The effects of exercise on cognition post-stroke: are there sex differences? A systematic review and meta-analysis

PURPOSE: The aim of this systematic review was to investigate if sex moderated the effect of exercise on cognition in adults post-stroke. METHODS: A systematic review was conducted of randomized controlled trials that involved adults ≥18 years with stroke, any exercise intervention, and reported any outcome related to cognitive function. We compared effect sizes of cognitive outcomes between studies of lower and higher proportion of females (CRD42018092757). RESULTS: The effects of exercise did not differ between studies of higher and lower female proportions with respect to memory (χ² =1.52, p = 0.22), executive function (χ² = 0.56, p = 0.45; Chi² = 0.00, p = 0.98), language (Chi² = 3.17, p = 0.08) or global cognition (χ² = 0.88, p = 0.35). CONCLUSION: There were no sex differences in the effects of exercise on memory, executive functioning, language or global cognition in individuals with stroke. Further research is warranted to address sex differences in individuals with stroke to enable better targeting, prevention, and interventions in stroke rehabilitation.IMPLICATIONS FOR REHABILITATIONUnderstanding sex differences and potentially similarities in the relationship between exercise and cognition is an important step in enhancing stroke rehabilitation and the development of optimal, sex-specific rehabilitation.Although our findings suggest that there is no clear rationale for incorporating sex into our clinical decision making, it is still imperative to consider sex factors in research and report results in the literature disaggregated by sex to help inform clinical practice.