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DOI: 10.1590/0004-282X-ANP-2020-0551
Effects of aerobic physical exercise on neuroplasticity after stroke: systematic review
Efeitos do exercício físico aeróbico na neuroplasticidade após o acidente vascular cerebral: revisão sistemática de literatura![](https://www.thieme-connect.de/media/10.1055-s-00054595/202109/lookinside/thumbnails/10-1590-0004-282x-anp-2020-0551_20200551-1.jpg)
ABSTRACT
Background: Stroke is among the leading causes of death and disability worldwide. Interventions for stroke rehabilitation aim to minimize sequelae, promote individuals’ independence and potentially recover functional damage. The role of aerobic exercise as a facilitator of post-stroke neuroplasticity in humans is still questionable. Objective: To investigate the impact of aerobic exercise on neuroplasticity in patients with stroke sequelae. Methods: A systematic review of randomized clinical trials and crossover studies was performed, with searches for human studies in the following databases: PUBMED, EMBASE, LILACS and PeDRO, only in English, following the PRISMA protocol. The keywords used for selecting articles were defined based on the PICO strategy. Results: This systematic review evaluated the impacts of aerobic exercise on neuroplasticity through assessment of neural networks and neuronal excitability, neurotrophic factors, or cognitive and functional assessment. Studies that evaluated the effects of aerobic exercise on neuroplasticity after stroke measured through functional resonance (fMRI) or cortical excitability have shown divergent results, but aerobic exercise potentially can modify the neural network, as measured through fMRI. Additionally, aerobic exercise combined with cognitive training improves certain cognitive domains linked to motor learning. Studies that involved analysis of neurotrophic factors to assess neuroplasticity had conflicting results. Conclusions: Physical exercise is a therapeutic intervention in rehabilitation programs that, beyond the known benefits relating to physical conditioning, functionality, mood and cardiovascular health, may also potentiate the neuroplasticity process. Neuroplasticity responses seem more robust in moderate to high-intensity exercise training programs, but dose-response heterogeneity and non-uniform neuroplasticity assessments limit generalizability.
RESUMO
Antecedentes: O acidente vascular cerebral (AVC) é a segunda causa principal de morte no mundo. Intervenções para reabilitação dos pacientes com AVC visam minimizar sequelas, promover sua independência e potencialmente recuperar danos funcionais. O papel do exercício aeróbico como facilitador da neuroplasticidade pós-AVC em humanos ainda é questionável. Objetivo: Investigar o impacto do exercício aeróbico na neuroplasticidade em pacientes com sequelas de AVC. Métodos: Foi realizada revisão sistemática de literatura, pesquisando nas seguintes bases de dados: PUBMED, EMBASE, LILACS e PeDRO. Foram selecionados trabalhos em língua inglesa, realizados apenas com humanos, seguindo o protocolo PRISMA. As palavras-chave utilizadas para a seleção de artigos foram definidas com base na estratégia PICO. Resultados: Esta revisão sistemática avaliou os impactos do exercício aeróbico na neuroplasticidade através da avaliação das redes neurais e da excitabilidade neuronal, por meio de fatores neurotróficos, por meio da avaliação cognitiva e funcional. Estudos que avaliaram os efeitos do exercício aeróbico sobre neuroplasticidade após o AVC medido através de ressonância funcional ou excitabilidade cortical, são controversos, mas há dados sugerindo uma modificação da rede neural na ressonância funcional após o exercício aeróbico. Há evidências de que, associar exercício aeróbico com treinamento cognitivo melhora certos domínios cognitivos ligados à aprendizagem motora. Estudos que envolveram a análise de fatores neurotróficos, como avaliação da neuroplasticidade, tiveram resultados conflitantes. Conclusões: Exercício aeróbico é uma intervenção terapêutica em programas de reabilitação, pois, além de proporcionar os benefícios no condicionamento físico, funcionalidade, humor e saúde cardiovascular, pode potencializar a neuroplasticidade.
