Effect of Exercise on Cognitive Ability, Cardiovascular Fitness, and Quality of Life in Post-Stroke Patients: Systematic Review and Meta-Analysis
DOI:
https://doi.org/10.26911/theijmed.2024.09.03.04Abstract
Background: Following a stroke, cognitive ability, and cardiovascular fitness decline, exerting a substantial influence on physical rehabilitation and overall quality of life. Stroke management encompasses a multidisciplinary approach, with emerging studies highlighting the role of exercise in enhancing cognitive ability and cardiovascular fitness post-stroke. This study aims to analyze the effects of exercise on cognitive ability, cardiovascular fitness, and quality of life in stroke survivors, shedding light on potential therapeutic benefits.
Subject and Methods: The PICO Model eligibility criteria were employed to execute the article search including P= post-stroke patients; I= exercises C= standard care, O= cognitive ability OR cardiovascular fitness OR quality of life. The study extracted articles from PubMed and ScienceDirect databases, with keywords "exercises" AND "cognitive ability" OR "cardiovascular fitness" OR "quality of life" AND "post-stroke patients". Inclusion criteria required full-text articles with randomized controlled trial (RCT) designs, focusing on post-stroke patients and evaluating improvements in cognitive ability, cardiovascular fitness, or quality of life. PRISMA diagram and Review Manager 5.4.1 tool were used to analyse the selected articles.
Results: 25 studies included in the review had 2,110 participants, across Asia; Australia, Europe, North America, and South America eligible for meta-analysis. The result indicated a positive effect of exercise on cognitive ability (SMD=0.68, CI 95% (0.21 to 1.16); p=0.005); cardiovascular fitness (SMD=0.63, CI 95% (0.17 to 1.08); p=0.007) and quality of life (SMD=0.60, CI 95% (-0.08 to 1.27); p=0.080).
Conclusion: Engagement in diverse forms and durations of exercise emerges as a crucial element in post-stroke rehabilitation. This intervention signifies a promising avenue toward enhancing cognitive abilities, and cardiovascular fitness, and potentially elevating quality of life among stroke survivors.
Keywords:
stroke, exercise, cognitive ability, cardiovascular fitness, quality of lifeReferences
Aguiar LT, Nadeau S, Britto RR, Teixeira-Salmela LF, Martins JC, Samora GR, Da Silva Júnior JA, Faria CDCDM (2020). Effects of aerobic training on physical activity in people with stroke. NeuroRehabilitation, 46(3); 391–401. doi:10.3233/NRE-193013.
Ali A, Tabassum D, Baig SS, Moyle B, Red-grave J, Nichols S, McGregor G, Evans K, Totton N, Cooper C, Majid A (2021). Effect of Exercise Interven-tions on Health-Related Quality of Life after Stroke and Transient Ische-mic Attack. Stroke, 2445–2455. doi: 10.1161/STROKEAHA.120.032979.
Baig MU, and Bodle J (2023). Thrombolytic Therapy. StatPearls. https://www.-ncbi.nlm.nih.gov/books/NBK557411/
Boehme AK, Esenwa C, Elkind MSV, Fisher M, Iadecola C, Sacco R (2017). Stroke Risk Factors, Genetics, and Prevention. Circ Res, 120(3); 472–495. doi: 10.1161/CIRCRESAHA.116.308398.
Bonkhoff AK, Schirmer MD, Bretzner M, Hong S, Regenhardt RW, Brudfors M, Donahue KL, Nardin MJ, Dalca AV, Giese A-K, Etherton MR, Hancock BL, T Mocking SJ, McIntosh EC, Attia J, Benavente OR, Bevan S, Cole JW, Donatti A, Rost NS (2021). Outcome after acute ischemic stroke is linked to sex-specific lesion patterns. doi:10.1038/s41467-021-23492-3.
Ciarambino T, Crispino P, Mastrolorenzo E, Viceconti A, Giordano M (2022). Stroke and Etiopathogenesis: What Is Known? Genes. 13(6): 978. doi:10.3390/GENES13060978.
