The effects of exercise modality and dose on improving executive function in stroke patients: A systematic review and...

This Bayesian network meta-analysis examined exercise effects on executive function in stroke patients, exploring dose-response relationships and comparing the efficacy of different modalities to identify the optimal rehabilitation protocol.

A systematic search was conducted in PubMed, Embase, the Cochrane Library, Web of Science, and SPORTDiscus from inception to September 15, 2025. Twenty randomized controlled trials (RCTs) were included. Study quality was assessed using the PEDro scale. A Bayesian random-effects network meta-regression model examined the nonlinear dose-response relationship between exercise dosage (in Metabolic Equivalent of Task-minutes, MET-mins) and executive function, with heterogeneity, publication bias, and model robustness evaluated.

The analysis demonstrated a significant inverted U-shaped relationship between weekly exercise dose and improvements in executive function, with the peak effect occurring at approximately 1000 MET-minutes per week (mean effect size = 0.65, 95 % credible interval: 0.34-1.00). Among different exercise modalities, exercise combined with cognitive training showed the most favorable and consistent association across a broad weekly dose range (approximately 170-1000 MET-minutes). Multicomponent exercise exhibited apparent benefits only at higher weekly doses (around 890-1000 MET-minutes), though with greater statistical uncertainty, whereas other modalities did not demonstrate clear or consistent effects.

The association between exercise and executive function in stroke patients appears to follow an optimal weekly dose (∼1000 MET-minutes) rather than a maximal one. Exercise combined with cognitive training provides synergistic, stable benefits within this range. These findings offer moderate-quality evidence to guide individualized rehabilitation that optimizes cognitive recovery and improves quality of life after stroke.