Keywords:
Stroke - Stroke Rehabilitation - Exercise - Neuronal Plasticity - Endurance Training - High-Intensity Interval Training - Brain-Derived Neurotrophic Factor - Nerve Growth FactorPalavras-chave:
Acidente Vascular Cerebral - Reabilitação do Acidente Vascular Cerebral - Exercício Físico - Plasticidade Neuronal - Treino Aeróbico - Treinamento Intervalado de Alta Intensidade - Fator Neurotrófico Derivado do Encéfalo - Fator de Crescimento NeuralAuthors’ contributions:
LGP: author responsible for contextualization of the theme, research and methodology, project leader and main author responsible for writing and reviewing of the content; JPP: co-author responsible for supporting the investigation and methodology of the work, assisting with project supervision and assisting with the main author’s writing and reviewing of the project; SHRR: co-author responsible for supervising the content and leading the writing and reviewing process in partnership with the other authors; CFR: co-author responsible for assisting with writing and reviewing of the content.
Publication History
Received: 28 November 2020
Accepted: 18 February 2021
Article published online:
01 June 2023
© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Brasil, Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Ações Programáticas Estratégicas. Diretrizes de atenção à reabilitação da pessoa com acidente vascular cerebral. 1st ed. Brasília (DF): Ministério da Saúde; 2016. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/diretrizes_reabilitacao_acidente_vascular_cerebral.pdf
- 2 Billinger SA, Arena R, Bernharst J, Eng JJ, Franklin BA, Johnson CM, et al. Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014 Aug;45(8):2532-53. https://doi.org/10.1161/STR.20200551202005510022
- 3 Hankey GJ. Stroke. Lancet. 2017 Feb 11;389(10069):P641-54. https://doi.org/10.1016/S0140-6736(16)30962-X
- 4 Belagaje SR. Stroke rehabilitation. Continuum (Minneap Minn). 2017 Feb;23(1):238-53. https://doi.org/10.1212/CON.20200551202005510423
- 5 Linder SM, Rosenfeldt AB, Davidson S, Zimmerman N, Penko A, Lee J, et al. Forced, not voluntary, aerobic exercise enhances motor recovery in persons with chronic stroke. Neurorehabil Neural Repair. 2019 Aug;33(8):681-90. https://doi.org/10.1177/1545968319862557
- 6 Ploughman M, Eskes GA, Kelly LP, Kirkland MC, Devasahayam AJ, Wallack EM, et al. Synergistic benefits of combined aerobic and cognitive training on fluid intelligence and the role of IGF-1 in chronic stroke. Neurorehabil Neural Repair. 2019 Mar;33(3):199-212. https://doi.org/10.1177/1545968319832605
- 7 Mang CS, Campbell KL, Ross CJD, Boyd LA. Promoting neuroplasticity for motor rehabilitation after stroke: considering the effects of aerobic exercise and genetic variation on brain-derived neurotrophic factor. Phys Ther. 2013 Dec 1;93(12):1707-16. https://doi.org/10.2522/ptj.20130053
- 8 Helm EE, Matt KS, Kirschner KF, Pohling RT, Kohl D, Reisman DS. The influence of high intensity exercise and the Val66Met polymorphism on circulating BDNF and locomotor learning. Neurobiol Learn Mem. 2017 Oct;144:77-85. https://doi.org/10.1016/j.nlm.2017.06.003
- 9 Ploughman M, Austin MW, Glynn L, Corbett D. The effects of poststroke aerobic exercise on neuroplasticity: a systematic review of animal and clinical studies. Transl Stroke Res. 2015 Feb;6(1):13-28. https://doi.org/10.1007/s12975-014-0357-7
- 10 Enzinger C, Dawes H, Johansen-Berg H, Wade D, Bogdanovic M, Collett J, et al. Brain activity changes associated with treadmill training after stroke. Stroke. 2009 Jul;40(7):2460-7. https://doi.org/10.1161/STROKEAHA.109.550053
- 11 Luft AR, Macko RF, Forrester LW, Villagra F, Ivey F, Sorkin JD, et al. Treadmill exercise activates subcortical neural networks and improves walking after stroke: a randomized controlled trial. Stroke. 2008 Dec;39(12):3341-50. https://doi.org/10.1161/STROKEAHA.108.527531
