Neuroplasticity Induced by Therapeutic Exercise in Stroke Rehabilitation: A Scoping Review Supporting SDGs 3 (Good Health and Well-being)
Abstract
Background: Stroke is a leading cause of long-term disability globally, imposing a significant burden on the health, social, and economic sectors. Therapeutic exercise plays a crucial role in stroke rehabilitation by stimulating neuroplasticity—a process of functional recovery driven by structural and functional adaptations within the central nervous system. Mapping the scientific evidence regarding this recovery is essential for optimizing rehabilitation strategies and supporting SDG 3 (Good Health and Well-being) indicators related to equitable access to quality healthcare. Objective: This scoping review aims to map evidence on therapeutic exercise interventions that promote neuroplasticity in stroke patients, identify reported biomarkers and neurophysiological parameters, and summarize strategies regarding exercise dosage and progression. Methods: The methodology follows the Arksey & O'Malley framework as refined by the Joanna Briggs Institute (JBI) and adheres to PRISMA-ScR reporting guidelines. A literature search covering the period 2023-2026 was conducted using ScienceDirect, PubMed, and Google Scholar, with inclusion criteria limited to randomized controlled trials investigating the relationship between therapeutic exercise and post-stroke neuroplasticity outcomes. Results: Six studies met the inclusion criteria. Moderate-intensity aerobic exercise, cardiorespiratory training, robotic-assisted gait training, extracorporeal shockwave therapy combined with neuroplasticity-based training, and early multimodal rehabilitation consistently improved neuroplasticity-related outcomes, including increased brain-derived neurotrophic factor (BDNF), enhanced corticospinal excitability, cortical activation, and functional recovery. Conclusions: Therapeutic exercise effectively promotes neuroplasticity and functional recovery after stroke. Standardized exercise prescription and high-quality multicenter trials are needed to strengthen clinical implementation and advance evidence-based rehabilitation supporting SDG 3s.