Skip to main content Accessibility help
×
Home

The effect of physical activity on cognitive function after stroke: a systematic review

  • Toby B. Cumming (a1), Karen Tyedin (a1), Leonid Churilov (a1), Meg E. Morris (a2) and Julie Bernhardt (a1) (a3)...

Abstract

Background: Research in both humans and animals indicates that physical activity can enhance cognitive activity, but whether this is true in patients with stroke is largely unknown. We aimed to evaluate the relationship between increased physical activity after stroke and cognitive performance.

Methods: A systematic review was conducted of MEDLINE, EMBASE, PsycINFO and other electronic databases. All randomized controlled trials and controlled clinical studies that evaluated the effect of physical activity or exercise on cognitive function in stroke were included. Study quality was assessed using four criteria concerning sources of bias (use of randomization, allocation concealment, blinding of outcome assessment, whether all patients were accounted for in outcome data).

Results: The literature search (first run in 2008, updated in 2011) yielded 12 studies that satisfied inclusion criteria. Exercise interventions were heterogeneous; some studies compared different intensities of movement rehabilitation, others included a specific exercise program. Cognitive function was rarely the primary outcome measure, and cognitive assessment tools used were generally suboptimal. Nine studies had sufficient data to be included in a meta-analysis, which indicated a significant benefit of intervention over control (SMD = 0.20, 95% CI: 0.04–0.36; z = 2.43, p = 0.015). Studies that met all four quality criteria reported smaller treatment benefit than studies that did not.

Conclusions: There is some evidence that increased physical activity after stroke enhances cognitive performance. The pool of studies identified, however, was small and methodological shortcomings were widespread.

Copyright

Corresponding author

Correspondence should be addressed to: Dr Toby Cumming, Florey Neuroscience Institutes, 245 Burgundy St, Heidelberg Vic 3084, Australia. Phone: +61 3 9035 7152; Fax: +61 3 9496 2251. Email: tcumming@unimelb.edu.au.

