Abstract 86: Does Exercise Post Stroke have a Beneficial Effect on Post-Stroke Depression: A Meta-Analysis

Abstract

Given the high prevalence and negative personal and social consequences of post-stroke depression (PSD), identification and application of safe and effective treatments is imperative. While recent publications examining the evidence regarding the impact of physical activity on depression suggest that, in the general population, exercise is associated with significant benefit in terms of reduction of depressive symptomatology, it is not clear that physical activity has the same benefit for individuals who have experienced stroke. Objective: To examine the effectiveness of exercise or physical activity on depressive symptomatology following stroke. Methods: We undertook a literature review to identify stroke-specific clinical trials examining the effectiveness of exercise or exercise programs when compared to a control condition that included longitudinal assessment of depression as a primary or secondary study outcome. Identified studies were evaluated for methodological quality using the PEDro scale and, where possible, results entered into a pooled, random effect analysis based on reported means and standard deviations from repeated assessments. Pre-post test correlations were estimated using published test/re-test reliability coefficients. Results: Eight studies were identified for inclusion; total PEDro scores ranged from 4 to 8. Depression was assessed at baseline and post-intervention using 4 self-report and 1 interview-based assessment tool(s). Participants were community-dwelling individuals; mean age ranged from 56 to 87. Only two trials reported significant between group differences for the outcome of depression, although several noted significant improvement within the intervention group only. Of the 8 identified studies, 6 reported sufficient data for inclusion in pooled analysis. Based on data from 276 participants, there was a moderate reduction in self-reported symptoms of depression associated with post-stroke exercise (ES=0.576; 95% CI 0.22, 0.93). No significant publication bias was identified (Egger’s intercept = 1.21, p=0.64). Conclusions: Although previous trials have reported a positive trend toward improvement of the self-reported symptoms of depression associated with exercise, the impact of exercise on depression has not been clear. On pooled analysis, however, it is apparent that participation in exercise is associated with a moderate and significant reduction in self-reported depressive symptomatology in older, community-dwelling individuals with stroke. Since physical impairments may limit participation in exercise programs for many individuals following stroke, additional research is required to examine exercise frequency and/or intensity required to demonstrate benefit.