Efficacy of Exercise Interventions for Autonomic and Cardiovascular Dysfunction in Chronic Ischemic Stroke: A Systematic Review and Meta-analysis
Rida Shakeel1, Muhammad Abdullah2, Anas Mansour3, Tuba Basit1, Bilal Ahmad4, Muhammad Ahmed Haroon Janjua5, Haadi Ur Rehman6, Ezza Bashir7, Sohaib Aftab Ahmad Chaudhry8, Immad Muhammad Usman1, Huzaifa Nawaz9, Hafiz Sohail Ashraf10
1Dow University of Health Sciences, 2Bahria University Health Sciences Campus, Karachi, 3Al-Azhar University, Cairo, Egypt, 4DG Khan Medical College, 5Rawalpindi Medical University, Rawalpindi, Punjab, Pakistan, 6Rawalpindi Medical University, Punjab, Pakistan, 7Akhter Saeed Medical and Dental College Lahore, Department of medicine, 8ABWA Medical College, Faisalabad, Pakistan, 9Services Institute of Medical Sciences (SIMS), Ghaus-ul-Azam Jail Road, Lahore, Pakistan 54000, 10Carle foundation Hospital Urbana Illinois
Objective:
To evaluate the efficacy of exercise interventions on autonomic and cardiovascular outcomes in chronic ischemic stroke survivors for secondary prevention.
Background:
Autonomic and cardiovascular dysfunction are common post-ischemic stroke complications, heightening recurrence risk and impairing recovery.These issues, including altered heart rate variability and hypertension, necessitate effective interventions.Despite growing interest in autonomic regulation and secondary prevention, evidence remains inconsistent.This systematic review and meta-analysis assessed therapeutic interventions’ efficacy in chronic ischemic stroke survivors, addressing a critical gap in stroke management.
Design/Methods:
We conducted a systematic review and meta-analysis of randomized and observational studies evaluating autonomic or cardiovascular outcomes post-stroke.The study adhered to PRISMA 2020 guidelines and the Cochrane Handbook for Systematic Reviews of Interventions.Searches of PubMed, Embase, Scopus, Cochrane Library, and ClinicalTrials.gov were performed up to July 2025.Analyses in RStudio used a random-effects model, reporting mean differences (MD) with 95% confidence intervals (CI).Heterogeneity was assessed via I² and Cochran’s Q tests.Risk of bias was evaluated using the ROB 2 tool for randomized trials and the Newcastle–Ottawa Scale for observational studies.Sensitivity analysis employed leave-one-out meta-analysis for high heterogeneity.
Results:
From 2,134 records, 1,684 were screened after duplicate removal. Of 49 full-text reports, 6 met inclusion criteria and were included in the analysis.The random-effects model showed modest improvements:peak VO2 by 1.09 L/min (95% [CI: 0.29–1.90]), resting SBP by 1.30 mmHg (95% [CI: -1.39–4.00]), resting DBP by 0.87 mmHg (95% [CI: -0.78–2.51]), and six-minute walking distance by 2.74 meters (95% [CI: -6.20–11.69]).Heterogeneity was high for peak VO2 (I² = 90.0%) but low for walking distance (I² = 0.0%).Leave-one-out analysis for peak VO2 confirmed stability (MD: 0.71–1.65 L/min).
Conclusions:
This Meta-Analysis indicates therapeutic interventions modestly improve cardiovascular and functional outcomes post-stroke, with significant peak VO2 gains.Stable sensitivity results despite high heterogeneity suggest potential efficacy, supporting their role in secondary prevention.Larger, high-quality trials are needed to validate findings and reduce variability.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.