The effects of exercise on cognition post-stroke: are there sex differences? A systematic review and meta-analysis

Abstract

Purpose

The aim of this systematic review was to investigate if sex moderated the effect of exercise on cognition in adults post-stroke.

Methods

A systematic review was conducted of randomized controlled trials that involved adults ≥18 years with stroke, any exercise intervention, and reported any outcome related to cognitive function. We compared effect sizes of cognitive outcomes between studies of lower and higher proportion of females (CRD42018092757).

Results

The effects of exercise did not differ between studies of higher and lower female proportions with respect to memory (χ² =1.52, p = 0.22), executive function (χ² = 0.56, p = 0.45; Chi² = 0.00, p = 0.98), language (Chi² = 3.17, p = 0.08) or global cognition (χ² = 0.88, p = 0.35).

Conclusion

There were no sex differences in the effects of exercise on memory, executive functioning, language or global cognition in individuals with stroke. Further research is warranted to address sex differences in individuals with stroke to enable better targeting, prevention, and interventions in stroke rehabilitation.

IMPLICATIONS FOR REHABILITATION

• Understanding sex differences and potentially similarities in the relationship between exercise and cognition is an important step in enhancing stroke rehabilitation and the development of optimal, sex-specific rehabilitation.

• Although our findings suggest that there is no clear rationale for incorporating sex into our clinical decision making, it is still imperative to consider sex factors in research and report results in the literature disaggregated by sex to help inform clinical practice.

Keywords:

• Sex and gender
• cognition
• stroke
• rehabilitation
• exercise

Acknowledgements

The authors thank Stephanie Sanger, Clinical Outreach Librarian and Dr. Anita Gross, Associate Clinical Professor, McMaster University.

Disclosure statement

The authors above have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.