- 12 Nepveu J-F, Thiel A, Tang A, Fung J, Lundbye-Jensen J, Boyd LA, et al. A single bout of High-Intensity interval training improves motor skill retention in individuals with stroke. Neurorehabil Neural Repair. 2017 Aug;31(8):726-35. https://doi.org/10.1177/1545968317718269
- 13 Abraha B, Chaves AR, Kelly LP, Wallack EM, Wadden KP, McCarthy J, et al. A bout of high intensity interval training lengthened nerve conduction latency to the non-exercised affected limb in chronic stroke. Front Physiol. 2018 Jul 2;9:827. https://doi.org/10.3389/fphys.2018.00827
- 14 Broderick P, Horgan F, Blake C, Ehrensberger M, Simpson D, Monaghan K. Mirror therapy and treadmill training for patients with chronic stroke: a pilot randomized controlled trial. Top Stroke Rehabil. 2019 Apr;26(3):162-72. https://doi.org/10.1080/10749357.2018.1556504
- 15 Murdoch K, Buckley JD, McDonnell MN. The effect of aerobic exercise on neuroplasticity within the motor cortex following stroke. PLoS One. 2016 Mar 28;11(3):e0152377. https://doi.org/10.1371/journal.pone.0152377
- 16 Quaney BM, Boyd LA, McDowd JM, Zahner LH, He J, Mayo MS, et al. Aerobic exercise improves cognition and motor function poststroke. Neurorehabil Neural Repair. 2009 Nov;23(9):879-85. https://doi.org/10.1177/1545968309338193
- 17 Yang H-C, Lee C-L, Lin R, Hsu M-J, Chen C-H, Lin J-H, et al. Effect of biofeedback cycling training on functional recovery and walking ability of lower extremity in patients with stroke. Kaohsiung J Med Sci. 2014 Jan;30(1):35-42. https://doi.org/10.1016/j.kjms.2013.07.006
- 18 Saunders DH, Greig CA, Mead GE. Physical activity and exercise after stroke: review of multiple meaningful benefits. Stroke. 2014 Dec;45(12):3742-7. https://doi.org/10.1161/STROKEAHA.114.004311
- 19 El-Tamawy MS, Abd-Allah F, Ahmed SM, Darwish MH, Khalifa HA. Aerobic exercises enhance cognitive functions and brain derived neurotrophic factor in ischemic stroke patients. NeuroRehabilitation. 2014;34(1):209-13. https://doi.org/10.3233/NRE-131020
- 20 Charalambous CC, Helm EE, Lau KA, Morton SM, Reisman DS. The feasibility of an acute high-intensity exercise bout to promote locomotor learning after stroke. Top Stroke Rehabil. 2018 Mar;25(2):83-9. https://doi.org/10.1080/10749357.2017.1399527
- 21 Boyne P, Meyrose C, Westover J, Whitesel D, Hatter K, Reisman DS, et al. Effects of exercise intensity on acute circulating molecular responses poststroke. Neurorehabil Neural Repair. 2020 Mar;34(3):222-34. https://doi.org/10.1177/1545968319899915
- 22 Boyne P, Meyrose C, Westover J, Whitesel D, Hatter K, Reisman DS, et al. Exercise intensity affects acute neurotrophic and neurophysiological responses poststroke. J Appl Physiol (1985). 2019 Feb 1;126(2):431-43. https://doi.org/10.1152/japplphysiol.00594.2018
- 23 Shaughnessy M, Michael K, Resnick B. Impact of treadmill exercise on efficacy expectations, physical activity, and stroke recovery. J Neurosci Nurs. 2012 Feb;44(1):27-35. https://doi.org/10.1097/JNN.0b013e31823ae4b5
- 24 Sanderg K, Kleist M, Falk L, Enthoven P. Effects of Twice-Weekly intense aerobic exercise in early subacute stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2016 Aug 1;97(8):1244-53. https://doi.org/10.1016/j.apmr.2016.01.030
- 25 Nave AH, Rackoll T, Grittner U, Bläsing H, Gorsler A, Nabavi DG, et al. Physical fitness training in patients with Subacute Stroke (PHYS-STROKE): multicentre, randomised controlled, endpoint blinded trial. BMJ. 2019 Sep 18;366:l5101. https://doi.org/10.1136/bmj.l5101
- 26 Hasan SMM, Rancourt SN, Austin MW, Ploughman M. Defining optimal aerobic exercise parameters to affect complex motor and cognitive outcomes after stroke: a systematic review and synthesis. Neural Plast. 2016;2016:2961573. https://doi.org/10.1155/2016/2961573
- 34 Li X, Charalambous CC, Reisman DS, Morton SM. A short bout of high-intensity exercise alters ipsilesional motor cortical excitability post-stroke. Top Stroke Rehabil. 2019 Sep;26(6):405-11. https://doi.org/10.1080/10749357.2019.1623458