Sleep moderates the effects of exercise on cognition in chronic stroke: secondary analysis of a randomized trial
Bibliographic record
Abstract
Abstract Background Exercise (EX) or cognitive and social enrichment (ENRICH) are two promising strategies for promoting cognitive function post-stroke. Sleep may moderate the effects of these interventions on cogntion, whereby intervention effects may be more robust among individuals suffering from poor sleep. We examined whether sleep moderates the effects of EX or ENRICH on cognitive function in adults with chronic stroke. Methods Secondary analysis of a three-arm parallel, single-blinded, randomized clinical trial among community-dwelling adults aged 55+ years with chronic stroke (i.e., ≥12 months since stroke). Participants were randomized to 2x/week EX, ENRICH, or balance and tone control (BAT). At baseline, device-measured sleep duration and efficiency were measured using MotionWatch8 wrist-worn actigraphy; self-reported quality was measured by Pittsburgh Sleep Quality Index (PSQI). Participants were categorized at baseline as having good or poor: 1) device-measured duration; 2) device-measured efficiency; or 3) self-reported quality. The primary cognitive outcome was Alzheimer’s Disease Assessment Scale Plus (ADAS-Cog-Plus) measured at baseline, 6 months (end of intervention), and 12 months (6-month follow-up). Linear mixed models examined if baseline sleep categorizations (i.e., good/poor) moderated the effects of EX or ENRICH on ADAS-Cog-Plus. Results We enrolled 120 participants in the trial (EX=34; ENRICH=34; BAT=52). Baseline sleep categorization did not moderate the effect of ENRICH on ADAS-Cog-Plus; however, it moderated the effect of EX. EX participants with poor baseline sleep efficiency (estimated mean difference: −0.48; 95% CI:[−0.85, −0.10]; p =0.010) or self-reported sleep quality (estimated mean difference: −0.38; 95% CI:[−0.70, −0.07]; p= 0.014) had significantly better ADAS-Cog-Plus performance at 6 months compared with BAT participants with poor sleep. There was no effect of EX on ADAS-Cog-Plus for participants with good baseline sleep. Conclusion The effects of EX on cognitive function in adults with chronic stroke is moderated by sleep, whereby poor sleepers benefit more.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.008 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.008 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".