Effects of exercise therapy on patients with poststroke cognitive impairment: A systematic review and meta-analysis

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Effects of exercise therapy on patients with poststroke cognitive impairment: A systematic review and meta-analysis

Yuanxing Zhang^1†, Xichenhui Qiu^2†, Jinghao Chen^1†, Cuiling Ji³, Fang Wang³, Dan Song⁴, Caiyan Liu¹, Lu Chen^3* and Ping Yuan^3*

• ¹Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
• ²Health Science Center, Shenzhen University, Shenzhen, China
• ³Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
• ⁴Nursing Department, Shenzhen Shekou People's Hospital, Shenzhen, China

Objective: To evaluate the effects of exercise therapy on patients with poststroke cognitive impairment and compare the differences in the effect of this method when compared with conventional measures, providing evidence for a more standardized and effective clinical application of exercise therapy.

Methods: A search was conducted using 7 electronic databases, including PubMed, CINAHL, Web of Science, CENTRAL, CNKI, Wanfang, SinoMed, and clinical trials registry platforms for randomized controlled trials concerning exercise therapy on patients with poststroke cognitive impairment. Two researchers independently screened the literature, evaluated the quality, and extracted information. Meta-analysis was carried out using Review Manager 5.4 software.

Results: There were 11 studies with 1,382 patients. Meta-analysis showed that exercise therapy could improve cognitive function [SMD = 0.67, 95% CI (0.31, 1.04), P = 0.0003], motor function [SMD = 1.81, 95% CI (0.41, 3.20), P = 0.01], and the activities of daily living [MD = 8.11, 95% CI (3.07, 13.16), P = 0.002] in patients with poststroke cognitive impairment.

Conclusion: Exercise therapy can not only improve cognitive function in patients with poststroke cognitive impairment but also improve motor function and the activities of daily living. Medical staff should prioritize the management of patients with post stroke cognitive impairment and carry out exercise therapy actively to improve the cognitive function of patients with stroke.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42023397553.

Introduction

Stroke is an important cause of cognitive impairment and dementia (Zhao et al., 2018). Poststroke cognitive impairment (PSCI) refers to cognitive impairment or dementia after a stroke. It is common in patients with stroke and usually occurs within 6 months after the stroke. The prevalence of PSCI ranges from 20 to 80% and is one of the most common complications in patients with stroke (Sun et al., 2014). PSCI is an important factor that seriously affects patients' quality of life and survival time, and it has evolved into one of the hot topics in stroke research and intervention (Dong et al., 2017). Due to cognitive impairment, patients' cognitive abilities decline, and their adaptability to the external environment is disturbed. Therefore, patients are prone to emotional disorders such as anxiety and depression. It can also be characterized by impaired memory function, decreased computing power, and abstract thinking, which affects not only the daily lives of patients but also their rehabilitation of limbs and neurological functions. It can induce a secondary stroke and even threaten their lives, seriously affecting the overall rehabilitation process (Dong et al., 2021). Stroke survivors with moderate PSCI were six times more likely to progress to occasional dementia than stroke survivors without cognitive impairment, and up to 25% of patients with cognitive impairment were diagnosed with dementia within 3 years of stroke (Narasimhalu et al., 2009; Sachdev et al., 2009). Therefore, the rehabilitation of cognitive function in patients with stroke is an urgent issue.

Early intervention is particularly important for patients with PSCI. Studies have shown that there is a wide variation in the treatment of cognitive problems after stroke, including pharmacological and non-pharmacological interventions (Quinn et al., 2021). However, the long-term efficacy of pharmacological interventions is unclear and may be associated with adverse effects. For example, an analysis of the evidence suggests that actovegin and cerebrolysin are animal-derived nootropics that may have potential efficacy in the treatment of neurodegenerative diseases. It has a beneficial effect on improving cognitive function after stroke (Quinn et al., 2021). However, the most common adverse event was a recurrent ischemic stroke. Therefore, more researchers are inclined toward non-pharmacological interventions, such as exercise therapy, cognitive intervention, and acupuncture therapy. Early non-pharmacological exercise therapy for patients can delay the progression of the disease, sometimes even reverse the process of cognitive decline, and reduce the disability rate. Huang et al. (2022) conducted a network meta-analysis of the comparative effectiveness of different exercise interventions on cognitive function in patients with mild cognitive impairment or dementia and found that all types of exercise can effectively improve overall cognitive function in patients. However, there is a lack of effective evidence for exercise therapy in patients with PSCI.

Although routine rehabilitation training can delay the process of cognitive decline in patients and prevent the disease from progressing to dementia, there are shortcomings, such as a single form of training, low patient acceptance, and difficulty in conducting continuous and effective training, which are not conducive to the recovery of cognitive function (Yu et al., 2019). Some studies have found that exercise therapy can improve health by increasing oxygen and blood supply to the brain and indirectly improving cognitive impairment (Tang et al., 2020). Exercise therapy is defined as “a regimen or plan of physical activity designed and prescribed for specific therapeutic goals with the purpose of restoring normal physical function or reducing symptoms caused by disease or injury (Caspersen et al., 1985)”. The regimen includes aerobic exercise, resistance exercise, and multiple combination exercises, as well as some traditional Chinese medicine exercises such as Baduanjin. Traditional Chinese medicine exercise therapy has been found to improve cognitive function in elderly patients with mild cognitive impairment (MCI) by regulating cognition-related brain function and structure (Su et al., 2022). Although there are many studies on the use of exercise therapy to improve PSCI, there is a relative lack of consensus, and there is no meta-analysis on the effects of exercise therapy on patients with PSCI. This study evaluated the effects of exercise therapy on patients with PSCI through a meta-analysis, aiming to provide a new evidence-based basis for intervention in patients with PSCI.

This systematic evaluation program is registered in the PROSPERO database (CRD42023397553).

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