Exercise for depressive symptoms in stroke patients: a systematic review and meta-analysis

Objective: The objective was to conduct a systematic review and meta-analysis of studies that examined the effects of structured exercise on depressive symptoms in stroke patients. Methods: We searched for published randomized controlled trials that evaluated the effect of structured exercise programs (e.g. functional, resistance, or aerobic training) on depressive symptoms. The mean effect size, a 95% confidence interval (CI) and I-squared (I-2) for heterogeneity were estimated. Sensitivity analyses were conducted. Results: Thirteen studies (n = 1022) were included in the meta-analysis. Exercise resulted in less depressive symptoms immediately after the exercise program ended, standardized mean difference = -0.13 [95% CI = -0.26, -0.01], I-2 = 6%, p = 0.03, but these effects were not retained with longer term follow-up. Exercise appeared to have a positive effect on depressive symptoms across both the subacute (6 months post stroke) and chronic stage of recovery (>6 months). There was a significant effect of exercise on depressive symptoms when higher intensity studies were pooled, but not for lower intensity exercise protocols. Antidepressant medication use was not documented in the majority of studies and thus, its potential confounding interaction with exercise could not be assessed. Conclusions: Exercise may be a potential treatment to prevent or reduce depressive symptoms in individuals with subacute and chronic stroke.