Does aerobic exercise affect memory, attention, working memory, and fatigue after acquired brain injury? A single-blinded, randomized controlled pilot study
DOI:
https://doi.org/10.2340/jrm.v58.44745Keywords:
stroke, traumatic brain injury, cognition, fatigue, aerobic exercise, magnetic resonance imaging, neuronal plasticityAbstract
Objective: To explore potential effects of aerobic exercise on cognitive function, fatigue, and neuroplasticity after stroke or traumatic brain injury.
Design: A randomized controlled pilot study.
Subjects/Patients: Twelve participants, 10 men and 2 women aged 16–65 years diagnosed with acquired brain injury (moderate to severe stroke or traumatic brain injury), enrolled in an outpatient rehabilitation programme at least 3 months post-injury.
Methods: The intervention group (n = 6) participated in 30 min of aerobic exercise 3–4 times/week for 8 weeks during their outpatient rehabilitation. The control group (n = 6) received routine physical therapy. In addition, both groups received rehabilitation according to their rehabilitation plan. Neuropsychological and endurance testing was performed before and after the intervention and at a 3-month follow-up. Functional magnetic resonance imaging was performed before and after the intervention.
Results: Preliminary findings show no significant difference between the groups regarding cognitive variables, fatigue, or neuroplasticity. However, working memory/executive demanding processing speed, measured with the Paced Auditory Serial Addition Test, improved significantly (p = 0.042) in the aerobic exercise group and there were trends of improvements on several other executive tests in the aerobic exercise group. Automatic visual search speed improved in the control group (p = 0.027).
Conclusion: The question of whether aerobic exercise promotes cognition and fatigue after brain injury remains unanswered. This randomized controlled pilot study and its preliminary findings indicate greater improvements in executive processing speed in the aerobic exercise group, while more automatized attention speed improved more in the control group. The experiences from this study might facilitate the design of future studies on this intriguing topic.
Trial registration: ClinicalTrials.gov Identifier: NCT07429526
Downloads
References
Ekdahl N, Lannsjö M, Stålnacke BM, Möller MC. The relationship between cognitive reserve, cognitive performance, and outcomes of return to work and life satisfaction after brain injury: a retrospective cohort study. Disabil Rehabil 2025: 1–11.
https://doi.org/10.1080/09638288.2025.2517240 DOI: https://doi.org/10.1080/09638288.2025.2517240
Cumming TB, Brodtmann A, Darby D, Bernhardt J. The importance of cognition to quality of life after stroke. J Psychosom Res 2014; 77: 374–379.
https://doi.org/10.1016/j.jpsychores.2014.08.009 DOI: https://doi.org/10.1016/j.jpsychores.2014.08.009
Chin LM, Keyser RE, Dsurney J, Chan L. Improved cognitive performance following aerobic exercise training in people with traumatic brain injury. Arch Phys Med Rehabil 2015; 96: 754–759.
https://doi.org/10.1016/j.apmr.2014.11.009 DOI: https://doi.org/10.1016/j.apmr.2014.11.009
Hillman CH, Erickson KI, Kramer AF. Be smart, exercise your heart: exercise effects on brain and cognition. Nat Rev Neurosci 2008; 9: 58–65.
https://doi.org/10.1038/nrn2298 DOI: https://doi.org/10.1038/nrn2298
Smith PJ, Blumenthal JA, Hoffman BM, Cooper H, Strauman TA, Welsh-Bohmer K, et al. Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials. Psychosom Med 2010; 72: 239–252.
https://doi.org/10.1097/PSY.0b013e3181d14633 DOI: https://doi.org/10.1097/PSY.0b013e3181d14633
Hotting K, Roder B. Beneficial effects of physical exercise on neuroplasticity and cognition. Neurosci Biobehav Rev 2013; 37: 2243–2257.
https://doi.org/10.1016/j.neubiorev.2013.04.005 DOI: https://doi.org/10.1016/j.neubiorev.2013.04.005
Erickson KI, Hillman C, Stillman CM, Ballard RM, Bloodgood B, Conroy DE, et al. Physical activity, cognition, and brain outcomes: a review of the 2018 Physical Activity Guidelines. Med Sci Sports Exerc 2019; 51: 1242–1251.
https://doi.org/10.1249/MSS.0000000000001936 DOI: https://doi.org/10.1249/MSS.0000000000001936
Ide K, Secher NH. Cerebral blood flow and metabolism during exercise. Prog Neurobiol 2000; 61: 397–414.
https://doi.org/10.1016/S0301-0082(99)00057-X DOI: https://doi.org/10.1016/S0301-0082(99)00057-X
Erickson KI, Leckie RL, Weinstein AM. Physical activity, fitness, and gray matter volume. Neurobiol Aging 2014; 35: S20–S28.
https://doi.org/10.1016/j.neurobiolaging.2014.03.034 DOI: https://doi.org/10.1016/j.neurobiolaging.2014.03.034
Ogoh S, Ainslie PN. Regulatory mechanisms of cerebral blood flow during exercise: new concepts. Exerc Sport Sci Rev 2009; 37: 123–129.
https://doi.org/10.1097/JES.0b013e3181aa64d7 DOI: https://doi.org/10.1097/JES.0b013e3181aa64d7
Redila VA, Christie BR. Exercise-induced changes in dendritic structure and complexity in the adult hippocampal dentate gyrus. Neuroscience 2006; 137: 1299–1307.
https://doi.org/10.1016/j.neuroscience.2005.10.050 DOI: https://doi.org/10.1016/j.neuroscience.2005.10.050
Meeusen R. Exercise and the brain: insight in new therapeutic modalities. Ann Transplant 2005; 10: 49–51.
Schmidt W, Endres M, Dimeo F, Jungehulsing GJ. Train the vessel, gain the brain: physical activity and vessel function and the impact on stroke prevention and outcome in cerebrovascular disease. Cerebrovasc Dis 2013; 35: 303–312.
https://doi.org/10.1159/000347061 DOI: https://doi.org/10.1159/000347061
Ambrogini P, Lattanzi D, Ciuffoli S, Betti M, Fanelli M, Cuppini R. Physical exercise and environment exploration affect synaptogenesis in adult-generated neurons in the rat dentate gyrus: possible role of BDNF. Brain Res 2013; 1534: 1–12.
https://doi.org/10.1016/j.brainres.2013.08.023 DOI: https://doi.org/10.1016/j.brainres.2013.08.023
van Praag H. Neurogenesis and exercise: past and future directions. Neuromol Med 2008; 10: 128–140.
https://doi.org/10.1007/s12017-008-8028-z DOI: https://doi.org/10.1007/s12017-008-8028-z
Szuhany KL, Bugatti M, Otto MW. A meta-analytic review of the effects of exercise on brain-derived neurotrophic factor. J Psychiatr Res 2015; 60: 56–64.
https://doi.org/10.1016/j.jpsychires.2014.10.003 DOI: https://doi.org/10.1016/j.jpsychires.2014.10.003
Montero-Almagro G, Bernal-Utrera C, Geribaldi-Doldán N, Nunez-Abades P, Castro C, Rodriguez-Blanco C. Influence of high-intensity interval training on neuroplasticity markers in post-stroke patients: systematic review. J Clin Med 2024; 13: 1–12.
https://doi.org/10.3390/jcm13071985 DOI: https://doi.org/10.3390/jcm13071985
Lee SY, Amatya B, Judson R, Truesdale M, Reinhardt JD, Uddin T, et al. Clinical practice guidelines for rehabilitation in traumatic brain injury: a critical appraisal. Brain Inj 2019; 33: 1263–1271.
https://doi.org/10.1080/02699052.2019.1641747 DOI: https://doi.org/10.1080/02699052.2019.1641747
Jolliffe L, Lannin NA, Cadilhac DA, Hoffmann T. Systematic review of clinical practice guidelines to identify recommendations for rehabilitation after stroke and other acquired brain injuries. BMJ Open 2018; 8: e018791.
https://doi.org/10.1136/bmjopen-2017-018791 DOI: https://doi.org/10.1136/bmjopen-2017-018791
Mead G, Bernhardt J, Kwakkel G. Stroke: physical fitness, exercise, and fatigue. Stroke Res Treat 2012; 2012: 632531.
https://doi.org/10.1155/2012/632531 DOI: https://doi.org/10.1155/2012/632531
Hu X, Wester P, Stibrant Sunnerhaagen K. [Evidence-based methods in clinical practice in updated Swedish national stroke guidelines]. Lakartidningen 2018; 115: 1–10.
Wilson JT, Pettigrew LE, Teasdale GM. Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: guidelines for their use. J Neurotrauma 1998; 15: 573–785.
https://doi.org/10.1089/neu.1998.15.573 DOI: https://doi.org/10.1089/neu.1998.15.573
Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982; 14: 377–381.
https://doi.org/10.1249/00005768-198205000-00012 DOI: https://doi.org/10.1249/00005768-198205000-00012
Delis DC KE, Kramer JH. Dean Delis and Edith Kaplans Executive Function System, D-KEFS Swedish edition. San Antonio, TX: Harcourt Assessment Inc; 2005.
Spreen O, Strauss E. Compendium of neuropsychological tests. Oxford: Oxford University Press; 1998. p 243–252.
Wechsler D. WAIS-III Svensk version (M. Hagelthorn, Trans.). Stockholm: Psykologiförlaget AB; 2003.
Wechsler D. WAIS-IV Sv. Wechsler Adult Intelligence Scale–fourth edition. Bloomington, MN: NCS Pearson Inc; 2010.
Gronwall DM. Paced auditory serial-addition task: a measure of recovery from concussion. Percept Mot Skills 1977; 44: 367–373.
https://doi.org/10.2466/pms.1977.44.2.367 DOI: https://doi.org/10.2466/pms.1977.44.2.367
Holmqvist A, Bartfai A, Markovic G, Möller MC. Does intensive training of attention influence cognitive fatigability in patients with acquired brain injury? Front Neurosci 2021; 15: 656876.
https://doi.org/10.3389/fnins.2021.656876 DOI: https://doi.org/10.3389/fnins.2021.656876
Ruff R, Allen C. Ruff 2 & 7 Selective Attention Test: Professional manual. Odessa, FL: Psychological Assessment Resources. Inc [Google Scholar]; 1996.
Åstrand PO, Ryhming I. A nomogram for calculation of aerobic capacity from pulse rate during submaximal work. J Appl Physiol 1954; 7: 218–221.
https://doi.org/10.1152/jappl.1954.7.2.218 DOI: https://doi.org/10.1152/jappl.1954.7.2.218
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361–370.
https://doi.org/10.1111/j.1600-0447.1983.tb09716.x DOI: https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
Johansson IB SA, Berglund P, Rödholm M, Rönnbäck L. Mental fatigue-subjective problem possible to assess: new Swedish self-assessment scale tested in different patient groups. Läkartidningen 2010; 107: 2964–2967.
Johansson B, Starmark A, Berglund P, Rödholm M, Rönnbäck L. Evaluation of the mental fatigue scale and its relation to cognitive and emotional functioning after traumatic brain injury or stroke. Int J Phys Med Rehabil 2014; 2: 1–7.
AFNI [Internet]. Bethesda, MD: National Institute of Mental Health; c1996. Available from: http://afni.nimh.nih.gov/afni
Li X, Fischer H, Manzouri A, Månsson KNT, Li TQ. A quantitative data-driven analysis framework for resting-state functional magnetic resonance imaging: a study of the impact of adult age. Front Neurosci 2021; 15: 768418.
https://doi.org/10.3389/fnins.2021.768418 DOI: https://doi.org/10.3389/fnins.2021.768418
Vanderbeken I, Kerckhofs E. A systematic review of the effect of physical exercise on cognition in stroke and traumatic brain injury patients. NeuroRehabilitation 2017; 40: 33–48.
https://doi.org/10.3233/NRE-161388 DOI: https://doi.org/10.3233/NRE-161388
Oberlin LE, Waiwood AM, Cumming TB, Marsland AL, Bernhardt J, Erickson KI. Effects of physical activity on poststroke cognitive function: a meta-analysis of randomized controlled trials. Stroke 2017; 48: 3093–100.
https://doi.org/10.1161/STROKEAHA.117.017319 DOI: https://doi.org/10.1161/STROKEAHA.117.017319
Tang A, Eng JJ, Krassioukov AV, Tsang TS, Liu-Ambrose T. High- and low-intensity exercise do not improve cognitive function after stroke: a randomized controlled trial. J Rehabil Med 2016; 48: 841–846.
https://doi.org/10.2340/16501977-2163 DOI: https://doi.org/10.2340/16501977-2163
Morris T, Gomes Osman J, Tormos Munoz JM, Costa Miserachs D, Pascual Leone A. The role of physical exercise in cognitive recovery after traumatic brain injury: a systematic review. Restor Neurol Neurosci 2016; 34: 977–988.
https://doi.org/10.3233/RNN-160687 DOI: https://doi.org/10.3233/RNN-160687
Penna LG, Pinheiro JP, Ramalho SHR, Ribeiro CF. Effects of aerobic physical exercise on neuroplasticity after stroke: systematic review. Arq Neuropsiquiatr 2021; 79: 832–843.
https://doi.org/10.1590/0004-282x-anp-2020-0551 DOI: https://doi.org/10.1590/0004-282x-anp-2020-0551
Huang Y, Ou H, Zhao W, Lin Q, Xue Y, Xia R, et al. The effects of moderate-intensity aerobic exercise on cognitive function in individuals with stroke-induced mild cognitive impairment: a randomized controlled pilot study. J Rehabil Med 2024; 56: jrm33001.
https://doi.org/10.2340/jrm.v56.33001 DOI: https://doi.org/10.2340/jrm.v56.33001
Pastor D, Ballester-Ferrer JA, Carbonell-Hernández L, Baladzhaeva S, Cervello E. Physical exercise and cognitive function. Int J Environ Res Public Health 2022; 19: 9564.
