Effects of aerobic physical exercise on neuroplasticity after stroke: systematic review

Abstract

Background: Stroke is among the leading causes of death and disability worldwide. Interventions for stroke rehabilitation aim to minimize sequelae, promote individuals’ independence and potentially recover functional damage. The role of aerobic exercise as a facilitator of post-stroke neuroplasticity in humans is still questionable. Objective: To investigate the impact of aerobic exercise on neuroplasticity in patients with stroke sequelae. Methods: A systematic review of randomized clinical trials and crossover studies was performed, with searches for human studies in the following databases: PUBMED, EMBASE, LILACS and PeDRO, only in English, following the PRISMA protocol. The keywords used for selecting articles were defined based on the PICO strategy. Results: This systematic review evaluated the impacts of aerobic exercise on neuroplasticity through assessment of neural networks and neuronal excitability, neurotrophic factors, or cognitive and functional assessment. Studies that evaluated the effects of aerobic exercise on neuroplasticity after stroke measured through functional resonance (fMRI) or cortical excitability have shown divergent results, but aerobic exercise potentially can modify the neural network, as measured through fMRI. Additionally, aerobic exercise combined with cognitive training improves certain cognitive domains linked to motor learning. Studies that involved analysis of neurotrophic factors to assess neuroplasticity had conflicting results. Conclusions: Physical exercise is a therapeutic intervention in rehabilitation programs that, beyond the known benefits relating to physical conditioning, functionality, mood and cardiovascular health, may also potentiate the neuroplasticity process. Neuroplasticity responses seem more robust in moderate to high-intensity exercise training programs, but dose-response heterogeneity and non-uniform neuroplasticity assessments limit generalizability.

Systematic review on post-stroke computerized cognitive training: Unveiling the impact of confounding factors

“…Since physical activity is also considered a proxy for CR, achieved through the development of lifestyles ( Barulli and Stern, 2013 ), strong evidence suggests that aerobic exercise is beneficial to improve aerobic fitness, walking speed, and endurance in people who have suffered a mild to moderate stroke ( Pang et al, 2013 ). Furthermore, among the benefits related to physical conditioning, such as functionality, mood, and cardiovascular health, it was identified that aerobic exercise might potentiate the neuroplasticity process with more robust responses in training programs with moderate to high-intensity exercises ( Penna et al, 2021 ). Finally, cognitive improvement is indicated in aerobic exercises combined with cognitive training, especially computerized training ( Amorós-Aguilar et al, 2021 ).…”

“…Taking into account that no reviews have explored the influence of diverse CR proxies on training outcomes cognitive ( Cumming et al, 2012 ; Pang et al, 2013 ; McHutchison et al, 2017 ; Penna et al, 2021 ; Chen et al, 2022 ; Mugisha et al, 2022 ; Nie et al, 2022 ; O’Donoghue et al, 2022 ; Wiley et al, 2022 ), this research is essential to identify which patients benefit the most from the intervention and to guide the development of intervention programs, investment in equipment, research funding, and to identify the quality of life markers for patients with stroke.…”

The effect and mechanism of exercise for post-stroke pain

“…Exercise can enhance brain function and reduce the degeneration of nerves. Exercise can also alter post-stroke neural networks, neuronal excitability, and neurotrophic factors, thereby affecting neuroplasticity (Penna et al, 2021) anterior cingulate cortex (ACC), regulation of endogenous opioids in vivo, reversal of brain-derived neurotrophic factor (BDNF) overexpression, inhibition of purinergic receptor (P2X4R, P2X7R) expression, and inhibition of microglia activation (Figure 1).…”

Effects of a 12-week, seated, virtual, home-based tele-exercise programme compared with a prerecorded video-based exercise programme in people with chronic neurological impairments: protocol for a randomised controlled trial

“…Incorporating an exercise regimen is vital to preventing secondary complications such as muscular weakness, fatigue, limited mobility, pain, spasticity, bone loss and increased risk of fractures, falls, diabetes, depression and obesity 7 8 12 13. Exercise can be neuroprotective and neuroregenerative by increasing neurotrophic factors, which are involved in neuroprotection, neuroplasticity and maintenance of neuronal health 2 14–18. Exercise can also improve muscle strength and bone integrity in people with CNI 19–21…”