Abstract
Background: Inflammatory markers, such as C-reactive Protein (CRP), Interleukin-6 (IL-6), tumor necrosis factor (TNF)-alpha and fibrinogen, are upregulated following acute stroke. Studies have shown associations of these biomarkers with increased mortality, recurrent vascular risk, and poor functional outcome. It is suggested that physical fitness training may play a role in decreasing long-term inflammatory activity and supports tissue recovery.Aim: We investigated the dynamics of selected inflammatory markers in the subacute phase following stroke and determined if fluctuations are associated with functional recovery up to 6 months. Further, we examined whether exposure to aerobic physical fitness training in the subacute phase influenced serum inflammatory markers over time.Methods: This is an exploratory analysis of patients enrolled in the multicenter randomized-controlled PHYS-STROKE trial. Patients within 45 days of stroke onset were randomized to receive either four weeks of aerobic physical fitness training or relaxation sessions. Generalized estimating equation models were used to investigate the dynamics of inflammatory markers and the associations of exposure to fitness training with serum inflammatory markers over time. Multiple logistic regression models were used to explore associations between inflammatory marker levels at baseline and three months after stroke and outcome at 3- or 6-months.Results: Irrespective of the intervention group, high sensitive CRP (hs-CRP), IL-6, and fibrinogen (but not TNF-alpha) were significantly lower at follow-up visits when compared to baseline (p all ≤ 0.01). In our cohort, exposure to aerobic physical fitness training did not influence levels of inflammatory markers over time. In multivariate logistic regression analyses, increased baseline IL-6 and fibrinogen levels were inversely associated with worse outcome at 3 and 6 months. Increased levels of hs-CRP at 3 months after stroke were associated with impaired outcome at 6 months. We found no independent associations of TNF-alpha levels with investigated outcome parameters.Conclusion: Serum markers of inflammation were elevated after stroke and decreased within 6 months. In our cohort, exposure to aerobic physical fitness training did not modify the dynamics of inflammatory markers over time. Elevated IL-6 and fibrinogen levels in early subacute stroke were associated with worse outcome up to 6-months after stroke.Clinical Trial Registration:ClinicalTrials.gov, NCT01953549.
Highlights
Over the past decades, progress in stroke treatment has led to lower mortality rates but at the same time, increased numbers of stroke survivors implicate an increasing need for post-stroke rehabilitation
We investigated the dynamics of high-sensitive C-reactive protein, interleukin-6 (IL-6), tumor necrosis factoralpha (TNF-alpha) and fibrinogen in the subacute phase following stroke
With our intervention group receiving a 4-week fitness training program, we explored whether aerobic physical fitness training in the subacute phase is associated with the course of inflammatory biomarkers
Summary
Progress in stroke treatment has led to lower mortality rates but at the same time, increased numbers of stroke survivors implicate an increasing need for post-stroke rehabilitation. Some studies suggest that elevated inflammatory markers are associated with the risk of recurrent events and poorer outcome after stroke and lead to poorer outcome [11, 12]. Approaches of measuring inflammatory biomarkers to predict stroke outcome in the clinical setting have been discussed [1, 13,14,15]. Their final role in stroke pathogenesis and functional recovery, remains uncertain [12, 16]. Physical fitness training may downregulate inflammatory processes in the long term [20] Inflammatory markers, such as C-reactive Protein (CRP), Interleukin-6 (IL-6), tumor necrosis factor (TNF)-alpha and fibrinogen, are upregulated following acute stroke. It is suggested that physical fitness training may play a role in decreasing long-term inflammatory activity and supports tissue recovery
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
