Effects of Combined Cognitive and Exercise Interventions on Poststroke Cognitive Function: A Systematic Review and Meta-Analysis

Abstract

Objective. We investigated combined cognitive and exercise interventions in the literature and summarized their effectiveness in improving poststroke cognitive impairment (PSCI). Data Sources. Electronic databases and trial registries were searched from their inception until July 2020. Study Selection. Trials were collected with the following study inclusion criteria: (1) patients over 18 years of age who were diagnosed with PSCI; (2) combined cognitive-exercise interventions, regardless of the order of the two types of interventions or whether they were administered simultaneously; (3) any control group studied at the same time that was deemed acceptable, including no intervention/routine care, delayed intervention, sham intervention, and passive training; (4) the use of any validated cognitive neuropsychological test to evaluate cognitive function; and (5) clinically administered random trials with controls. Data Extraction. Five randomized controlled trials met the inclusion criteria. Two reviewers independently assessed the eligibility of the full texts and methodological quality of the included studies using the Cochrane risk of bias tool. Inconsistent results were resolved by additional discussion or decided by a third examiner, if necessary. Data Analysis. Meta-analysis demonstrated that the combined interventions had a significant effect on executive function and working memory [Stroop test (time), standardized mean difference SMD = 0.42 , 95% confidence interval (CI): 0.80–0.04, p = 0.02 ; Trail Making Test, SMD = 0.49 , 95% CI: 0.82–0.16, p = 0.004 ; Forward Digit Span Test, SMD = 0.91 , 95% CI: 0.54–1.29, p ≤ 0.001 ]. While it was impossible to conduct a meta-analysis of global cognitive function and other cognitive domains, individual experiments demonstrated that the combined interventions played a significant role in global cognition, reasoning ability, logical thinking, and visual-spatial memory function. Conclusions. Our analyses demonstrated that the combined interventions had a significant effect on the improvement of PSCI, particularly in terms of executive function. However, the moderate risk of bias in the included trials and the small number of relevant studies indicated a need for more uniform diagnostic and evaluation criteria, and larger trials would provide stronger evidence to better understand the effectiveness of the combined interventions. This trial is registered with trial registration number INPLASY202160090.

Cognitive‐exercise dual‐task promotes cognitive function recovery in chronic cerebral ischemia male rats through regulating PI3K/Akt signaling pathway via inhibition of EphrinA3/EphA4

“…CEDT training is an innovative rehabilitation method that has been developed in recent years and has been proven effective in improving cognitive impairment, such as aging‐related cognitive impairment, post‐stroke cognitive impairment, and AD (Ali et al., 2022; Cui et al., 2023; Gavelin et al., 2020; Huber et al., 2022; Li et al., 2022). In our previous study, it was identified that CEDT training can directly improve cognitive impairment in CCI patients (Sun et al., 2021). In our current study, we analyzed the impacts and possible underlying mechanisms of exercise, cognitive, and CEDT interventions using an in vivo CCI model, in vitro OGD model in which the astrocytes and neuronal cells were co‐cultured.…”

“…Extensive studies have demonstrated that cognitive or exercise intervention is an effective method to improve cognitive impairment in stroke (Best et al., 2018; Michel & Mateer, 2006; Mura et al., 2018; Swatridge et al., 2017). The cognitive‐exercise dual‐task (CEDT) training, which combined cognitive training with exercise training, had a significant effect on the improvement of post‐stroke cognitive impairment in the clinical trials (He et al., 2018; Pang et al., 2018; Sun et al., 2021; Yeh et al., 2017). However, it is not clear whether CEDT training is more effective than single exercise or cognitive training, and what the underlying mechanisms are.…”

Effects and mechanisms of mindfulness training and physical exercise on cognition, emotional wellbeing, and brain outcomes in chronic stroke patients: Study protocol of the MindFit project randomized controlled trial

“…This sample size supports a 20% tracking loss rate. We established a minimum effect size of 0.75 standard deviations by considering the results of meta-analyses studying the effects of mindfulness or PE on cognition or emotional wellbeing in stroke patients (e.g., Abbott et al, 2014 ; Oberlin et al, 2017 ; Ali et al, 2021 ; Sun et al, 2021 ). The effect sizes reported in these papers range from small-moderate (between d = 0.30 and d = 0.50) to moderate-large (between d = 0.50 and d = 1), depending on the intervention and the outcome studied.…”

Comparison of Rehabilitative Interventions That Ameliorate Post-stroke Working Memory Deficit: A Systematic Review

“…Although very few studies had shown improvement in working memory [ 15 ], many studies had contradicting results to support this statement [ 1 , 2 ]. Some studies have shown improvement when combined cognitive and exercise interventions are included [ 22 ]. Because of the small sample size and other contradicting studies, further extensive sample studies are needed.…”