A systematic review of the effect of physical exercise on cognition in stroke and traumatic brain injury patients

OBJECTIVE: To determine whether physical exercise enhances cognition following TBI or stroke. DATA SOURCES: Studies were identified through searches of PubMed, ScienceDirect and the reference lists of papers that were included for full-text evaluation. Medical subject headings from three concepts, i. e. brain injury, physical exercise and cognition, were used to incorporate related search terms. STUDY SELECTION: Included were all trials published in English that assessed cognition before and after an exercise intervention in human adults with TBI or stroke. Nine randomized and two non-randomized controlled trials, as well as three single group pre-post studies were included. DATA EXTRACTION: Relevant data concerning the methods and results of the included studies were extracted. Methodological quality of the RCT's was evaluated using the PEDro scale. Non-randomized trials were assessed using the Downs and Black checklist. DATASYNTHESIS: The included trials were generally of medium methodological quality, though often plagued with issues of internal and external validity. The studies exhibited great heterogeneity, rendering a meta-analysis infeasible. CONCLUSIONS: Though well-designed studies are still needed, the preponderance of evidence suggests a positive effect of physical exercise on global cognitive functioning, especially in the chronic stages of a brain injury. Time after injury as well as the duration of the exercise program are mediating factors.