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Published on: May 22, 2019
Optimizing exercise interventions for depression in stroke patients: A network and dose-response meta-analysis
Wei Wang1, Zhide Liang2, Jiao Xiong1
1Nursing College, Guangxi University of Chinese Medicine, Guangxi, China.
Objective:
Post-stroke depression (PSD) is a common complication following stroke and is associated with increased mortality risk. Evidence suggests that exercise has a beneficial effect on depression. However, the optimal modality and dose of exercise interventions remain unclear. Therefore, this study aims to explore the optimal exercise intervention modality and dose for post-stroke depression.
Methods:
We screened six databases, including PubMed, Cochrane Library, Embase, Scopus, Web of Science, and CINAHL, for randomized controlled trials (RCTs) published up to September 2025. The Cochrane risk of bias tool was made available to assess the quality of the literature. A random-effects model was employed to perform a network meta-analysis (NMA).
Results:
A total of 29 randomized controlled trials involving 1061 stroke patients were included. Aerobic exercise was the most effective intervention (Hedges' g = -1.14, 95 % CrI: -1.62 to -0.63, k = 6, SUCRA = 0.89). This was followed by qigong exercise (Hedges' g = -0.55, 95 % CrI: -0.99 to -0.10, n = 7, SUCRA = 0.79), flexibility exercises (Hedges' g = -0.55,95 % CrI: -1.00 to -0.10, n = 6 SUCRA = 0.66), Tai Chi (Hedges' g = -0.44,95 % CrI: -0.86 to -0.01, n = 5 SUCRA = 0.48), and resistance training (Hedges' g = -0.29,95 % CrI: -0.72 to 0.16, n = 5 SUCRA = 0.30), whereas yoga (Hedges' g = -0.03, 95 % CrI: -0.79 to 0.72, n = 2, SUCRA = 0.26) did not reach clinical significance (defined as an effect size >0.2 SD). It was also found that the optimal dose range was 500-1100METs-min/week.
Conclusion:
Exercise can significantly improve depressive symptoms in patients after stroke. Based on our findings, exercise interventions may be considered a non-pharmacological option for post-stroke depression, as an adjunct to standard care. The optimal dose range appears to be 500-1100 METs-min/week. The effectiveness of different interventions may vary based on patient characteristics, suggesting that clinicians should tailor exercise prescriptions to the individual.
Registration:
The review protocol has been registered on PROSPERO(CRD42024601846).
