Effect of Exercise Interventions on Health-Related Quality of Life After Stroke and Transient Ischemic Attack

Abstract

Exercise interventions have been shown to help physical fitness, walking, and balance after stroke, but data are lacking on whether such interventions lead to improvements in health-related quality of life (HRQoL). In this systematic review and meta-analysis, 30 randomized controlled trials (n=1836 patients) were found from PubMed, OVID MEDLINE, Web of Science, CINAHL, SCOPUS, The Cochrane Library, and TRIP databases when searched from 1966 to February 2020 that examine the effects of exercise interventions on HRQoL after stroke or transient ischemic attack. Exercise interventions resulted in small to moderate beneficial effects on HRQoL at intervention end (standardized mean difference, −0.23 [95% CI, −0.40 to −0.07]) that appeared to diminish at longer-term follow-up (standardized mean difference, −0.11 [95% CI, −0.26 to 0.04]). Exercise was associated with moderate improvements in physical health (standardized mean difference, −0.33 [95% CI, −0.61 to −0.04]) and mental health (standardized mean difference, −0.29 [95% CI, −0.49 to −0.09]) domains of HRQoL while effects on social or cognitive composites showed little difference. Interventions that were initiated within 6 months, lasted at least 12 weeks in duration, involved at least 150 minutes per week, and included resistance training appeared most effective. Exercise can lead to moderate beneficial effects on HRQoL and should be considered an integral part of stroke rehabilitation.

Effect of innovative vs. usual care physical therapy in subacute rehabilitation after stroke. A multicenter randomized controlled trial

“…This may suggest a larger proportion of cognitive/mental problems in this group, which may have been caused by the stroke, result from the lower premorbid function, a higher age and stroke severity, or a combination of these. Exercise interventions are known to have small to moderate beneficial effects on HRQOL in physical and mental health domains that diminish at longer-term follow up, and no significant effects on societal or participatory domains, (67). The limited uptake of physical activity after the intervention, as indicated by the activity monitoring at 12-weeks along with lower HRQOL-scores on cognitive/mental components, supports these notions.…”

Effects and mechanisms of mindfulness training and physical exercise on cognition, emotional wellbeing, and brain outcomes in chronic stroke patients: Study protocol of the MindFit project randomized controlled trial

“…This sample size supports a 20% tracking loss rate. We established a minimum effect size of 0.75 standard deviations by considering the results of meta-analyses studying the effects of mindfulness or PE on cognition or emotional wellbeing in stroke patients (e.g., Abbott et al, 2014 ; Oberlin et al, 2017 ; Ali et al, 2021 ; Sun et al, 2021 ). The effect sizes reported in these papers range from small-moderate (between d = 0.30 and d = 0.50) to moderate-large (between d = 0.50 and d = 1), depending on the intervention and the outcome studied.…”

“…In stroke patients, contrarily to the effects of mindfulness, the gains of PE on cognition and emotional wellbeing have been more thoroughly studied. Some meta-analyses of randomized controlled trials have shown small-to-moderate effects of PE on cognition ( Oberlin et al, 2017 ), depressive symptoms ( Eng and Reime, 2014 ), and post-stroke health-related quality of life ( Ali et al, 2021 ).…”

The effect and mechanism of exercise for post-stroke pain

“…It has been shown that exercise can improve cognitive function and activities of daily living in stroke patients (Li et al, 2022;Nindorera et al, 2022). Physical exercise is also effective in improving patients' quality of life and depressive symptoms after stroke (Ali et al, 2021;Zhang W. et al, 2021). However, there is still a lack of research on the mechanisms of exercise interventions for PSP.…”