Objective: To systematically evaluate the clinical effects of core stability exercise for rehabilitation of stroke patients with hemiplegia. Methods: Cochrane Library, Web of Science, PubMed, Embase, CNKI, Wanfang, VIP, CBM were searched for relevant articles from the inception to September 2018. All randomized controlled trials assessing core stability exercises for stroke patients were included. Studies screening, data extraction, and quality evaluation were conducted independently by two researchers. Data was analyzed using RevMan 5.3, and trial sequential analysis (TSA) was conducted by TSA 0.9. Results: Totally 11 studies and 736 patients were included. Results showed that combination of core stability exercise and conventional rehabilitation had significantly better effects on trunk control ability, balance ability, activities of daily living, and maximum walking speed in 10 meters than single conventional rehabilitation, and differences of all subgroups in four outcomes were not significant. TSA confirmed that the pooled results of outcomes above were stable and reliable. Conclusion: Core stability exercise combined with conventional rehabilitation can significantly improve the trunk control, balance, activities of daily living and walking speed of stroke patients, and thus it should be applied in clinical practice.