Chung SH, Kim JH, Yong SY, Lee YH, Park JM, Kim SH, Lee HC (2019). Effect of task-specific lower extremity training on cognitive and gait function in stroke patients. Ann Rehabil Med, 43(1), 1–10. doi:10.5535/arm.2019-.43.1.1.
Deijle IA, Hemmes R, Boss HM, de Melker EC, van den Berg BTJ, Kwakkel G, van Wegen E, Bosboom WM, Wein-stein HC, van Schaik SM, Van den Berg-Vos RM (2022). Effect of an exercise intervention on global cogni-tion after transient ischemic attack or minor stroke. BMC Neurology, 22(1). doi:10.1186/s12883-022-02805-z.
El Husseini N, Katzan IL, Rost NS, Blake ML, Byun E, Pendlebury ST, Aparicio HJ, Marquine MJ, Gottesman RF, Smith EE (2023). Cognitive Impair-ment After Ischemic and Hemorrha-gic Stroke: A Scientific Statement From the American Heart Associa-tion /American Stroke Association. Stroke, 54(6); E272–E29. doi: 10.11-61/STR.0000000000000430.
Feigin VL, Stark BA, Johnson CO, Roth GA, Bisignano C, Abady GG, Abbasifard M, et al. (2021). Global, regional, and national burden of stroke and its risk factors. Lancet Neurol, 20(10); 795–820. doi: 10.1016/S1474-4422(21)00252-0.
Gauberti M, Martinez de Lizarrondo S, Vivien D (2021). Thrombolytic strate-gies for ischemic stroke in the throm-bectomy era. JTH, 19(7); 1618–1628. doi:10.1111/jth.15336.
Geidl W, Knocke K, Schupp W, Pfeifer K (2018). Measuring stroke patients’ exercise preferences using a discrete choice experiment. Neurol Int, 10(1); 13–17. doi:10.4081/ni.2018.6993.
Gjellesvik TI, Becker F, Tjønna AE, Indre-davik B, Lundgaard E, Solbakken H, Brurok B, Tørhaug T, Lydersen S, Askim T (2021). Effects of High-Intensity Interval Training After Stroke (The HIIT Stroke Study) on Physical and Cognitive Function. Arch Phys Med Rehabil, 102(9); 1683–1691. doi:10.1016/j.apmr.2021.05.008.
Guillaumier A, Spratt NJ, Pollack M, Baker A, Magin P, Turner A, Oldmeadow C, et al. (2022). Evaluation of an online intervention for improving stroke survivors’ health-related quality of life. PLoS Med, 19(4). doi:10.1371/-journal.pmed.1003966.
Han EY, Im SH (2017). Effects of a 6-week aquatic treadmill exercise program on cardiorespiratory fitness and walking endurance in subacute stroke patients. J Cardiopulm Rehabil Prev, 1–8. doi:10.1097/HCR.0000000000000243.
Hsu CC, Tsai HH, Fu TC, Wang JS (2019). Exercise training enhances platelet mitochondrial bioenergetics in stroke patients. J Clin Med, 8(12); 1–15. doi:10.3390/jcm8122186.
Hyun SJ, Lee J, Lee BH (2021). The effects of sit-to-stand training combined with real-time visual feedback on strength, balance, gait ability, and quality of life in patients with stroke. Int J Environ Res Public Health, 18(22). doi:10.33-90/ijerph182212229.
Ihle-Hansen H, Langhammer B, Lydersen S, Gunnes M, Indredavik B, Askim T (2019). A physical activity interven-tion to prevent cognitive decline after stroke: Secondary results from the life after stroke study. J Rehabil Med, 51(9); 646–651. doi: 10.2340/165-01977-2588.
