95% CI 16.1 to 66.5)), suggesting that high-intensity exercise may be a key factor in improving walking distance. Given the low-certainty evidence of the included studies, these data are to be interpreted with caution. As such, the true effect may be substantially different from the effect estimate effect due to concerns of risk of bias, indirectness and imprecision.

We also found that HIIT was the superior intervention for improving Usual Gait Speed with effect estimates ranging 0.28–0.34 m/s compared with usual care. We are moderately confident in these effect estimates, and the effects observed are clinically significant, such that the minimal clinical important difference (MCID) for 10 m Usual Gait Speed is 0.13–0.19 m/s 114 115 for people poststroke. For 6MWT, we found clinically significant improvements following HICT (39.4 m (95% CrI 16.1 to 66.5)), whereby MCIDs for 6MWT distance in stroke populations have been reported to range between 34 and 50 m. 116–118 This finding is of low certainty and requires careful interpretation given concerns to risk of bias and imprecision of effect estimates. Nonetheless, our results extend the findings of a previous pairwise meta-analysis that found that all types of cardiorespiratory training can improve 6MWT distance by 32.1 m (95% CI 10.11 to 54.1) and Usual Gait Speed by 0.08 m/s (95% CI 0.03 to 0.11) compared with no exercise and usual care interventions. 12 Given the observed dose–response relationship, where higher AE intensities proved to be both superior and clinically effective, stroke rehabilitation professionals should choose to prioritise HIIT or higher intensity AE using task-specific walking as the training modality 54 to challenge the neuromotor and cardiorespiratory systems to promote walking recovery after stroke.


Several limitations of this study should be acknowledged. Our risk of bias assessment revealed several methodological limitations that are consistent across all the exercise training literature in stroke, including poor exercise and control group adherence monitoring, lack of reporting of intention to treat analyses, lack of outcome assessment blinding and lack of allocation concealment. In addition, exercise intervention parameters and exercise compliance data were poorly reported, making it challenging to ascertain exercise grouping. To mitigate this challenge, we developed a decision-making algorithm that allows the review team to consistently determine exercise groups between reviewers. We also detected potential publication bias in our V̇O 2 peak NMA; however, our results remained consistent after excluding these studies in sensitivity analyses. In addition, there was a lack of consistent reporting regarding adverse events and safety outcomes within the literature, thus, we were to conduct meaningful safety analyses. Future research is required to explore the safety of high-intensity AE after stroke to help guide clinical decision-making. Lastly, the BUGSnet R package could only handle one covariate per NMA. Thus, we could not explore the effects of additive effect modifiers on our estimates. Future work using other complex modelling techniques could explore the effects of age, sex and other effect modifiers on V̇O 2 peak.

This NMA represents the most extensive synthesis of AE data from RCTs after stroke. We identified that higher intensity AE, whether performed in intervals or continuously, are top-ranked exercise prescriptions that can significantly and clinically improve V̇O 2 peak, 6MWT and usual 10 m Usual Gait Speed. Guideline developers and healthcare professionals should encourage the adoption of HIIT and HICT in clinical practice or community settings since all high-intensity AE interventions can improve fitness and physical function in individuals poststroke.

Ethics statements

Patient consent for publication.

Not applicable.


The authors would like to acknowledge Denise Smith, a librarian with the Faculty of Health Science at McMaster University, for their assistance with developing the electronic search strategy.

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Supplementary materials

Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

  • Data supplement 1

Twitter @memorylab1

Contributors KM and AT conceived the review, with assistance from JR, MJM and MR. KM designed and executed the systematic search. KM, LR, EW and KSN screened titles, abstracts and full-text articles. KM, LR and EW extracted study data. KM, LR and EW completed risk of bias assessments. KM conducted the statistical analysis with assistance from AN. KM and AT drafted the manuscript. AT is the guarantor and accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish. All authors critically reviewed the manuscript and approved the submission of this manuscript.

Funding KM is supported by an Ontario Graduate Scholarship. LR is supported by a Doctoral Scholarship from the Fonds Recherche Santé Québec. KSN is supported by an Ontario Graduate Scholarship. MR is supported by a Salary Award (Junior I) from Fonds de Recherche Santé Québec.

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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The Night Owl’s Special: Midnight Spaghetti

Sometimes a simple pasta of pantry staples is the best company.

Peanut Butter and Parmesan noodles.

By Eric Kim

I recently moved in with a man. Until now, for the last decade, I lived alone in a shoe-box studio apartment on the north end of Manhattan with my dog, Quentin Compson. Now the man, the dog and I live in a shoe-box one-bedroom in Brooklyn. It took awhile to get used to having another occupy my space, when all I ever had to account for was myself and my wire-haired familiar.

I didn’t know how much I would rely on midnight for both my cravings and my work. As the man goes to bed, I stay up to write: I had heard from friends that this was how they got their “alone time,” by staggering the hours, a necessary cushion from the joys of coupled life. It doesn’t hurt that I get my best writing done after-hours and often finalize my recipes late into the evening, long after the man has gone to bed. This leaves me to the living room, to the kitchen and to myself. And if there’s one dish that encompasses these precious hours of recuperative solitude, it has to be midnight spaghetti.

