A physical activity intervention to prevent cognitive decline after stroke: Secondary results from the Life After STroke study, an 18-month randomized controlled trial

Abstract

Physical activity may help to keep the brain healthier and preserve cognitive ability and mood years after a stroke. In The Life After STroke (LAST) study, stroke survivors were allocated into 2 groups. A training group was encouraged to perform physical activity for 30 min daily, and 45-60 min of moderate-to-intense physical exercise every week. A control group was followed by their general practitioner as usual. This study aimed to measure the effect on cognitive and emotional function in both groups after 18 months. Of the 362 participants, almost half were in the training group. The mean age was 72 years and 40% were female. There were no differences between the groups regarding effect on cognitive or emotional function. In conclusion, this study did not show an effect of the physical training programme on cognition or mood after stroke. Objective: To examine the effects of individualized regular coaching and exercise on post-stroke cognitive and emotional function. Methods: The Life After STroke (LAST) study investigated the differences between intervention and care-as-usual between 3 and 21 months post-stroke. Outcome measures were the Trail Making Test (TMT) A and B, Mini Mental State Examination (MMSE), Hospital Anxiety and Depression Scale (HADS), and adherence to the intervention. Results: Of the 362 patients included in the study, 177 were assigned to the intervention. The mean age was 71.7 years (SD 11.3) and 39.5% were female. The adjusted mean difference between groups for TMT A was 8.54 (95% CI 0.7 to 6.3), p = 0.032, for TMT B 8.6 (95% CI-16.5 to 33.6), p = 0.50, for MMSE-0.1 (95% CI-0.8 to 0. 6), p = 0.77, for HADS A-0.2 (95% CI-0.9 to 0.5), p = 0.56 and for HADS D-0.1 (95% CI-0.7 to 0.5), p = 0.76). A higher level of adherence to the intervention was significantly associated with increased MMSE (B = 0.030 (95% CI 0.005-0.055), p = 0.020). Conclusion: No clinically relevant effects on cognitive or emotional function were found of individualized regular coaching for physical activity and exercise. However, increased adherence to the intervention was associated with improved cognitive function.

Influence of an Aquatic Therapy Program on Perceived Pain, Stress, and Quality of Life in Chronic Stroke Patients: A Randomized Trial

“…However, not all studies have shown positive results such as those presented here. An 18-month program of aquatic therapy among a group of stroke patients failed to find an advantage for the control of depression and anxiety [41]. According to the authors, these findings may have been due to the lack of adherence to the sessions on behalf of the selected sample.…”

“…The advantages of physical exercise in water include a greater variety of possible movements, the ability to perform easy and low-impact exercises in a pleasant and leisurely environment, along with the possibility of working in a group. All of this has a positive effect on this population, along with the water temperature [41]. This latter factor means that, on a therapeutic level, certain motor symptoms such as increased muscle tone and postural instability improve in this environment with these types of patients.…”

Cognitive Gains of Aerobic Exercise in Patients With Ischemic Cerebrovascular Disorder: A Systematic Review and Meta-Analysis

“…The possible reason is that the compliance might decline as the project goes on. Ihle-Hansen's research also found increased adherence to the intervention was significantly associated with up-regulated MMSE scores (Ihle-Hansen et al, 2019). Therefore, effort is needed to motivate the patients to engage in aerobic exercise in the long term.…”

“…There was no significant difference in age between intervention (66.1; SD:12) and control groups (68.2; SD:10.8). Patients were diagnosed with stroke in 10 studies (Quaney et al, 2009;El-Tamawy et al, 2014;Liu-Ambrose et al, 2016;Tang et al, 2016;Ploughman et al, 2018;Bo et al, 2019;Debreceni-Nagy et al, 2019;Ihle-Hansen et al, 2019;Nave et al, 2019;Rosenfeldt et al, 2019) and with small vessel ischemic disease in the rest one (Liu-Ambrose et al, 2016). Among the aerobic exercise interventions, one study maintained participants' heart rate reserve (HRR) below 40% (Debreceni-Nagy et al, 2019) and three studies adopted moderate intensity training (El-Tamawy et al, 2014;Liu-Ambrose et al, 2016;Nave et al, 2019).…”

Cognitive Rehabilitation Interventions After Stroke: Protocol for a Systematic Review and Meta-analysis of Randomized Controlled Trials

“…To our knowledge, another systematic review compared the e cacy of cognitive rehabilitation interventions in the treating PSCI, but it only included literature from 2009 through 2014 [41]. and several important clinical trials have been published since then [42][43][44][45]. As a result, an up-to-date review is needed.…”