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Exercise plan ‘cost-effective’ for improving cognition in stroke – study

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A multicomponent exercise program was found to be cost-effective and improved cognitive in older adults with chronic stroke, according to a recent study.

The program, which included strength, aerobic, agility, and balance training exercises, was considered to be the most cost-effective post-stroke intervention to improve cognitive function, when compared to a control group.

Researchers in Canada conducted an economic evaluation using data obtained from a previously completed randomised clinical trial, the Vitality study, between 1 June 2022 to 31 March 31, 2023.

They calculated the cost effectiveness of three interventions (exercise, cognitive and social enrichment activities, and balance and tone) over a 6-month treatment period and 6-month follow-up period compared with a balance and tone control group.

All participants were aged 55 and older, lived in the community and had experienced a stroke at least 12 months prior to the study.

They were randomly assigned to twice-weekly classes for one one of three groups. A multicomponent exercise program made up of  strength, aerobic, and balance training exercises; a cognitive and social enrichment activities program, involving exercises covering memory, learning, attention, and executive functions, alongside social and cognitive enrichment activities; or the balance and tone control program, which included stretches, deep breathing and relaxation techniques, general posture education, and core control exercises in the sitting position.

Cognitive function was assessed using The Alzheimer Disease Assessment Scale–Cognitive-Plus [ADAS-Cog-Plus].

The findings, published in JAMA Network Open, report that the exercise program was more effective in improving cognitive function among older adults with chronic stroke, at additional cost compared with the control balance and tone program. After the 6-month treatment period, the cost of each intervention per person was highest for the cognitive and social enrichment activities, followed by the exercise program and lastly, the balance and tone group.

However, the multicomponent exercise intervention was the most effective of the three interventions for promoting cognitive function based on the cost per mean change in the ADAS-Cog-Plus score.

The researchers conclude: “This economic evaluation provides novel evidence supporting the potential for multicomponent exercise as a cost-effective intervention for improving cognitive function in older adults with chronic stroke and reducing the economic burden of stroke. Cognitive and social enrichment activities show promise for improving cognitive function after stroke but come with higher costs. Future research should focus on optimizing the cost-effectiveness of these interventions and enhancing the health-related quality of life for this population.

The authors report several limitations to their research, including the fact that the duration of the study may not capture the longer-term costs and benefits of the interventions. The lack of stroke severity data limits the understanding of diverse responses to interventions and the sample size may introduce uncertainty in cost-effectiveness assessment.

They add that these results may not be generalisable to health care systems outside of Canada.

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