Perspectives on rehabilitation, exercise and synaptogenesis after stroke

Strokes are a leading cause of death, persistent neurological deficits, and physical disability worldwide. Exercise-mediated adaptations are an emerging form of therapies that aim to attenuate the severity of post-stroke physical disability; however, there are uncertainties regarding how specific parameters, such as time to initiation and intensity of exercise, affect rehabilitation outcomes. At the cellular level, physical rehabilitation after stroke may enhance post-stroke gluconeogenesis to promote neuroplasticity over cellular damage via hypoxia-inducible factor-1α and exosomes. Furthermore, there is thought to be an optimal time for the initiation of exercise after a stroke, but there is disagreement and uncertainty about this optimal time. This paper discusses the pathophysiology of physical rehabilitation after stroke and reviews current studies on the effects of physical exercise on stroke rehabilitation and plasticity.