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High-intensity aerobic, resistance, and combined exercise to improve cognition in stroke and dementia: A systematic review

geriatrics
rehabilitation
sports-medicine

Abstract

Background. Stroke and dementia exhibit a reciprocal relationship; international proclamations and the field of Geroscience promote their joint exploration to enhance understanding and prevention. Through a systematic review, we aimed to determine: 1) optimal training parameters of high-intensity exercise to improve cognition in people with stroke or dementia, 2) overlap in training parameters between pathologies, and 3) safety in implementing these interventions.

Methods. In accordance with PRISMA, we searched six databases and conducted dual-independent screening. Data extraction followed an identical procedure. We included randomized and non-randomized interventions assessing changes in cognition after high-intensity exercise in people with stroke or dementia.

Results. We included 35 studies (n=22 aerobic, n=8 resistance, n=5 combined), of which 15 were in stroke. Fourteen, five, and three studies of aerobic, resistance, and combined exercise, respectively, demonstrated significant cognitive improvement post-intervention. Adverse events varied in severity (i.e., minor to life-threatening) and were reported in 20-38% of studies. High-intensity aerobic exercise of >86-95% of HRmax appears to facilitate the most consistent improvement in cognitive outcomes, while posing no additional risk. Relatively, resistance exercise demonstrated comparable or better numbers than those of aerobic exercise. ~ 40% of studies did not report an exercise prescription parameter, making reproducibility and implementation impossible.

Conclusion. High-intensity aerobic exercise is a broad term; critical insights emerge when it is analyzed in discrete segments. There is an urgent need for better reporting of intervention parameters and more high-intensity resistance exercise trials to evaluate cognitive outcomes in stroke and dementia, particularly given the feasibility demonstrated herein.

Registration. PROSPERO CRD42025648400.
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