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Olaleye OA1, Abba MA2, Hamzat TK1
1University of Ibadan, Department of Physiotherapy, Ibadan, Nigeria, 2Bayero University Kano, Department of Physiotherapy, Kano, Nigeria
Background: Cognitive impairment is a common sequel of stroke and occurs in about 20-30% of all cases. Post-Stroke Cognitive Impairment (PSCI) impacts negatively on performance of ADLs and quality of life. Therefore, minimising the impact of PSCI is one of the goals of stroke rehabilitation. Several approaches have been used in the rehabilitation of PSCI. These approaches often incorporate aerobic and resistant trainings. However, conflicting results have been reported on the effect of aerobic exercises on PSCI. In addition, highly varied methodologies were used, making it difficult to draw a conclusive inference.
Purpose: This systematic review was conducted to analyse available scientific evidence on the effectiveness of aerobic exercise on PSCI.
Methods: This review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Three online databases (PubMed, EMBASE, Web of Science) were systematically searched for published articles from their inception up to 13 July, 2017 using the keywords: stroke/exercise/cognition. Search filters were further applied to restrict the search output to clinical trial involving human subjects published in English language. Studies that reported on the short and long-term effect of aerobic exercises interventions (I) on the global or individual domains of cognitive function including memory, attention and executive function outcomes (O) among stroke survivors (P) were included. The methodological quality of the studies was assessed using the PEDro scale, independently by two reviewers and where necessary, a third reviewer was contacted for consensus. Qualitative data synthesis was performed after taking into account number of studies and exposure in each study.
Results: 3953 articles were identified from database hits. 35 full-text articles were retrieved for further evaluation. Only seven(7) articles (4 randomized controlled trials, 2 pre-test, post-test and 1 clinical control trial) were reviewed for evidence synthesis.
Aerobic exercises was administered using treadmill walking, overground walking, lower body cycle, bicycle ergometry and body weight support treadmill training. Intensity of exercise varied from low to high. Exercise duration ranged from 20-60 minutes, including a warm-up and a cool-down period while training frequency ranged from 2 to 5 times per week.
There was moderate evidence (consistent findings from two low quality studies) on the efficacy of aerobic exercise in improving global cognitive function post-stroke. Similarly, moderate evidence (consistent findings in one high quality and two low quality studies) was found in support of the effectiveness of aerobic exercise in improving attention in patients with PSCI.
There is however, conflicting evidence (inconsistent findings) on the effect of aerobic exercise on memory post-stroke. Only moderate evidence (consistent findings from one high quality and one low quality studies) existed on the effectiveness of aerobic exercise on working memory post stroke.
Conclusion(s): Aerobic exercise is moderately effective in improving some aspects of cognitive function among stroke survivors.
Implications: Aerobic exercise should remain a component of stroke rehabilitation programmes. High quality clinical trials involving larger samples are needed among stroke survivors to provide adequate studies for future reviews.
Keywords: Aerobic exercises, cognitive impairment, stroke
Funding acknowledgements: The study was no funded
Purpose: This systematic review was conducted to analyse available scientific evidence on the effectiveness of aerobic exercise on PSCI.
Methods: This review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Three online databases (PubMed, EMBASE, Web of Science) were systematically searched for published articles from their inception up to 13 July, 2017 using the keywords: stroke/exercise/cognition. Search filters were further applied to restrict the search output to clinical trial involving human subjects published in English language. Studies that reported on the short and long-term effect of aerobic exercises interventions (I) on the global or individual domains of cognitive function including memory, attention and executive function outcomes (O) among stroke survivors (P) were included. The methodological quality of the studies was assessed using the PEDro scale, independently by two reviewers and where necessary, a third reviewer was contacted for consensus. Qualitative data synthesis was performed after taking into account number of studies and exposure in each study.
Results: 3953 articles were identified from database hits. 35 full-text articles were retrieved for further evaluation. Only seven(7) articles (4 randomized controlled trials, 2 pre-test, post-test and 1 clinical control trial) were reviewed for evidence synthesis.
Aerobic exercises was administered using treadmill walking, overground walking, lower body cycle, bicycle ergometry and body weight support treadmill training. Intensity of exercise varied from low to high. Exercise duration ranged from 20-60 minutes, including a warm-up and a cool-down period while training frequency ranged from 2 to 5 times per week.
There was moderate evidence (consistent findings from two low quality studies) on the efficacy of aerobic exercise in improving global cognitive function post-stroke. Similarly, moderate evidence (consistent findings in one high quality and two low quality studies) was found in support of the effectiveness of aerobic exercise in improving attention in patients with PSCI.
There is however, conflicting evidence (inconsistent findings) on the effect of aerobic exercise on memory post-stroke. Only moderate evidence (consistent findings from one high quality and one low quality studies) existed on the effectiveness of aerobic exercise on working memory post stroke.
Conclusion(s): Aerobic exercise is moderately effective in improving some aspects of cognitive function among stroke survivors.
Implications: Aerobic exercise should remain a component of stroke rehabilitation programmes. High quality clinical trials involving larger samples are needed among stroke survivors to provide adequate studies for future reviews.
Keywords: Aerobic exercises, cognitive impairment, stroke
Funding acknowledgements: The study was no funded
Topic: Disability & rehabilitation; Neurology: stroke
Ethics approval required: No
Institution: N/A
Ethics committee: N/A
Reason not required: The study is a systematic review
All authors, affiliations and abstracts have been published as submitted.
