Exercise based rehabilitation for cognitive and physical recovery in working age adults after early onset stroke a systematic review

Early-onset strokes have become increasingly common in the last ten years, leading to disabilities, reduced productivity, and ongoing neurological and physical deficits. Cognitive dysfunctions, especially in the areas of executive function, attention, and memory, continue to be one of the most debilitating consequences of strokes among younger patients. Recent research indicates that exercise interventions can help increase neuroplasticity and facilitate recovery. Synthesize the available literature regarding the effect of exercise-based rehabilitation on recovery of both cognitive and physical functions in working-aged adult individuals (aged between 18 and 50 years or studies reporting mean ages below 57 years) after early stroke. Based on the PRISMA 2020 recommendations, a systematic search of the literature was conducted using articles from the PubMed database, PubMed Central (PMC), Embase, Scopus, Web of Science, DOAJ, and BMC from January 2000 to October 2025. The total number of articles found is 3,204. After excluding duplicates and applying the inclusion criteria, 13 articles for primary intervention were selected for the final analysis. The quality assessment of research included in the articles was carried out according to the PEDro scale and JBI checklists. Intervention approaches generally entailed high-intensity aerobic exercise, resistance exercise, or their combination. From the 13 included primary research articles, enhancement was noted for executive function, global cognitive performance, and attention/working memory. Physiological measures, including gait velocity, endurance, and balance enhanced in 100% of cases. Relevant supporting studies pointed to neurobiological processes, including cerebral perfusion, upregulation of neurotrophic factors, and enhanced neural connectivity. Physical exercise interventions are highly beneficial for improving cognitive and physical functions in middle-aged adults who have experienced early stroke attacks. Interventions that involve high intensity and mixed aerobic and cognitive exercises seem to be particularly effective.