Meta-Analysis on Cognitive Benefit of Exercise after Stroke

Abstract

ObjectiveThe objective of this paper is to evaluate the cognitive benefit of exercise after stroke, so as to provide more accurate and reliable guidance for targeted exercise intervention. Methods. Randomized controlled trials of the relationship between exercise and cognition after stroke were identified in Cochrane Library and PubMed. Methodological quality was assessed using the Cochrane tool of bias. SMD and 95% confidence intervals were calculated, and Chi-squared test (Q) was adopted to estimate the heterogeneity. Results. (a) Twenty-three studies met inclusion criteria, including 1528 participants. Heterogeneity was from low to high such as attention (I2 = 0.00%), executive function (I2 = 0.00%), cognition (I2 = 64%), and working memory (I2 = 77%). (b) The overall effect on cognition was small (SMD = 0.16 [0.04, 0.28]) but significant and there is a difference between cognitive domains in attention (SMD = −0.35 [−0.57, −0.14]), executive function (SMD = −0.24 [−0.40, −0.08]), and working memory (SMD = 0.36 [0.20, 0.53]). (c) Exercise training was less effective before the 18th month after stroke. Higher benefits on cognition were found after combined therapy compared with other exercise programs, and the older the stroke survivors, the less the cognitive benefit of exercise. Conclusion. Small-to-moderate effect of exercise on cognitive benefit after stroke was found, and the effect was moderated by treatment protocols and sample characteristics.

The relationship between physical activity trajectories and frailty: a 20-year prospective cohort among community-dwelling older people

“…The older adults in our study who increased their physical activity levels despite experiencing health problems were observed to be less frail. Older people who remained physically active in their 80s were less likely to be hospitalized compared with those who were less physically active [40,41]. The activity and physical activity patterns of the older people in our study had four trajectories.…”

Duration and Efficiency of Combined versus Isolated Aerobic Training Interventions in Post-Stroke Cognition: A Systematic Review

“…Regarding the duration of rehabilitation training programs, it is essential to understand what predicts the effectiveness of exercise, as it can guide clinicians on how to better design exercise programs for people with stroke, as programs lasting less than 8 weeks are not long enough to elicit noticeable cognitive gains [84]. A moderator-effect analysis revealed that the 12-14-week exercise interventions are associated with the most significant magnitude of cognitive gains [85]. These results reinforce the need to use relatively long programs to rehabilitate people with stroke [85][86][87][88].…”

“…Two very recent meta-analyses by Yang and Wang [84,85] also consolidate this idea of long-term exercise (exercise programs for 12 weeks) because it explains that the cycle of intervention with exercise after stroke is mainly controlled at 12 weeks since this period has good patient tolerance, as well as potentiation of long-term effects on physical and mental health, and further explains that 8 weeks of post-stroke aerobic training is more or less the ideal period to have a positive impact on cardiopulmonary and cognitive function [85].…”

“…Concerning exercise intensity, in the studies reviewed here, there is a predominance of moderate-intensity physical activity; this fact seems to result from the need to safeguard the health of the participants (patients with stroke), as post-stroke exercise recommendations include moderate-intensity continuous cardiovascular exercise with a suggested intensity of 40-70% maximum oxygen consumption or heart rate reserve of 50-80% of the maximum heart rate [94][95][96]. On the other hand, it is possible that higher-intensity exercises were not chosen because evidence indicates that high-intensity physical activity does not generate greater cognitive gain [85]. However, this is a controversial position, as studies show that intensity only mediates domains of gain [97].…”

“…A moderator-effect analysis revealed that the 12–14-week exercise interventions are associated with the most significant magnitude of cognitive gains [85]. These results reinforce the need to use relatively long programs to rehabilitate people with stroke [85‒88]. However, contradictions persist regarding the duration that best optimizes cognition, as seen in a recent review where the analysis showed no difference between using a program of more than 12 weeks or less [89].…”