References

Hide All
Angevaren, M., Aufdemkampe, G., Verhaar, H. J., Aleman, A. and Vanhees, L. (2008). Physical activity and enhanced fitness to improve cognitive function in older people without known cognitive impairment. Cochrane Database of Systematic Reviews, CD005381.
Bateman, A., Culpan, F. J., Pickering, A. D., Powell, J. H., Scott, O. M. and Greenwood, R. J. (2001). The effect of aerobic training on rehabilitation outcomes after recent severe brain injury: a randomized controlled evaluation. Archives of Physical Medicine & Rehabilitation, 82, 174182.
Blake, H., McKinney, M., Treece, K., Lee, E. and Lincoln, N. B. (2002). An evaluation of screening measures for cognitive impairment after stroke. Age & Ageing, 31, 451456.
Bouchard, C., Blair, S. N. and Haskell, W. L. (2007). Physical Activity and Health. Champaign, IL: Human Kinetics.
Chen, X. (2006). Effect of community-based-rehabilitation on activities of daily life and cognitive function in stroke patients. Chinese Journal of Clinical Rehabilitation, 10, 46.
Cicerone, K. D. et al. (2000). Evidence-based cognitive rehabilitation: recommendations for clinical practice. Archives of Physical Medicine & Rehabilitation, 81, 15961615.
Cicerone, K. D. et al. (2005). Evidence-based cognitive rehabilitation: updated review of the literature from 1998 through 2002. Archives of Physical Medicine and Rehabilitation, 86, 16811692.
Colcombe, S. and Kramer, A. F. (2003). Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychological Science, 14, 125130.
Colcombe, S. J. et al. (2006). Aerobic exercise training increases brain volume in aging humans. Journals of Gerontology, Series A: Biological Sciences & Medical Sciences, 61, 11661170.
Cotman, C. W. and Engesser-Cesar, C. (2002). Exercise enhances and protects brain function. Exercise & Sport Sciences Reviews, 30, 7579.
das Nair, R. D. and Lincoln, N. B. (2007). Cognitive rehabilitation for memory deficits following stroke. Cochrane Database of Systematic Reviews, CD002293.
Devine, J. M. and Zafonte, R. D. (2009). Physical exercise and cognitive recovery in acquired brain injury: a review of the literature. Pm & R, 1, 560575.
Egger, M., Smith, G. D. and Altman, D. G. (2001). Systematic Reviews in Health Care: Meta-analysis in Context. London: BMJ.
Fang, Y., Chen, X., Li, H., Lin, J., Huang, R. and Zeng, J. (2003). A study on additional early physiotherapy after stroke and factors affecting functional recovery. Clinical Rehabilitation, 17, 608617.
Fratiglioni, L., Paillard-Borg, S. and Winblad, B. (2004). An active and socially integrated lifestyle in late life might protect against dementia. Lancet Neurology, 3, 343353.
Griesbach, G. S., Hovda, D. A., Molteni, R., Wu, A. and Gomez-Pinilla, F. (2004). Voluntary exercise following traumatic brain injury: brain-derived neurotrophic factor upregulation and recovery of function. Neuroscience, 125, 129139.
Heinemann, A. W., Hamilton, B., Linacre, J. M., Wright, B. D. and Granger, C. (1995). Functional status and therapeutic intensity during inpatient rehabilitation. American Journal of Physical Medicine & Rehabilitation, 74, 315326.
Heyn, P., Abreu, B. C. and Ottenbacher, K. J. (2004). The effects of exercise training on elderly persons with cognitive impairment and dementia: a meta-analysis. Archives of Physical Medicine & Rehabilitation, 85, 16941704.
Higgins, J. and Green, S. (eds.) 2008. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. Cochrane Collaboration.
Hochstenbach, J. B., Anderson, P. G., van Limbeek, J. and Mulder, T. T. (2001). Is there a relation between neuropsychologic variables and quality of life after stroke? Archives of Physical Medicine and Rehabilitation, 82, 13601366.
Horn, S. D., DeJong, G., Smout, R. J., Gassaway, J., James, R. and Conroy, B. (2005). Stroke rehabilitation patients, practice, and outcomes: is earlier and more aggressive therapy better? Archives of Physical Medicine & Rehabilitation, 86, S101S114.
Jin, Y. P., Di Legge, S., Ostbye, T., Feightner, J. W. and Hachinski, V. (2006). The reciprocal risks of stroke and cognitive impairment in an elderly population. Alzheimer's and Dementia, 2, 171178.
Katz-Leurer, M., Carmeli, E. and Shochina, M. (2003). The effect of early aerobic training on independence six months post stroke. Clinical Rehabilitation, 17, 735741.
Keith, R. A., Wilson, D. B. and Gutierrez, P. (1995). Acute and subacute rehabilitation for stroke: a comparison. Archives of Physical Medicine & Rehabilitation, 76, 495500.
Lai, S. et al. (2006). Therapeutic exercise and depressive symptoms after stroke. Journal of the American Geriatrics Society, 52, 240247.
Lautenschlager, N. T. et al. (2008). Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. JAMA, 300, 10271037.
Lincoln, N. B., Majid, M. J. and Weyman, N. (2000). Cognitive rehabilitation for attention deficits following stroke. Cochrane Database of Systematic Reviews, CD002842.
