Abstract
IntroductionFemales experience more severe ischemic strokes than do males. A higher pre-stroke physical activity level is associated with less severe stroke. The primary aim of this study was to explore the association between pre-stroke physical inactivity and stroke severity in male and female patients.MethodsThis was a retrospective, registry-based study. The data were retrieved from two stroke registries from 2014 to 2019. The primary explanatory variable was physical activity level before the stroke, assessed using the Saltin-Grimby Physical Activity Level Scale. The outcome was moderate to severe stroke at hospital admission, assessed using the National Institutes of Health Stroke Scale (NIHSS). A moderate to severe stroke was defined as a NIHSS score of ≥6. Binary logistic regression analysis was performed to explore if physical inactivity before the stroke could explain stroke severity in male and female patients.ResultsIn total, we included 4,535 patients with ischemic stroke. Female patients (n = 2,145) had a mean age of 76 years, 35% had a moderate to severe stroke, and 64% were physically inactive pre-stroke. Male patients (n = 2,390) had a mean age of 72 years, 25% had a moderate to severe stroke, and 49% were physically inactive pre-stroke. Physical inactivity was associated with higher odds for moderate to severe stroke in both sexes (females' odds ratio [OR], 2.7, 95% confidence interval [CI]: 2.2–3.3, p < 0.001 and males' OR, 2.06, 95% CI: 1.7–2.5, p < 0.001). The association remained significant in the adjusted models.ConclusionsPhysically inactive females and males had higher odds of experiencing a moderate to severe stroke. However, the OR of female patients was somewhat higher than that of male patients.
Highlights
Females experience more severe ischemic strokes than do males
For individuals aged younger than 85 years, males have a higher risk of ischemic stroke than females; for those aged older than 85 years, females have a higher risk than males, and a 15% higher stroke mortality compared with age-matched males [9]
The results were evaluated as follows: at the variable level, we reported β coefficients with standard errors (SE), odds ratios (ORs) and 95% confidence intervals (CI), and p-values
Summary
A higher pre-stroke physical activity level is associated with less severe stroke. The primary aim of this study was to explore the association between pre-stroke physical inactivity and stroke severity in male and female patients. Several studies have indicated that females experience greater stroke severity than do males [1–5]. A recurring possible explanation for sex differences in stroke severity is that females have a longer lifespan than males and are approximately 5 years older at stroke onset [1, 4, 6–8]. Pre-stroke physical activity (PA) level is associated with lower severity of stroke and better outcomes [11, 12]. Six studies reported that patients with higher pre-stroke PA had less severe strokes, whereas two studies found no association [12]. Several studies have shown associations between pre-stroke PA and stroke severity, investigations regarding sex differences are limited
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