Effect of Physical Activity on Cognitive Impairment in Patients With Cerebrovascular Diseases: A Systematic Review and Meta-Analysis

Abstract

Background and purpose: This study investigates the effect of physical activity (PA) on cognition in patients with cerebrovascular disease and explored the maximum benefit of different PA characteristics.

Methods: Databases, such as Pubmed, Web of Science, Embase, and Cochrane Library, were searched from their inception to May 31, 2021. Standardized mean difference (SMD) and 95% confidence intervals (CIs) were calculated to generate a forest plot. In addition, subgroup analysis, moderation analysis, and regression analysis were performed to explore the possible adjustment factors.

Results: In total, 22 studies that met the criteria were included, demonstrating data from 1,601 participants. The results indicated that PA produced a positive effect on the global cognition for patients with cerebrovascular disease (SMD: 0.20 [95% CI: 0.12-0.27]), at the same time, PA training prominently improved executive function (SMD: 0.09 [95% CI: 0.00-0.17]) and working memory (SMD: 0.25 [95% CI: 0.10-0.40]). Furthermore, patients with baseline cognitive impairment received the greater benefit of PA on cognition (SMD: 0.24 [95% CI: 0.14-0.34]) than those without cognitive impairment before intervention (SMD: 0.15 [95% CI: 0.04-0.26]). For patients in the acute stage (≤ 3 months), PA did not rescue impairment dysfunction significantly (SMD: 0.08 [95% CI: -0.04-0.21]) and remarkable cognitive gains were detected in the chronic stage of participants (>3 months) (SMD: 0.25 [95% CI: 0.16-0.35]). Moderate intensity PA showed a larger pooled effect size (SMD: 0.23 [95% CI: 0.11-0.36]) than low intensity (SMD: -0.01 [95% CI: -0.44-0.43]) and high intensity (SMD: 0.16 [95% CI: 0.03-0.29]). However, the different types, duration, and frequency of PA resulted in no differences in the improvement of cognitive function. Further regression analysis demonstrated that the beneficial effects of PA on cognition are negatively correlated with age (p < 0.05).

Conclusions: This study revealed that PA can prominently improve the cognitive ability in patients with cerebrovascular diseases and strengthened the evidence that PA held promise as a widely accessible and effective non-drug therapy for vascular cognitive impairment (VCI).

Keywords: cerebrovascular disease; cognitive function; meta-analysis; physical activity; stroke; systematic review; vascular cognitive impairment.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) flow diagram of the search strategy. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analysis; RCT, randomized controlled trial.

Figure 2

Forest plot of meta-analysis in the effect of PA on global cognitive function. Positive values of pooled effect size represented that PA improved cognitive performance. CI, confidence interval; PA, physical activity.

Figure 3

Forest plot of meta-analysis in the effect of regulatory factors on the global cognitive improvement by PA. Positive values of pooled effect size represented that PA improved cognitive performance. CI, confidence interval; PA, physical activity.

Figure 4

Forest plot of meta-analysis in the PA on specific cognitive domains. (A) Meta-analysis of effect of PA on executive function. (B) Meta-analysis of effect of PA on working memory. (C) Meta-analysis of effect of PA on spatial function. Positive values of pooled effect size represented that PA improved cognitive performance. Abbreviation: CI, confidence interval; PA, physical activity.

Figure 5

Meta-regression of age for the improvement of cognitive performance by PA. ES, effect size; PA, physical activity.

Figure 6

Funnel plots representing standard error (SE) and pooled effect size in the effect of PA on cognitive performance. CI, confidence interval; PA, physical activity.