MacKay-Lyons, M. et al. (2010). Program of rehabilitative exercise and education to avert vascular events after non-disabling stroke or transient ischemic attack (PREVENT Trial): a multi-centred, randomised controlled trial. BMC Neurology, 10, 122.
McMorris, T., Collard, K., Corbett, J., Dicks, M. and Swain, J. P. (2008). A test of the catecholamines hypothesis for an acute exercise-cognition interaction. Pharmacology, Biochemistry & Behavior, 89, 106115.
Mead, G. E. et al. (2007). Stroke: a randomized trial of exercise or relaxation. Journal of the American Geriatrics Society, 55, 892899.
Morris, S. B. and DeShon, R. P. (2002). Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychological Methods, 7, 105125.
Nilsson, L. et al. (2001). Walking training of patients with hemiparesis at an early stage after stroke: a comparison of walking training on a treadmill with body weight support and walking training on the ground. Clinical Rehabilitation, 15, 515527.
Nys, G. M., van Zandvoort, M. J., de Kort, P. L., Jansen, B. P., Kappelle, L. J. and de Haan, E. H. (2005). Restrictions of the Mini-Mental State Examination in acute stroke. Archives of Clinical Neuropsychology, 20, 623629.
Özdemir, F., Birtane, M., Tabatabaei, R., Kokino, S. and Ekuklu, G. (2001). Comparing stroke rehabilitation outcomes between acute inpatient and nonintense home settings. Archives of Physical Medicine & Rehabilitation, 82, 13751379.
Pasquini, M., Leys, D., Rousseaux, M., Pasquier, F. and Henon, H. (2007). Influence of cognitive impairment on the institutionalisation rate 3 years after a stroke. Journal of Neurology, Neurosurgery & Psychiatry, 78, 5659.
Patel, M. D., Coshall, C., Rudd, A. G. and Wolfe, C. D. (2002). Cognitive impairment after stroke: clinical determinants and its associations with long-term stroke outcomes. Journal of the American Geriatrics Society, 50, 700706.
Pereira, A. C., et al. (2007). An in vivo correlate of exercise-induced neurogenesis in the adult dentate gyrus. Proceedings of the National Academy of Sciences of the United States of America, 104, 56385643.
Ploughman, M., McCarthy, J., Bosse, M., Sullivan, H. J. and Corbett, D. (2008). Does treadmill exercise improve performance of cognitive or upper-extremity tasks in people with chronic stroke? A randomized cross-over trial. Archives of Physical Medicine & Rehabilitation, 89, 20412047.
Prakash, R. S. et al. (2007). Cardiorespiratory fitness: a predictor of cortical plasticity in multiple sclerosis. Neuroimage, 34, 12381244.
Pyoria, O., Talvitie, U., Nyrkko, H., Kautiainen, H., Pohjolainen, T. and Kasper, V. (2007). The effect of two physiotherapy approaches on physical and cognitive functions and independent coping at home in stroke rehabilitation: a preliminary follow-up study. Disability & Rehabilitation, 29, 503511.
Pyun, S.-B., Yang, H., Lee, S., Yook, J., Kwon, J. and Byun, E.-M. (2009). A home programme for patients with cognitive dysfunction: a pilot study. Brain Injury, 23, 686692.
Quaney, B. M., et al. (2009). Aerobic exercise improves cognition and motor function poststroke. Neurorehabilitation & Neural Repair, 23, 879885.
Rand, D., Eng, J. J., Liu-Ambrose, T. and Tawashy, A. E. (2010). Feasibility of a 6-month exercise and recreation program to improve executive functioning and memory in individuals with chronic stroke. Neurorehabilitation & Neural Repair, 24, 722729.
Ruff, R. M., Yarnell, S. and Marinos, J. M. (1999). Are stroke patients discharged sooner if in-patient rehabilitation services are provided seven v six days per week? American Journal of Physical Medicine & Rehabilitation, 78, 143146.
Smith, P. J. et al. (2010). Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials. Psychosomatic Medicine, 72, 239252.
Studenski, S., Duncan, P. W., Perera, S., Reker, D., Lai, S. and Richards, L. (2005). Daily functioning and quality of life in a randomised controlled trial of therapeutic exercise for subacute stroke survivors. Stroke, 36, 17641770.
van Uffelen, J. G. Z., Chin a Paw, M. J. M., Hopman-Rock, M. and van Mechelen, W. (2008). The effects of exercise on cognition in older adults with and without cognitive decline: a systematic review. Clinical Journal of Sport Medicine, 18, 486500.
WHO (2003). World Health Report. Geneva: World Health Organization.
Wilson, D. J., Powell, M., Gorham, J. L. and Childers, M. K. (2006). Ambulation training with and without partial weightbearing after traumatic brain injury: results of a randomized, controlled trial. American Journal of Physical Medicine & Rehabilitation, 85, 6874.
Winter, B. et al. (2007). High impact running improves learning. Neurobiology of Learning & Memory, 87, 597609.
Wolfe, C. D., Tilling, K. and Rudd, A. G. (2000). The effectiveness of community-based rehabilitation for stroke patients who remain at home: a pilot randomized trial. Clinical Rehabilitation, 14, 563569.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed