Exercise-Based Strategies to Enhance BDNF and Cognitive Recovery After Stroke: A Clinical Review

Vollständiger Abstract

Worum geht es in dieser Arbeit?

Introduction Stroke is one of the leading causes of death and long-term disability worldwide, with a growing number of survivors living with cognitive impairment. Aerobic exercise is recognised as a promising non-pharmacological intervention supporting neuroplasticity and functional recovery after stroke. Brain-derived neurotrophic factor (BDNF) plays a key role in activity-dependent plasticity and has been proposed as a potential biomarker of rehabilitation success; however, clinical evidence regarding exercise-induced changes in BDNF remains inconsistent. Aim This clinical narrative review summarises clinical studies evaluating the effects of structured aerobic training on circulating BDNF levels and cognitive outcomes in stroke survivors. Materials and methods A literature search identified five eligible clinical trials. Results Across these studies, aerobic exercise interventions consistently improved cognitive performance or related functional outcomes. Moderate-intensity aerobic training, corresponding to approximately 50–60% of heart rate reserve, was associated with the most consistent cognitive benefits. In contrast, high-intensity exercise protocols were linked to increases in circulating BDNF concentrations but did not demonstrate clearly superior cognitive outcomes compared with moderate-intensity training. Chronic BDNF responses to aerobic training were heterogeneous. One study reported an increase in resting BDNF levels, two studies observed no significant change, one study reported a decrease, and one study demonstrated BDNF increases only following high-intensity interval training. In most trials, changes in circulating BDNF were not associated with improvements in cognitive or clinical outcomes. Conclusions These findings indicate that aerobic exercise is an effective component of post-stroke rehabilitation aimed at improving cognitive function. However, resting circulating BDNF shows substantial variability and does not consistently reflect cognitive recovery, suggesting that BDNF alone is not a reliable long-term biomarker of exercise-induced cognitive improvement after stroke. Moderate-intensity aerobic training remains the most practical and clinically beneficial strategy.