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WORLD ACADEMY OF SCIENCES JOURNAL 7: 39, 2025
Abstract. Cognitive impairment affects >50% of individuals
who survive for 6 months following a stroke. Cognitive impair‑
ment not only reduces the ability of patients to relearn motor
skills due to memory problems or poor judgment, but also
signicantly impairs daily living activities and quality of life.
Early intervention in mild cognitive impairment (MCI) not
only improves cognition, but also attenuates the progression to
dementia. The present controlled prospective study included
38 older adults with post‑stroke MCI, who were assigned to
the intervention group (aerobic + cognitive exercise) and the
control group (cognitive exercise). Both groups participated in
60‑min sessions, three times per week, for 12 weeks (4 weeks
in the hospital and 8 weeks at home). The intervention group
exhibited a significant improvement in cognitive function
(Montreal cognitive assessment and frontal assessment battery,
P<0.05), as well as in physical function and quality of life,
compared to the control group. On the whole, the present study
demonstrates that the combination of aerobic and cognitive
exercise is benecial leading to improvements in the cognitive
function, physical function and quality of life of individuals
with post‑stroke MCI.
Introduction
Stroke is one of the main causes of mortality and permanent
disability. The stroke rate doubles every decade and frequently
affects individuals aged ≥55 years (1). Of note, ~90% of
stroke survivors continue to suffer from chronic sequelae, and
~30% of these patients are unable to perform daily activities
independently (2). Among these sequelae, cognitive impair‑
ment, a common consequence of stroke, affects >50% of
individuals who survive for 6 months following a stroke (3).
Another study found that 83% of patients had impairment
in at least one cognitive domain, while 50% had cognitive
impairment across multiple domains (4). The American
Heart Association/American Stroke Association (AHA/ASA)
Guidelines for Stroke Rehabilitation and Treatment in Adults
(2016) state that the majority of patients who suffer a
clinical stroke undergo cognitive assessment prior to hospital
discharge (5). Cognitive impairment and cognitive rehabilita‑
tion have been identied as top research priorities in stroke
survivors (top 10). The majority of available treatments aim to
either restore lost skills or to teach compensatory techniques;
however, the evidence has not been persuasive yet (6,7).
A previous systematic review article found that targeted
cognitive training in specic cognitive domains provides several
positive effects (8). Starovasnik Žagavec et al (9) conducted a
study with 11 stroke survivors who underwent intensive training
in selective attention. The results of their study revealed a signif‑
icant improvement from a moderate to strong level in divided
attention, and a mild effect on alertness (9). Another study high‑
lighted the functional connectivity of the hippocampus with
the left frontal and parietal lobes through cognitive training,
indicating a key mechanism in cognitive recovery following a
st roke (10). Physical exercise is another effective approach for
improving the cognitive function of patients. A previous system‑
atic review examin ing the effects of physical activity on cognitive
function following a stroke demonstrated that physical exercise
exerted signicant cognitive benets (11). Aerobic exercise not
only exerts benecial effects in improving physical function
and reducing the risk of developing secondary complications,
but also reduces the risk of developing Alzheimer's disease and
related cognitive disorders (12). Aerobic exercise has a positive
effect on overall cognitive function, with potential benets to
memory, attention and the visuospatial domain in stroke survi‑
vors (13). The improvement in cognitive function following
exercise is probably due to the regulation of angiogenic and
neurotrophic growth factors, which may facilitate neurogenesis,
circuitry and synaptic plasticity in the hippocampus and other
cognitively relevant cortical regions (14).
There is mounting evidence to indicate that combining
aerobic interventions with cognitive training may yield
additional benets to cognitive performance, surpassing the
effects of a single type of training alone (15). Combining
physical activity with cognitive training leads to signicant
cognitive improvements and reduces depression symptoms in
older adults (16). A previous systematic review found that this
combination enhanced overall cognitive function, memory,
Effect of combined aerobic exercise and cognitive training
in older adults with post‑stroke cognitive impairment
THI NGOC ANH NGUYEN1 and VAN MINH PHAM1,2
1Rehabilitation Department, Hanoi Medical University, Hanoi 100000, Vietnam; 2Hanoi Rehabilitation Hospital, Hanoi 100000, Vietnam
Received December 5, 2024; Accepted February 6, 2025
DOI: 10.3892/wasj.2025.327
Correspondence to: Professor Van Minh Pham, Rehabilitation
Department, Hanoi Medical University, 1 Ton That Tung Road,
Trung Tu, Dong Da, Hanoi 100000, Vietnam
E‑mail: phamvanminh@hmu.edu.vn
Key words: aerobic exercise, cognitive training, cognitive
impairment, older adults, stroke
NGUYEN and PHAM: A EROBIC EXERCISE AND COGNITIVE TRAINING FOR POST‑STROKE MCI
2
executive function and attention, in both cognitively impaired
and non‑impaired populations (17). In another study, in a
population with cognitive impairment following a stroke, the
combination of exercise and cognitive training exerted greater
benecial effects on cognitive function compared to exercise
alone (18). In addition, a previous study posited that for exercise
to effectively produce combined neurological and cognitive
benets, it needs to occur within a cognitively challenging
environment (19). Performing aerobic sessions prior to cogni‑
tive training prepares the brain for compensatory recruitment
during the subsequent cognitive training session (17). Aerobic
exercise prior to cognitive exercise can increase arousal levels,
facilitate neurogenesis and enhance memory consolidation,
which may benet memory retrieval and cognitive task perfor‑
mance afterwards (20).
Several studies have evaluated the effects of combining
physical activity with cognitive training in older adults or
those with cognitive impairment (16‑18). However, evidence
in older adults with mild cognitive impairment (MCI) after
stroke remains limited. The present study aimed to evaluate a
group of older adults for several reasons. First, the incidence
of stroke is higher among older adults. Older adults with
MCI following a stroke, if not addressed early, are at a risk
of further cognitive decline due to the degenerative process,
which may lead to the early onset of dementia and progress
more severely. Additionally, older adults generally engage
in less physical activity compared to younger individuals,
rendering them more likely to benet from participation in a
structured exercise program, which can improve adherence to
the training regimen.
In the present study, patient recruitment was conducted
at the National Geriatric Hospital in Hanoi, Vietnam, with
the target group primarily consisting of older adults. It
was observed that older adults with cognitive impairment
following a stroke often require long‑term care, which places
a notable burden on both families and society. It should be
noted that the classication of the ‘older adult’ age group is not
standardized across various organizations. The present study
followed the denition provided by the National Institute on
Aging (NIA) and the classications used in numerous Western
countries and studies, which dene older adults as individuals
aged ≥65 years. Furthermore, the methods of combining these
interventions need to be carefully considered for optimal
effectiveness. Patients residing at a marked distance from the
hospital or those with limited access to prolonged in‑hospital
programs may derive fewer benefits from the intervention
compared to others. Therefore, the present study not only
evaluated the effectiveness of sequential aerobic exercise and
cognitive training, but also proposed an intervention program
with follow‑up after hospital discharge. It was hypothesized
that the combination of aerobic exercise and cognitive training
would improve the cognitive function, physical health and
quality of life of patients than cognitive intervention alone.
Patients and methods
Study type and population. The present study was a controlled
prospective study and adopted a convenience sampling method
to evaluate the effectiveness of a combined aerobic exercise in
treating mild cognitive impairment following a stroke.
The sample size formula for a two‑independent‑sample
study, with a type I error probability of 5%, a two‑tailed test,
and 80% power, as proposed by Yeh et al (21), indicated a vari‑
ance of σ²=4.92 for the intervention group. A mean difference
of ∆=4.7 between the two groups was expected. The minimum
sample size per group was 17, with a 10% increase to ensure
adequacy, resulting in 19 participants per group.
Stroke survivors with MCI who met the inclusion criteria
were randomly assigned at a 1:1 ratio to either the intervention
or control group. Participants were rst paired based on similar
characteristics, and subsequently, within each pair, random‑
ization was used to assign one participant to the intervention
group and the other to the control group. One researcher was
responsible for conducting the screening and assessments both
before and after the intervention, while another researcher
was assigned to randomize the participants and prescribe the
corresponding exercise protocols.
There were no modications to the intervention method
following the recruitment of the participants. Each group
practiced for 60 min per day, 3 days per week, for 12 weeks.
A total of 36 sessions were divided into two phases as follows:
The rst 4 weeks in the hospital and the following 8 weeks at
home. No interim analysis was performed during the study.
Participation and recruitment. The study was conducted
at the Rehabilitation Department of the National Geriatric
Hospital in Hanoi, Vietnam. Participants were provided with
all information about the study and signed a consent form after
understanding the details of the study.
The inclusion criteria were as follows: i) Patients with a
confirmed diagnosis of MCI following an ischemic stroke
[according to DSM‑5 diagnostic criteria, Montreal cognitive
assessment (MoCA) score <26, mini‑mental state examination
score ≥19]; ii) patients with the rst ischemic stroke occurring
within the past 6 months; iii) those with an age ≥65 years;
iv) those with the ability to pa rticipate in the program, including
sufficient mobility, balance, cognitive capacity to engage
in and adhere to the program, and the presence of a family
member or caregiver to monitor and supervise self‑practice
process; v) those who agreed to provide informed consent and
participate in the study.
The exclusion criteria were the following: i) Patients with
other neurological disorders, such as Parkinson's disease,
multiple sclerosis, etc.; ii) patients with injuries or musculo‑
skeletal diseases that markedly impaired mobility, preventing
participation in the program; ii) patients with acute or chronic
respiratory or cardiovascular diseases that were not stably
controlled or were at a risk of acute exacerbations during
physical activity.
The present study was approved by Hanoi Medical
University under Decision No. 3963/QĐ‑ĐHYHN, dated
September 26, 2022 and Hanoi Medical University
Institutional Ethical Review Board under Decision No.
1259/GCN‑HDDDNCYSH‑DHYHN, dated May 7, 2024. All
patients provided a written consent to participate in this study.
Clinical intervention, part 1: Training program in the hospital
(rst 4 weeks)
Aerobic exercise. Patients in the intervention group performed
a 30‑min treadmill exercise, including 3 min of warm‑up, and
WORLD ACADEMY OF SCIENCES JOURNAL 7: 39, 2025 3
25 min of main exercise (walking on the treadmill) and ending
with 2 min of cool‑down. The target intensity of the exercise
was moderate, assessed by aiming for a target heart rate during
the aerobic period that was 40% of the reserve heart rate of the
patient, calculated using the Karvonen formula. Additionally,
the Borg Perceived Exertion Scale was recorded during each
session. Depending on the ability and the physical activity
level of each individual, the 25‑min main exercise was divided
into 2‑3 intervals, interspersed with short 2‑min rest periods,
to achieve the target after 4 weeks. Achieving the target
meant reaching the target heart rate and completing 25 min
of sustained exercise. All sessions were conducted by physical
therapists. The exercise was fully monitored by rehabilitation
doctors and physiotherapists to observe the symptoms of the
patient and adjust the intensity as needed (Fig. 1).
Cognitive training. The cognitive training program
was conducted on paper, focusing on cognitive domains
commonly impaired in patients who have suffered a stroke,
including executive function, processing speed, concentration
and attention, memory, etc. Participants performed various
tasks and the level was gradually increased until an improve‑
ment was observed. Occupational therapists conducted and
monitored the sessions. The duration of cognitive training
was 30 min per day for the intervention group and 60 min
per day for the control group. The following exercises were
performed: i) Memory exercises: Interventions for memory
retrieval (mnemonic methods for language memor y recover y;
organizing information into categories; using visual imagery
to enhance semantic memory; linking new information
with previously known information, etc.) and compensa‑
tory memory interventions (using devices, schedules, etc.).
ii) Attention, concentration and processing speed exercises:
Applying attention process training to improve sustained,
selective, alternating and divided attention. iii) Executive
function exercises: Applying metacognitive strategy training
to process tasks.
Clinical intervention, part 2: Home training program
(8 weeks). The program was continued at home following the
instructions provided at the hospital. The duration of training
was 8 weeks, comprising 24 sessions in total.
Aerobic exercise consisted of brisk walking on a flat
surface to achieve the target intensity. Cognitive exercises
involved instructing patients to prepare comic strips, images
and various objects related to different topics, similar to the
tasks practiced during their hospital sessions. In addition,
patients were provided with a document that recorded the exer‑
cises, along with illustrative images of previously taught tasks.
This allowed patients to continue practicing at home with the
support of family members or caregivers.
Compliance monitoring. Groups of patients were created
on the phone app with 3‑5 patients per group. All participants
were required to exercise within a specied time frame each
day and on specic days of the week. Researchers were aware
of the training schedules for each group and regularly moni‑
tored and supervised each the training sessions of group via
video using phone software. A tracking sheet was used for
each patient. The evaluators veried the exercise sessions of
the patients according to the exercise schedule of each group
and marked the tracking sheet accordingly.
Outcome assessment. The outcomes were evaluated at two‑time
points as follows: Once before the intervention began and again
at 12 weeks following the commencement of the intervention.
Primary outcome measures. Primary outcome measures
were cognitive functions, including the MoCA and the frontal
assessment battery (FAB). The MoCA is a brief screening tool
with a high sensitivity and specicity for detecting mild cogni‑
tive impairment, assessing six domains: Memory, executive
function, attention, language, visuospatial ability and orienta‑
tion. The FAB includes six subdomains related to frontal lobe
function and is a simple tool for assessing frontal lobe function.
Secondary outcome measures. Secondary outcomes
included measures of physical function and quality of life.
Physical functions were assessed using the Fugl‑Meyer
Assessment Lower Extremity (FMA‑LE) and the 6‑min walk
test (6MWT). The FMA‑LE is designed to evaluate motor
function, balance, sensation and joint function in patients of
all ages with post‑stroke hemiplegia. The 6MWT measures the
distance a patient can walk in 6 min and is used as an indicator
of walking endurance. It is an important predictor of mobility
and community integration in stroke survivors.
Quality of life was assessed using the European Quality of
Life‑5 Dimension‑5 Level (EQ‑5D‑5L) instrument. This tool
evaluates ve health aspects: Mobility, self‑care, usual daily
activities, pain or discomfort and anxiety or depression. Each
aspect is rated on a ve‑level severity scale: No problems,
slight problems, moderate problems, severe problems and
extreme problems.
Statistical analysis. The data were analyzed using SPSS
20.0 software (IBM Corp.). The Kolmogorov‑Smirnov test was
used to assess the normality of the data. The basic characteris‑
tics of the participants were compared using the Chi‑squared
(χ²) test and Fisher's exact test. The Wilcoxon signed rank test
was used to compare pre‑ and post‑intervention values within
each group. To compare the differences between the two groups,
the Mann‑Whitney U test was applied. To evaluate the strength
of the difference, the effect size was calculated using the r
Figure 1. Aerobic exercise training.
NGUYEN and PHAM: A EROBIC EXERCISE AND COGNITIVE TRAINING FOR POST‑STROKE MCI
4
coefcient for each outcome: r≤0.1, small effect size; 0.1<r≤0.3,
moderate effect size; and r>0.3, large effect size. A value of
P<0.05 was considered to indicate a statistically significant
difference. The Bonferroni correction was applied to adjust the
P‑values, thereby controlling the overall type I error rate at 0.05
across all statistical tests conducted in the study.
Results
Initially, 50 ischemic stroke survivors were selected, of whom
12 did not meet the age eligibility criteria. Therefore, 38
stroke survivors with MCI were randomly assigned to two
groups as follows: An intervention groups (n=19) and a control
group (n=19) (Fig. 2). The selection and follow‑up period
took place concurrently from November 1, 2022, to May 31,
2023. During this period, participants were enrolled, trained,
and followed‑up. The follow‑up continued until July 31, 2023.
No changes were made to the study outcomes after the study
commenced. No adverse events were reported during the
study, and the study was conducted according to the planned
protocol until its completion. The results revealed that no
signicant difference was observed in the demographic char‑
acteristics between the two groups (P>0.05), apart from sex
(P<0.05; Table I).
Primary outcome measures. After applying the Bonferroni
correction, the MoCA score results indicated that both groups
exhibited a significant improvement following treatment,
for the intervention group (P=0.003) and the control group
(P=0.014). However, the difference in MoCA score changes
between the intervention and control groups was not statisti‑
cally signicant (P=0.041). As regards the FAB scores, the
intervention group exhibited a signicantly greater improve‑
ment compared to the control group (P=0.008). The FAB score
in the intervention group improved signicantly (P=0.001); by
contrast, the improvement in the control group was not statisti‑
cally signicant (P=0.068) (Table II).
Secondary outcome measures. The data collected using the
sub‑measures in FMA‑LE, 6MWT and EQ‑5D‑5L (Tabl e III)
revealed that both groups experienced significant physical
improvement following treatment, with the intervention
group demonstrating a signicant change compared to the
control group. After applying the Bonferroni correction, the
intervention group exhibited signicant improvements in both
FMA‑LE and 6MWT, whereas in the control group, only the
6MWT exhibited signicant improvements. As regards quality
of life, only the intervention group exhibited a significant
improvement (P=0.002) (Table III).
Discussion
The results of the present study demonstrated that the group
participating in aerobic exercises experienced positive
Figure 2. Flowchart of the study design.
WORLD ACADEMY OF SCIENCES JOURNAL 7: 39, 2025 5
improvements in general cognition compared to the group
that received cognitive training only. This supports the initial
hypothesis that incorporating aerobic exercise would lead to
greater overall cognitive improvement. The intervention group
also demonstrated notable improvements in physical function
and quality of life outcomes.
Table I. General characteristics of the study participants.
Variables Intervention group (n=19) Control group (n=19) P‑value
Age (years) 71.42±5.10 73.95±7.04 0.278
Sex 0.036
Male 16 (84.2) 10 (52.6)
Female 3 (15.8) 9 (47.4)
BMI 20.75±1.55 20.32±1.56 0.365
NIHSS score 6.47±1.98 5.68±1.89 0.218
Side of brain lesion 0.103
Right 6 (31.6) 11 (57.9)
Left 13 (68.4) 8 (42.1)
Education 0.201
I (primary school) 8 (42.1) 3 (15.8)
II (middle school) 5 (26.3) 7 (36.8)
III (secondary school) 6 (31.6) 9 (47.4)
Values are presented as the mean ± standard deviation or n (%). NIHSS, National Institute of Health Stroke Scale; BMI, body mass index.
Table II. Primary outcome measures.
Wilcoxon Mann‑Whitney
Pre‑training Post‑training signed rank test P‑valuea U test (∆)
‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑ ‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑ ‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑ ‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑
Intervention Control Intervention Control Intervention Control Effect
Outcome group (n=19) group (n=19) group (n=19) group (n=19) group (n=19) group (n=19) P‑valueb size (r)
MoCA 18.21±3.87 16.79±4.19 19.02±4.23 17.11±4.54 0.003 0.014 0.041 0.331
FAB 10.84±4.25 8.74±4.57 11.95±4.03 9.21±4.98 0.001 0.068 0.008 0.429
Values are presented as the mean ± SD. aValues for within‑group comparisons; bvalues for between‑group (intervention group vs. control group)
comparisons. MoCA, Montreal cognitive assessment, FAB, frontal assessment battery.
Table III. Secondary outcome measures.
Wilcoxon Mann‑Whitney
Pre‑training Post‑training signed rank test P‑valuea U test (∆)
‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑ ‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑ ‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑ ‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑‑
Intervention Control Intervention Control Intervention Control Effect
Outcome group (n=19) group (n=19) group (n=19) group (n=19) group (n=19) group (n=19) P‑valueb size (r)
FMA‑LE 17.58±3.50 17.42±3.61 20.21±3.77 17.74±3.86 <0.001 0.034 <0.001 0.759
6MWT 41.47±12.28 38.84±11.62 71.42±14.97 52.16±16.16 <0.001 <0.001 <0.001 0.797
(meters)
EQ–5D‑5L 0.78±0.04 0.77±0.04 0.81±0.41 0.78±0.05 0.002 0.128 0.011 0.41
Values are presented as the mean ± SD. aValues for within‑group comparisons; bvalues for between‑group (intervention group vs. control group)
comparisons. FMA‑LE, Fugl‑Meyer Assessment Lower Extremity; 6MWT, six‑minute walk test; EQ‑5D‑5L, European Quality of Life‑5
Dimension‑5 Level.
NGUYEN and PHAM: A EROBIC EXERCISE AND COGNITIVE TRAINING FOR POST‑STROKE MCI
6
Aerobic exercise positively enhances cognitive perfor‑
mance in patients who have suffered a stroke, both in general
cognitive function as measured using the MoCA scale and in
specic cognitive domains, including concentration, attention,
visual‑spatial and executive function (18,21,22,23)..The nd‑
ings of the present study are also partly in accordance with the
results of previous studies (13,21,22,23). The ndings indicate
that combined aerobic exercise can help patients enhance
general cognitive function and improves executive function,
as assessed using FAB. In addition, aerobic exercise can regu‑
late angiogenic and neurotropic growth factors, which likely
facilitate neurogenesis, angiogenesis and synaptic plasticity.
Aerobic exercise combined with cognitive exercise likely has
synergistic or complementary effects on cognition at both
the neurobiological and behavioral levels (17,20). The present
study illustrated that the intervention of aerobic exercise
exerted a synergistic effect on improving cognitive function in
patients who had suffered a stroke.
The minimal clinically important difference (MCID) for
the MoCA score in patients who have suffered a stroke is esti‑
mated to range from 1.22 to 2.15, based on both anchor‑based
and distribution‑based methods (24). In the present study, the
changes in MoCA scores before and after the intervention for
each group were as follows: Intervention group, from 18.21
to 19.02; difference=0.81); control group, from 16.79 to 17.11;
difference=0.32). Neither group exceeded the MCID according
to both methods. It was deemed that the small sample size was
a limitation. Furthermore, the participants had MCI, which
may explain the limited change in the MoCA scores.
Aerobic intervention led to multiple positive
outcomes simultaneously. The difference from previous
studies (18,21,22), is that the present study evaluated various
outcomes related to physical health and quality of life. The
results indicated significant improvements in both motor
function and endurance in patients who have suffered a
stroke following aerobic intervention, as assessed using the
FMA‑LE and 6MWT. Yeh et al (21) conducted a similar
study with 56 patients assigned to three groups: Aerobic
exercise, cognitive exercise and a combination of aerobic
and cognitive exercise. The of their study results revealed
improvements in endurance and mobility (6MWT); however,
their study did not evaluate quality of life, daily functioning,
or social engagement (21). Yeh et al (21) suggested that
sequential training may improve both general and specic
cognitive domains, although the effects were insufcient to
transfer to activities of daily living, quality of life or social
participation. A previous systematic review suggested that
cognitive improvements appeared to be limited to trained
cognitive functions and do not generalize to activities of daily
living (25)..It was hypothesized that, once the aerobic effects
are achieved at the neurobiological level, they not only have
a synergistic effect on cognitive function, but also on other
domains, specically physical function and daily living func‑
tions. The results of the present study support this hypothesis.
Incorporating aerobic exercise was shown to improve cogni‑
tive function, lower limb function, mobility and endurance,
which, in turn enhances quality of life. Quality of life was
assessed using the EQ‑5D‑5L instrument, which measures
ve dimensions. Improvements were observed in two of these
dimensions: Mobility and usual daily activities.
The present study has several limitations which should
be mentioned. Firstly, the sample size was relatively small,
which limits generalizability and may have been inuenced
by various confounding factors. The present study involved an
unequal sex distribution between the two groups. Considering
that this is an intervention study incorporating physical
activity, the sex imbalance may have inuenced both the inter‑
vention process and the outcomes. Future research with larger
sample sizes is thus required, along with the further explora‑
tion of how patient characteristics may affect the results of
the intervention. Secondly, the cognitive training conducted
on paper may have more limitations compared to similar
studies conducted on computers. Lastly, the present study only
evaluated the outcomes at the end of the intervention. The
present study did not monitor or assess whether the effects of
the sequential training could be maintained over time. This
remains an unknown factor that warrants further investigation.
When comparing the findings of the present study with
those of previous studies (18,21,22), it was observed that while
these studies support the combined approach of cognitive and
physical training, the present study differs in several ways: It
focused on older adults, utilized a paper‑based cognitive inter‑
vention instead of a computer‑based program, and implemented
a 4‑week hospital program followed by 8 weeks of home‑based
intervention, rather than a 12‑week hospital‑based program.
These modications were made to better align with practical
intervention programs commonly available at most healthcare
facilities, as numerous patients may nd it difcult to adhere to
a 3‑month hospital program. The home‑based approach, with
monitoring, helps patients establish a routine that can be main‑
tained after the intervention ends. Nevertheless, similar ndings
in cognitive and physical outcomes highlight the consistency of
the combined training approach across various settings.
In conclusion, MCI following a stroke is prevalent and
significantly affects the recovery of patients. The present
study found that a sequential combination of aerobic and
cognitive exercise improved general cognitive function and
frontal lobe executive function, physical function and quality
of life. However, further studies with larger sample sizes are
required to investigate the factors inuencing the effectiveness
of intervention in order for patients with MCI to fully benet
from the intervention.
Acknowledgements
Not applicable.
Funding
No funding was received.
Availability of data and materials
The data generated in the present study may be requested from
the corresponding author.
Authors' contributions
TNAN and VMP were involved in the conception and design
of the study, and performed the statistical analysis of the data.
WORLD ACADEMY OF SCIENCES JOURNAL 7: 39, 2025 7
TNAN and VMP were involved in the investigative aspects of
the study. TNAN and VMP were involved in the interpretation
of the data. TNAN and VMP were involved in the writing of
original draft of the manuscript, and the writing, reviewing
and editing of the manuscript. Both authors read and agreed
to the published version of the manuscript. TNAN and VMP
conrm the authenticity of all the raw data.
Ethics approval and consent to participate
The present study was approved by Hanoi Medical
University under Decision No. 3963/QĐ‑ĐHYHN, dated
September 26, 2022 and Hanoi Medical University
Institutional Ethical Review Board under Decision No.
1259/GCN‑HDDDNCYSH‑DHYHN, dated May 7, 2024. All
patients provided a written consent to participate in this study.
Patient consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
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