https://doi.org/10.3390/ijerph19159564 DOI: https://doi.org/10.3390/ijerph19159564
Vidoni ED, Johnson DK, Morris JK, Van Sciver A, Greer CS, Billinger SA, et al. Dose–response of aerobic exercise on cognition: a community-based, pilot randomized controlled trial. PLoS One 2015; 10: e0131647.
https://doi.org/10.1371/journal.pone.0131647 DOI: https://doi.org/10.1371/journal.pone.0131647
Shao Z, Hu M, Zhang D, Zeng X, Shu X, Wu X, et al. Dose–response relationship in non-pharmacological interventions for individuals with mild cognitive impairment: a systematic review and meta-analysis of randomised controlled trials. J Clin Nurs 2022; 31: 3390–3401.
https://doi.org/10.1111/jocn.16240 DOI: https://doi.org/10.1111/jocn.16240
Zotcheva E, Håberg AK, Wisløff U, Salvesen Ø, Selbæk G, Stensvold D, et al. Effects of 5 years aerobic exercise on cognition in older adults: the generation 100 study: a randomized controlled trial. Sports Med 2022; 52: 1689–1699.
https://doi.org/10.1007/s40279-021-01608-5 DOI: https://doi.org/10.1007/s40279-021-01608-5
Moriarty TA, Mermier C, Kravitz L, Gibson A, Beltz N, Zuhl M. Acute aerobic exercise based cognitive and motor priming: practical applications and mechanisms. Front Psychol 2019; 10: 2790.
https://doi.org/10.3389/fpsyg.2019.02790 DOI: https://doi.org/10.3389/fpsyg.2019.02790
Stoykov ME, Corcos DM, Madhavan S. Movement-based priming: clinical applications and neural mechanisms. J Mot Behav 2017; 49: 88–97.
https://doi.org/10.1080/00222895.2016.1250716 DOI: https://doi.org/10.1080/00222895.2016.1250716
Dąbrowski J, Czajka A, Zielińska-Turek J, Jaroszyński J, Furtak-Niczyporuk M, Mela A, et al. Brain functional reserve in the context of neuroplasticity after stroke. Neural Plast 2019; 2019: 9708905.
https://doi.org/10.1155/2019/9708905 DOI: https://doi.org/10.1155/2019/9708905
Arnold LM. Understanding fatigue in major depressive disorder and other medical disorders. Psychosomatics 2008; 49: 185–190.
https://doi.org/10.1176/appi.psy.49.3.185 DOI: https://doi.org/10.1176/appi.psy.49.3.185
Palejwala AH, O’Connor KP, Milton CK, Anderson C, Pelargos P, Briggs RG, et al. Anatomy and white matter connections of the fusiform gyrus. Sci Rep 2020; 10: 13489.
https://doi.org/10.1038/s41598-020-70410-6 DOI: https://doi.org/10.1038/s41598-020-70410-6
Delis DC, Kaplan E, Kramer JH. Delis–Kaplan executive function system. San Antonio: Psychological Corporation; 2001.
https://doi.org/10.1037/t15082-000 DOI: https://doi.org/10.1037/t15082-000
Seghier ML. Multiple functions of the angular gyrus at high temporal resolution. Brain Struct Funct 2023; 228: 7–46.
https://doi.org/10.1007/s00429-022-02512-y DOI: https://doi.org/10.1007/s00429-022-02512-y
Gambassi BB, Almeida FdJF, Almeida AEAF, Ribeiro JA, Novais TMG, Schwingel PA, et al. PASe. Effects of exercise training on cardiovascular and autonomic parameters in stroke survivors: a systematic review. Inter J Cardiovasc Sci 2019; 32: 408–413.
Talbert LD, Kaelberer Z, Gleave E, Driggs A, Driggs AS, Baldwin SA, et al. A systematic review of the relationship between traumatic brain injury and disruptions in heart rate variability. Appl Psychophysiol Biofeedback 2024; 49: 523–540.
https://doi.org/10.1007/s10484-024-09663-0 DOI: https://doi.org/10.1007/s10484-024-09663-0
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2026 Eygló Ingólfsdóttir, Ulla Bergfeldt , Märta Berthold Lindstedt , Lennart Bergfeldt , Tie-Qiang LI , Tomas Jonsson , Marika C. Möller
This work is licensed under a Creative Commons Attribution 4.0 International License.
All digitalized JRM contents is available freely online. The Foundation for Rehabilitation Medicine owns the copyright for all material published until volume 40 (2008), as from volume 41 (2009) authors retain copyright to their work and as from volume 49 (2017) the journal has been published Open Access, under CC-BY-NC licences (unless otherwise specified). The CC-BY-NC licenses allow third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
From 2024, articles are published under the CC-BY licence. This license permits sharing, adapting, and using the material for any purpose, including commercial use, with the condition of providing full attribution to the original publication.