Recipe: Peanut Butter Noodles

I live my truest life in that hour from 12 a.m. to 1 a.m., in the spirit of a spaghettata di mezzanotte, a late-night Italian spaghetti party, which often evolves (or devolves, depending on how you look at it) from the kind of evening that wants to linger. It’s one of the few things in life that is always within reach, even when your fridge is practically empty. As my colleague David Tanis once wrote, “The smell of pasta boiling is a heady cheap thrill.”

What I love to eat most during this cherished time is spaghetti, with its comforting slipperiness. Other shapes work, too: I’ve been known to make a mean midnight orzo with guanciale, Pecorino Romano and black pepper, sometimes egg yolks if I’m feeling “in the carbonara way.” Other nights, it’s something punchier, like an alla vodka sauce made à la minute with fusilli: tomato paste bloomed in some fat, such as butter or olive oil, then swirled with a splash of vodka and cream. For the man, it’s a ragù, made the way of his grandfather’s family in Ferrara. Maybe for you, midnight pasta is a fridge clear-out, where you turn all of your leftover crisper-drawer vegetables into a nubby sauce.

I’ve always felt that my best recipes come from real life, from discoveries I make in the kitchen when I’m strapped for time and ingredients. One mezzanotte, I tossed thin spaghetti with chopped capers and umeboshi, those salty, pink Japanese plums, in butter to great effect. Having just returned from Kyoto and Osaka, I missed those kinds of briny accents in my day to day. Another night, it was a simple lemon-buttered angel hair against a shield of simply dressed arugula with balsamic vinegar, like a yin and yang of salad and pasta, a remnant of my Macaroni Grill years in suburban Atlanta. Recently, I tossed a little tagliatelle with the leftovers of our Sunday roast chicken, with pine nuts and rosemary like a Venetian feast, something I learned from Nigella Lawson’s first book, my culinary bible, “How to Eat.”

A meal that is always within reach, even when your fridge is practically empty.

Midnight spaghetti, I’ve since gathered, is less a recipe than it is a means by which to linger into the night. My approach changes depending on the season, with my latest involving a jar of creamy peanut butter and a block of cheese. This nutty pasta is a dream to cook, requiring just a handful of pantry staples and one pot. Industrially produced peanut butter anchors a creamy sauce swathed in umami. Accentuated by a good, salty Parmesan, these noodles recall those cheesy peanut-butter crackers you can always find in a highway vending machine. They also happen to be an ideal dinner for one, whether you’re on the road or at your desk. Most nights, I love slurping these noodles hunched over my laptop, a glass of red wine in reach, my dog sleeping to my right.

Before I head to bed, I load the dishwasher and run it, maybe walk the dog once more. In the morning, as I sleep, the man slips out of bed and makes himself breakfast, usually toast and jam, sometimes my leftover pantry pasta reheated. Without a trace, he unloads the dishwasher and puts on a kettle of water for tea. As his day starts, mine ends.

Eric Kim is a cooking writer for the Food section and NYT Cooking and a columnist for The New York Times Magazine. More about Eric Kim

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    Foo Fighters fix that deficit by diving head on into disco and dance, the syncopations and polyrhythms so dominating Medicine at Midnight that the four-on-the-floor rock & roll ravers almost seem diminished in comparison. Dance-rock isn't necessarily the height of exploration -- the Rolling Stones cut disco the second they could back in the ...

  23. Album review: Foo Fighters

    Eponymous track 'Medicine At Midnight' is a funk/blues crossover track that is straight off David Bowie's 1983 album 'Let's Dance', with a sultry grove that makes the track infectious. However, it isn't all smooth sailing. Tracks like single 'Waiting on a War', a mid tempo anthem that have become common on Foo Fighters ...

  24. Biomarker Changes during 20 Years Preceding Alzheimer's Disease

    Images in Clinical Medicine Renal Malakoplakia S. Bagnasco and S.C. Gautam Perspective Unions at the Tip of the Iceberg — NOS Episode 2.4 Review Article Wearable Digital Health Technology for ...

  25. Julian Assange makes last-ditch attempt in UK court to avoid

    Julian Assange's legal team returned to London's High Court on Tuesday to fight for what could become his final attempt at avoiding extradition to the United States, where he is facing life in ...

  26. Aerobic exercise interventions for promoting cardiovascular health and

    Results There were 28 studies (n=1298) included in the NMA for V̇O 2 peak, 11 (n=648) for SBP, 28 (n=1494) for 6MWT and 18 (n=775) for the 10 m Usual Gait Speed. The greatest effect on V̇O 2 peak, 6MWT and 10 m Usual Gait Speed was observed after HIIT and HICT. No differences between interventions were found for SBP. SUCRA values identified HIIT as the superior AE intervention for all ...

  27. The Night Owl's Special: Midnight Spaghetti

    I live my truest life in that hour from 12 a.m. to 1 a.m., in the spirit of a spaghettata di mezzanotte, a late-night Italian spaghetti party, which often evolves (or devolves, depending on how ...