Comparative Efficacy of Specific Exercise Interventions on Post-Stroke Depression, Anxiety and Cognitive Function in Older Adults: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials
In brief
Mind-body exercise ranks highest for improving depression, anxiety and cognition after stroke in older adults
A network meta-analysis of 52 randomized trials (4,170 participants) found that mind-body exercise consistently outperformed usual care on post-stroke depression, anxiety and cognitive function, topping the ranking among diverse exercise modalities. Benefits were strongest for depression and anxiety, while balance training was the only approach showing a clear cognitive advantage versus usual care. The effect size varied with time since stroke, highlighting the need for timing-specific exercise prescriptions.
- Journal
- The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry (Q1)
- Published
- 12 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Yu-Cheng Wang, Yi-Ran Huang, Xiao-Xuan Meng, Qinge Zhang, Yuan Feng, Zhaohui Su, et al.
- PMID
- 42711194
- DOI
- 10.1016/j.jagp.2026.08.012
Why clinicians should know about it
- Picked for Neurology (clinical) (top studies of the week, 13 September 2026): Network meta‑analysis of post‑stroke exercise interventions
Abstract
BACKGROUND: Post-stroke depression, anxiety, and cognitive impairment are prevalent in older adults and may impede recovery. We evaluated the comparative efficacy of exercise interventions for these outcomes using network meta-analysis. METHODS: We systematically searched five international and two Chinese databases from inception to July 2025 for randomized controlled trials enrolling older adults with stroke receiving exercise-based interventions. Primary outcomes were depression, anxiety, and cognitive function. Treatment effects were estimated as standardized mean differences (SMDs) with 95% credible intervals (CrIs), and interventions were ranked using surface under the cumulative ranking curve (SUCRA). Risk of bias and confidence in estimates were assessed with RoB 2 and CINeMA. RESULTS: Fifty-two trials involving 4,170 participants were included; 11 were at low risk of bias. For depression, dual-task training (DTT), mind-body exercise (MBE), and balance/coordination training (BCT) ranked highest and showed statistically credible benefits versus usual care. For anxiety, MBE, resistance/strength training (RST), and DTT ranked highest, with statistically credible benefits observed for RST and DTT, whereas EFR was associated with worse anxiety outcomes. For cognitive function, MBE, general aerobic exercise (GA), and moderate-intensity continuous training (MICT) ranked highest, whereas BCT was the only intervention showing a statistically credible benefit versus usual care. Meta-regression suggested that longer time since stroke was associated with smaller benefits for anxiety and cognitive outcomes. CONCLUSIONS: Exercise interventions may yield outcome-specific benefits after stroke in older adults. These findings support individualized, phase-sensitive exercise prescription in post-stroke rehabilitation.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.