Influence of Aerobic Training and Combinations of Interventions on Cognition and Neuroplasticity after Stroke

The only way survivors will be helped is if all this research is written up in stroke protocol format and put in a publicly available location for critique and update. But this won't occur for at least 50 years.
http://journal.frontiersin.org/article/10.3389/fnagi.2016.00164/full

Annabelle Constans^1†, Caroline Pin-barre^1,2†, Jean-Jacques Temprado¹, Patrick Decherchi¹ and Jérôme Laurin^1*

• ¹Aix-Marseille Université, CNRS, ISM, UMR 7287, Marseille, France
• ²Université Nice Sophia Antipolis, LAMHESS, UPRES EA 6309, Nice, France

Stroke often aggravated age-related cognitive impairments that strongly affect several aspects of quality of life. However, few studies are, to date, focused on rehabilitation strategies that could improve cognition. Among possible interventions, aerobic training is well known to enhance cardiovascular and motor functions but may also induce beneficial effects on cognitive functions. To assess the effectiveness of aerobic training on cognition, it seems necessary to know whether training promotes the neuroplasticity in brain areas involved in cognitive functions. In the present review, we first explore in both human and animal how aerobic training could improve cognition after stroke by highlighting the neuroplasticity mechanisms. Then, we address the potential effect of combinations between aerobic training with other interventions, including resistance exercises and pharmacological treatments. In addition, we postulate that classic recommendations for aerobic training need to be reconsidered to target both cognition and motor recovery because the current guidelines are only focused on cardiovascular and motor recovery. Finally, methodological limitations of training programs and cognitive function assessment are also developed in this review to clarify their effectiveness in stroke patients.

Introduction

Sedentary older adults are prone to cardiovascular diseases, such as stroke (Bherer et al., 2013), which occurs when blood flow is interrupted to a part of the brain. This trauma leads to severe motor dysfunctions and it may also aggravate cognitive impairments resulting from normal aging (Rafnsson et al., 2007, 2009; Deary et al., 2009; Waldstein and Wendell, 2010). Indeed, stroke survivors have more than twice the risk of subsequently developing dementia compared with people who have never had a stroke (Tatemichi et al., 1992; Patel et al., 2002). For instance, a stroke situated on the left hemisphere might disturb language and comprehension, which reduce the ability to communicate (Karbe et al., 1990; Pirmoradi et al., 2016). When the right hemisphere is affected, the intuitive thinking, reasoning, solving problems as well as the perception, judgment and the visual-spatial functions could be impaired (Tatemichi et al., 1994; Patel et al., 2002; Cumming et al., 2012; Sun et al., 2014b; Harris et al., 2015; Tiozzo et al., 2015; Save-Pédebos et al., 2016). It makes thus difficult for patients to locate objects, walk up or down stairs or get dressed. Consequently, cognitive disorders are one of the strongest predictor of the inability to return to work, that contribute to the socioeconomic burden of stroke (Kauranen et al., 2013). However, stroke-induced cognitive disorders are often underestimated relative to motor impairments because they are confused with pre-existing symptoms of age-related mild cognitive impairments or Alzheimer’s Disease (AD; Figure 1; Sun et al., 2014b; Corriveau et al., 2016). Furthermore, cognitive impairments are frequently associated with poor motor recovery (Patel et al., 2002; Leśniak et al., 2008; Rand et al., 2010). It suggests that stroke-induced cognitive dysfunctions and brain plasticity might also affect the stability, flexibility and learning of complex movements (e.g., locomotion, unimanual aiming, bimanual coordination), in which cognitive resources are highly involved as it was already observed in older adults (Temprado et al., 1999, 2013; Sleimen-Malkoun et al., 2012, 2013; Cohen et al., 2016).

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