Exercise Program Cost-Effective to Improve Cognition in Chronic Stroke

Among older adults with chronic stroke, a multicomponent exercise program is considered to be the highest cost-effectiveness poststroke intervention to improve cognitive function, according to the findings of a study published in JAMA Network Open.

Researchers in Canada conducted an economic evaluation between June 1, 2022 to March 31, 2023 using data obtained from a previously completed randomized clinical trial, the Vitality study. The researchers performing the economic assessment calculated the cost effectiveness in Canadian dollars of 3 interventions (exercise, cognitive and social enrichment activities, and balance and tone) over a 6-month treatment period and 6-month follow-up period with the balance and tone group serving as the active control group.

In the Vitality study, 120 individuals with chronic ischemic or hemorrhagic stroke (62% men; mean age, 71) were randomly assigned between June 6, 2014 and February 26, 2019 to begin receiving 3 different interventions — exercise (n=34), cognitive and social enrichment activities (n=34), and balance and tone (n=52) — to assess how well each intervention promoted cognitive function poststroke. Each intervention involved a 60-minute class conducted twice weekly for 26 weeks.

The multicomponent exercise intervention consisted of strength, aerobic, and balance exercises. The cognitive and social enrichment activities consisted of brain training, group social games, and activities to improve memory, learning, attention, and executive function. The balance and tone intervention consisted of stretches, deep breathing, and relaxation techniques, general posture education, and core exercises in sitting. Effectiveness of each intervention at improving cognitive function was assessed using the Alzheimer Disease Assessment Scale-Cognitive-Plus (ADAS-Cog-Plus).

After the 6-month treatment period, the mean cost of each intervention per person was highest for the cognitive and social enrichment activities at CAD $1492 (US $1074.24) per person, followed by the exercise intervention at CAD $1090 (US $784.80), and lastly, the balance and tone intervention at CAD $777 (US $559.44).

Despite being costlier than the balance and tone group, the multicomponent exercise intervention demonstrated the highest effectiveness of the 3 interventions in promoting cognitive function based on the cost per mean change in the ADAS-Cog-Plus score. Mean ADAS-Cog-Plus scores decreased by 0.192 for the exercise group compared to 0.171 in the balance and tone group, indicating that those in the exercise group demonstrated better cognitive functioning than the balance and tone group after 6 months of treatment.

Of the 3 interventions, exercise was the most cost-effective intervention with an incremental cost-effectiveness ratio of CAD $8823 (US $6352.56).

Exercise also demonstrated the lowest cost utility per person based on health care resource utilization during the 6-month intervention period (mean cost per person, CAD $2161 [US $1618.14) compared to the balance and tone program (mean cost per person, CAD $2193 [US $1642.10) and the cognitive and social enrichment program (mean cost per person, CAD $3211 [US $2404.37]).

This cost-utility pattern was sustained through the end of the follow-up period at 12 months (mean cost per person, exercise: CAD $3149 [US $2357.94]; balance and tone: CAD $3481 [US $2606.54]; cognitive and social enrichment, CAD $4847 [US $3629.39]).

“The findings of this economic evaluation suggest that exercise demonstrated potential for cost-effectiveness to improve cognitive function in older adults with chronic stroke during a 6-month intervention,” the researchers concluded. “Future research should focus on optimizing the cost-effectiveness of these interventions and enhancing the health-related quality of life for this population.”

The study has several limitations, including that the duration may not fully capture the long-term costs and benefits of the interventions. The researchers also were unable to assess stroke severity in context of response to intervention. The cost-effectiveness assessment may be limited by sample size and underestimation of intervention costs. Self-reported health care data is subject to potential recall bias, affecting accuracy of findings. Lastly, the studied population was only from Canada, limiting generalizability of findings to other populations.

Disclosures: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see original source for full list of disclosures.