Network meta-analysis finds exercise therapies reduce depressive symptoms in post-stroke depressionExercise therapies reduce depression and improve function after stroke
Frontiers in MedicinePublished May 1, 2026DOI ↗Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease
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Key Takeaway
Consider exercise therapy as an adjunctive intervention for post-stroke depression, but recognize the need for higher-quality trials.
This systematic review and network meta-analysis evaluated the effects of exercise therapies on post-stroke depression. The analysis included 2,339 patients and compared interventions such as aerobic exercise, Tai Chi, Baduanjin, resistance training, Wuqinxi, yoga, and rehabilitation training against a control group.
For depressive symptoms, several exercise modalities significantly reduced Hamilton Depression Rating Scale scores, with mean differences ranging from -3.02 to -8.45. The Self-Rating Depression Scale also showed a significant decrease (MD = -12.48, 95% CI -17.79 to -7.17). Additionally, exercise improved daily living abilities (Barthel Index MD = 9.47), motor function (Fugl-Meyer Assessment SUCRA = 96.7%), and balance (Berg Balance Scale MD = 8.20).
The authors note several limitations: overall limited methodological quality of included studies, small sample sizes for some outcomes, relatively sparse evidence networks, and short follow-up durations in most studies. Adverse events were not reported.
While exercise therapy may serve as an effective adjunctive intervention for post-stroke depression, the findings require further validation through high-quality, large-sample, long-term randomized controlled trials. Clinicians should interpret these results cautiously given the evidence constraints.
This network meta-analysis examined exercise therapies for patients with post-stroke depression. The researchers included nearly 2,400 participants across multiple studies. Interventions ranged from aerobic exercise and yoga to Tai Chi and resistance training. The control group received standard care without specific exercise programs.
The analysis showed that exercise therapies significantly reduced depressive symptoms compared to the control group. Scores on the Hamilton Depression Rating Scale and Self-Rating Depression Scale were lower for those doing exercise. The study also found improvements in daily living abilities and balance function. Motor function scores were highest for specific exercise types like rehabilitation training.
Safety data were not reported in the included studies. The researchers noted several limitations, including small sample sizes for some outcomes and short follow-up durations. The overall methodological quality of the studies was limited. These findings require further validation through high-quality, large-sample, long-term randomized controlled trials. Exercise therapy can serve as an effective adjunctive intervention in the comprehensive management of post-stroke depression.
What this means for you:
Exercise therapies may help reduce depression and improve function after stroke, but more research is needed.
ObjectiveTo systematically evaluate the effects of exercise therapies such as aerobic exercise (CAE), Tai Chi (TC), Baduanjin (BDJ), resistance training (RE), Wuqinxi (WQX), yoga (YG), and rehabilitation training (RT) on depressive symptoms, daily living abilities, motor function, and balance function in patients with post-stroke depression (PSD). A network meta-analysis method was employed to compare the relative efficacy of various interventions, providing high-quality evidence-based medical data for clinical selection of optimal intervention strategies.MethodsWe conducted systematic searches in China National Knowledge Infrastructure, Wanfang Data, VIP Information, Chinese Biomedical Literature Database, PubMed, Embase, Cochrane Library, and Web of Science, with the search period concluding on April 5, 2026. Randomized controlled trials (RCTs) evaluating exercise therapy interventions for PSD were included. Two investigators independently performed screening, data extraction, and RoB 2.0 bias risk assessment. A network meta-analysis was performed using Stata 17.0 under the frequency framework, with continuous outcomes expressed as mean difference (MD) and 95% confidence interval (CI), and ranked by SUCRA.ResultsA total of 33 RCTs (n = 2,339) were included, comparing seven types of interventions: CAE, TC, BDJ, RE, WQX, YG, and RT. The network meta-analysis revealed that compared with the control group, RT [MD = −8.45, 95% CI (−11.59, −5.31)], WQX [MD = −5.55, 95% CI (−11.00, −0.10)], BDJ [MD = −3.41, 95% CI (−6.24, −0.58)], and TC [MD = −3.02, 95% CI (−5.32, −0.71)] significantly reduced the Hamilton Depression Rating Scale (HAMD) scores; CAE [MD = −12.48, 95% CI (−17.79, −7.17)] significantly decreased Self-Rating Depression Scale (SDS) scores; RT[MD = 9.47, 95% CI (2.39, 16.55)] demonstrated the largest effect size in improving the Barthel Index (BI) scores; RE (SUCRA = 96.7%) was the most effective intervention for improving the Fugl-Meyer Assessment (FMA) scores; BDJ [MD = 8.20, 95% CI (2.73, 13.67)] significantly enhanced the Berg Balance Scale (BBS) levels. HAMD and SDS were used to assess patients’ depressive status, BI to evaluate daily living abilities, FMA to assess motor function, and BBS to evaluate balance function.ConclusionExercise therapy can serve as an effective adjunctive intervention in the comprehensive management of PSD, demonstrating potential benefits in alleviating depressive symptoms and improving certain functional outcomes. The efficacy of different exercise modalities varies across outcome dimensions: RT shows superior performance in improving HAMD scores and BI, CAE exhibits greater advantages in enhancing SDS scores, RE ranks highest in promoting FMA improvement, and BDJ demonstrates optimal efficacy in improving BBS scores. Given the overall limited methodological quality of included studies, small sample sizes for some outcomes, relatively sparse evidence networks, and short follow-up durations in most studies, these findings require further validation through high-quality, large-sample, long-term randomized controlled trials.Systematic review registrationCRD420261333356.
