Deans' stroke musings: The effect of exercise interventions on reducing the risk of depressive and cognitive disorders in post-stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, March 31, 2025

The effect of exercise interventions on reducing the risk of depressive and cognitive disorders in post-stroke—a systematic review and meta-analysis

Why are you ignoring the elephant in the room explaining post stroke depression? It's incredibly simple; NO 100% RECOVERY PROTOCOLS!

You create EXACT 100% recovery protocols and your survivor will be motivated to do the millions of reps needed because they are looking forward to 100% recovery. GET THERE!

There would be no need for this useless research and no survivor depression.

The effect of exercise interventions on reducing the risk of depressive and cognitive disorders in post-stroke—a systematic review and meta-analysis

Zixian Yang¹^†

Shaokun Qin²^†

Jiaxing Li¹^†

Cong Li³^†

Ye Lu^4,5

Pei He^4,5^*

Jia Liu^4,5^*

Lin Pei^4,5^*

¹School of Basic Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
²Section of Science and Education, The Second Affiliated Hospital of Hebei University of Chinese Medicine, Dingzhou, Hebei, China
³Shijiazhuang Medical College, Shijiazhuang, Hebei, China
⁴Key Research Laboratory of Phlegm Stagnation Syndrome and Treatment in Hebei Province, Hebei Academy of Chinese Medicine Sciences, Shijiazhuang, China
⁵The Fourth Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China

Background: Stroke patients often experience sequelae such as depressive symptoms, cognitive impairment, and abnormal physical function. Exercise intervention may be an effective and safe non-drug treatment to address these health issues.

Objective: The aim of this meta-analytical review was to explore the effects of exercise intervention programs on depressive symptoms, cognitive function, physical function, and quality of life in stroke patients, as well as to identify appropriate exercise programs.

Methods: Seven databases were searched from the library’s construction until 30 August 2024. A meta-analysis was performed, and the risk of bias was assessed using Review Manager 5.4. Sensitivity analysis was conducted using Stata 16.0 software, and the overall certainty of the evidence was rated using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methods.

Results: A total of 11,607 studies were identified. Among these, 20 studies, which included 1,848 patients, were considered eligible for this network meta-analysis. Compared to the control group, exercise significantly improved cognitive function (standard mean difference [SMD] = 1.08, 95% confidence interval [CI] = 0.40–1.75, p = 0.002), physical balance ability (mean difference [MD] = 0.80, 95% CI = 0.23–1.37, p < 0.01), physical walking ability (MD = 48.39, 95% CI = 8.06–88.72, p = 0.02), and quality of life. However, exercise had no significant effect on depressive symptoms (SMD = −0.2, 95% CI = −0.46–0.05, p = 0.11). A subgroup analysis indicated that a longer duration of exercise (> 3 months) can effectively improve depressive symptoms in stroke patients.

Conclusion: The results indicated that cognitive function, balance, walking speed, and quality of life of stroke patients improved following exercise intervention, and longer exercise duration (> 3 months) contributed to alleviating the depressive symptoms of stroke patients. Therefore, we recommend that stroke patients engage in physical exercise 3 times a week for 1 h each session. The exercise duration should continue for at least 3 months to ensure the best therapeutic effect. Furthermore, determining exercise intensity should be a personalized process—carefully customized to align with the physical capabilities and limitations of each patient.

Systematic review registration: https://www.crd.york.ac.uk/prospero, CRD42024520778.

1 Introduction

Stroke is the leading cause of acquired disability among adults worldwide (1), and stroke survivors are likely to experience long-term neurological complications (2). Stroke patients are more likely to develop depressive symptoms, cognitive impairment, and physical movement disorder after surgery; these complications adversely affect the quality of life, survival rates, and functional recovery of stroke patients (3–5).

One of the most prevalent long-term effects of stroke is post-stroke depression (PSD), which affects 11–41% of stroke survivors worldwide and is associated with a markedly higher risk of death. According to the depression scale, approximately 50% of stroke patients have PSD (6, 7). Up to one-third of stroke survivors may experience the severe consequences of cognitive impairment, which frequently follows a stroke (8). Research shows that stroke survivors with mild cognitive impairment face a twofold increased risk of death (9). Hemiplegia affects over 85% of stroke patients, leading to impaired upper limb function and decreased motor ability (10). This impairment significantly impacts balance and the extent of daily and social activities (11). National and international stroke treatment guidelines rarely emphasize the most effective clinical prevention and treatment strategies for stroke survivors (12). Currently, medication and psychotherapy are the standard treatments; however, these do not significantly enhance physical function and quality of life (13, 14).

There is a wealth of evidence supporting the protective role of exercise in cognitive and depressive disorders after stroke. Exercise intervention offers multiple benefits and effects that may enhance the cognitive function following a stroke (15), recovery of arm function, improvement of balance index and gait speed, and improvement of physical function and quality of life. Cognitive and depressive disorders have been shown to benefit from exercises (12, 16–18). Research shows that exercise can improve cardiovascular fitness, elevate blood levels of adrenaline and brain-derived neurotrophic factors, and positively supervise brain function, including growth factors, brain metabolism, neurotransmitters, oxygen availability, glucose regulation, and oxidative stress. These processes can enhance both depression and cognitive function (19). Although the efficacy of exercise in managing stroke sequelae is well established, research findings regarding the dose–response relationship of exercise in stroke patients remain inconsistent. Current literature offers limited guidance on the best exercise parameters for treating stroke-related impairments.

Therefore, the aim of this meta-analysis and systematic review is to thoroughly examine all published randomized controlled trials. The effects of post-stroke exercise on patients’ depression symptoms, cognitive function, physical function, and quality of life will be assessed to provide scientific support for future clinical practice and research.