TOPLINE

In older adults who had stroke, dual-task training and mind-body exercise ranked highest for reducing depressive symptoms, while resistance/strength training and dual-task training were ranked most beneficial for reducing anxiety, a study showed. For cognitive function, balance/coordination training was linked to statistically credible improvement compared with usual care, though mind-body exercise and general aerobic exercise ranked highest.

METHODOLOGY

• Researchers conducted a systematic review and meta-analysis including 52 randomized controlled trials, searching five international and two Chinese databases from inception to July 2025. Studies were conducted in Asia, Europe, North America, and other regions, with intervention durations ranging from 2 weeks to 6 months.
• 4170 older adults (mean age, 55.6 to 79.5 years; 38.5% to 91.7% men) with stroke were included, with 2073 in the intervention groups and 2097 in the control groups.
• 11 exercise interventions (balance/coordination training, combined/mixed exercise, dual-task training, early/functional rehabilitation, general aerobic exercise, high-intensity interval training, mind-body exercise, moderate-intensity continuous training, resistance/strength training, technology-assisted exercise, and cognitive therapy) were compared with usual care and ranked using the surface under the cumulative ranking curve.
• The primary outcomes were depression, anxiety, and cognitive function, measured using validated instruments including the Hospital Anxiety and Depression Scale, Hamilton Depression Rating Scale, Montreal Cognitive Assessment, and Mini-Mental State Examination.

TAKEAWAY

• For depression, dual-task training ranked highest and showed statistically credible benefits compared with usual care (standardized mean difference [SMD], -3.83; 95% credibility interval [CrI], -7.48 to -0.02), followed by mind-body exercise (SMD, -2.95; 95% CrI, -5.84 to -0.03) and balance/coordination training  (SMD, -2.64; 95% CrI, -5.12 to -0.11).
• For anxiety, mind-body exercise (SMD, -6.22, 95% CrI: -14.18 to 2.09) was ranked highest, although resistance/strength training (SMD, -4.60; 95% CrI, -7.13 to -1.97), dual-task training (SMD, -3.69; 95% CrI, -6.95 to -0.50), and general aerobic exercise (SMD, -2.45, 95% CrI, -4.86 to 0.00) showed statistically credible benefits compared with usual care. Early/functional rehabilitation was associated with significantly worse outcomes in anxiety (SMD, 5.04; 95% CrI, 3.20 to 6.96).
• For cognitive function, balance/coordination training was the only intervention showing statistically credible improvement compared with usual care (SMD, 2.06; 95% CrI, 0.07 to 4.11), although mind-body exercise, general aerobic exercise, and moderate-intensity continuous training ranked highest.
• Longer time post-stroke was associated with smaller benefits for anxiety (beta, -0.42; 95% CrI, -0.84 to -0.08) and cognitive function (beta, -0.33; 95% CrI, -0.66 to 0.00), suggesting that earlier intervention may yield greater improvements.

IN PRACTICE

"Different exercise modalities may offer distinct benefits for psychological and cognitive outcomes after stroke in older adults. These findings support individualized, phase-sensitive exercise prescription in post-stroke rehabilitation," the investigators wrote.

SOURCE

The study was led by Yu-Cheng Wang, PhD, Faculty of Medicine, University of Macau, Macao SAR, China. It was published online on August 12 in The American Journal of Geriatric Psychiatry.

LIMITATIONS

The number of studies for certain interventions was limited. Heterogeneity in outcome measures, intervention protocols, and reporting quality across studies may have influenced the findings. Many included studies had methodological limitations, and most lacked long-term follow-up data and had limited generalizability.

DISCLOSURES

The study was funded by the Beijing High Level Public Health Technology Talent Construction Project, the Beijing Municipal Science & Technology Commission, the Capital's Funds for Health Improvement and Research, and the University of Macau. The investigators reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.