Jiang C, Yang S, Tao J, Huang J, Li Y, Ye H, Chen S, Hong W, Chen L (2016). Clinical Efficacy of Acupuncture Treatment in Combination With RehaCom Cognitive Training for Improving Cognitive Function in Stroke. J Am Med Dir Assoc, 17(12); 1114–1122. doi:10.1016/j.jamda.2016.07.021.
Koch S, Tiozzo E, Simonetto M, Loewen-stein D, Wright CB, Dong C, Bustillo A, et al. (2020). Randomized trial of combined aerobic, resistance, and cognitive training to improve recovery from strokep. J Am Heart Assoc, 9(10). doi:10.1161/JAHA.119.015377.
Kusznir Vitturi B, José Gagliardi R (2020). Use of CHADS2 and CHA2DS2-VASc scores to predict prognosis after stroke. J Neurol, 176(1–2); 85–91. doi:10.1016/J.NEUROL.2019.05.001.
Lee SY, Im SH, Kim BR, Han EY (2018). The Effects of a Motorized Aquatic Treadmill Exercise Program on Mus-cle Strength, Cardiorespiratory Fit-ness, and Clinical Function in Sub-acute Stroke Patients. Am J Phys Med Rehabil, 97(8); 533–540. doi:10.10-97/PHM.0000000000000920.
Li X, Geng D, Wang S, Sun G (2022). Aero-bic exercises and cognitive function in post-stroke patients. Medicine, 101 (41): E31121. doi:10.1097/MD.0000-000000031121.
Lim HS, Yoon S (2017). The effects of Pilates exercise on cardiopulmonary function in the chronicstroke patients. J Phys Ther Sci, 29(5); 959. doi: 10.1589/JPTS.29.959.
Lopez EO, Ballard BD, Jan A (2022). Car-diovascular Disease. Nursing. https:-//www.ncbi.nlm.nih.gov/books/N-BK535419/
Luo L, Meng H, Wang Z, Zhu S, Yuan S, Wang Y, Wang Q (2020). Effect of high-intensity exercise on cardiorespiratory fitness in stroke survivors. Ann Phys Rehabil Med, 63(1); 59–68. doi:10.1016/J.REHAB.2019.07.006.
Macleod MR, Tanriver-Ayder E, Hair K, Sena E (2020). Design of Meta-Ana-lysis Studies. Handbook of Experi-mental Pharmacology, 257; 299–317. doi:10.1007/164_2019_289.
Mahmood W, Ahmed Burq HSI, Ehsan S, Sagheer B, Mahmood T (2022). Effect of core stabilization exercises in addition to conventional therapy in improving trunk mobility, function, ambulation and quality of life in stroke patients. BMC Sports Sci Med Rehabil, 14(1). doi: 10.1186/s13102-022-00452-y.
Marilyn ML, Gordon G, Stephen P, Nicho-las G, Wanda F, Kara T, Chris T, et al. (2022). Program of rehabilitative exercise and education to avert vascular events after non-disabling stroke or transient ischemic attack. Neurorehabil Neural Repair, 36(2); 119–130. doi:10.1177/15459683211060345.
McDonald MW, Jeffers MS, Issa L, Carter A, Ripley A, Kuhl LM, Morse C, et al. (2021). An Exercise Mimetic Appro-ach to Reduce Poststroke Deconditio-ning and Enhance Stroke Recovery. Neurorehabil Neural Repair, 35(6); 471–485. doi:10.1177/154596832110-05019.
Morrison HW, White MM, Rothers JL, Taylor-Piliae RE (2022). Examining the Associations between Post-Stroke Cognitive Function and Common Comorbid Conditions among Stroke Survivors. Int J Environ Res Public Health, 19(20); 13445. doi:10.33-90/ijerph192013445.
Munari D, Pedrinolla A, Smania N, Picelli A, Gandolfi M, Saltuari L, Schena F (2018).High-intensity treadmill training improves gait ability, VO2peak and cost of walking in stroke survivors. Eur J Phys Rehabil Med, 54(3); 408–418. doi:10.23736/S1973-9087.16.04224-6.
Ozen S, Senlikci HB, Guzel S, Yemisci OU (2021). Computer Game Assisted Task Specific Exercises in the Treatment of Motor and Cognitive Function and Quality of Life in Stroke. J Stroke Cerebrovasc Dis, 30(9). doi:10.1016-/j.jstrokecerebrovasdis.2021.105991.
Pinckard K, Baskin KK, Stanford KI (2019). Effects of exercise to improve cardiovascular health. Front Cardiovasc Med, 6; 69. doi:10.3389/FCVM.2019.00069.
Reynolds H, Steinfort S, Tillyard J, Ellis S, Hayes A, Hanson ED, Wijeratne T, et al. (2021). Feasibility and adherence to moderate intensity cardiovascular fitness training following stroke. BMC Neurol, 21(1). doi:10.1186/s12883-021-02052-8.
Rocha LSO, Gama GCB, Rocha RSB, Rocha L de B, Dias CP, Santos LLS, Santos MC de S, et al. (2021). Constraint induced movement therapy increases functionality and quality of life after stroke. J Stroke Cerebrovasc Dis, 30(6). doi:10.1016/j.jstrokecerebrovas-dis.2021.105774
Rizvi MR, Sharma A, Malki A, Sami W (2023). Enhancing Cardiovascular Health and Functional Recovery in Stroke Survivors. J Clin Med, 12(20); 1–17. doi:10.3390/jcm12206589.
Roy-O’Reilly M, McCullough LD (2018). Age and Sex Are Critical Factors in Ischemic Stroke Pathology. Endocri-nology, 159(8); 3120–3131. doi:10.12-10/EN.2018-00465.
Shakir R (2018). The struggle for stroke reclassification. Nat Rev Neurol, 14(8) 447–448. doi:10.1038/s41582-018-0036-5
Soh SH, Joo MC, Yun NR, Kim MS (2020). Randomized Controlled Trial of the Lateral Push-Off Skater Exercise for High-Intensity Interval Training vs Conventional Treadmill Training. Arch Phys Med Rehabil, 101(2). doi:10.1016/j.apmr.2019.08.480
Song R, Park M, Jang T, Oh J, Sohn MK (2021). Effects of a tai chi-based stroke rehabilitation program on symptom clusters, physical and cog-nitive functions, and quality of life. Int J Environ Res Public Health, 18(10). doi:10.3390/ijerph18105453
Soto-Cámara R, González-Bernal JJ, Gon-zález-Santos J, Aguilar-Parra JM, Trigueros R, López-Liria R (2020). Age-related risk factors at the first stroke event. J Clin Med, 9(7); 1–12. doi:10.3390/jcm9072233
Vahlberg B, Cederholm T, Lindmark B, Zetterberg L, Hellström K (2017). Short-term and long-term effects of a progressive resistance and balance exercise program in individuals with chronic stroke: a randomized con-trolled trial. Disabil Rehabil, 39(16); 1615–1622. doi:10.1080/09638288.2016.1206631
Wu Z, Xu J, Yue C, Li Y, Liang Y (2020). Collaborative Care Model Based Telerehabilitation Exercise Training Program for Acute Stroke Patients in China. J Stroke Cerebrovasc Dis, 29(12). doi:10.1016/j.jstrokecerebro-vasdis.2020.105328
Yeh T ting, Chang K chou, Wu C yi (2019). The Active Ingredient of Cognitive Restoration: A Multicenter Rando-mized Controlled Trial of Sequential Combination of Aerobic Exercise and Computer-Based Cognitive Training in Stroke Survivors With Cognitive Decline. Arch Phys Med Rehabil, 100(5); 821–827. doi:10.1016/j.apm-r.2018.12.020
Zheng G, Zheng Y, Xiong Z, Ye B (2020). Effect of Baduanjin exercise on cog-nitive function in patients with post-stroke cognitive impairment. Clin Rehabil. 34(8), 1028–1039. doi:10.1-177/0269215520930256.
