Prestroke Physical Activity Research Articles

Prestroke Physical Activity Matters for Functional Limitations: A Longitudinal Case-Control Study of 12,860 Participants.

In the chronic phase after a stroke, limitations in basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs) initially plateau before steadily increasing. The benefits of prestroke physical activity on these limitations remain unclear. To clarify this relationship, the effect of physical activity on the long-term evolution of functional limitations in a cohort of people with stroke compared to a cohort of matched adults without stroke was examined. Longitudinal data from 2143 people with stroke and 10,717 adults without stroke aged 50years and older were drawn from a prospective cohort study based on the Survey of Health, Ageing and Retirement in Europe (2004-2022; eight data collection waves). Physical activity was assessed in the prestroke wave. Functional limitations were assessed in the poststroke waves. Each person with stroke was matched with five adults without stroke who had similar propensity scores computed on the basis of key covariates, including baseline age, sex, body mass index, limitations in ADLs and IADLs, chronic conditions, and country of residence, before any of the participants from either cohort had experienced a stroke. Results showed an interaction between stroke status and physical activity on ADL limitations (b = -0.076; 95% CI = -0.142 to -0.011), with the beneficial effect of physical activity being stronger in people with stroke (b = -0.345; 95% CI = -0.438 to -0.252) than in adults without stroke (b = -0.269; 95% CI = -0.269 to -0.241). The beneficial effect of prestroke physical activity on ADL limitations after stroke is stronger than its effect in matched adults without stroke followed for a similar number of years. Physical activity, an intervention within the physical therapist's scope of practice, is effective in reducing the risk of functional dependence after stroke. Moreover, prestroke levels of physical activity can inform the prognosis of functional dependence in people with stroke.

PRE-STROKE PHYSICAL ACTIVITY IN RELATION TO POST-STROKE OUTCOMES: A SYSTEMATIC REVIEW

Background: Stroke has a direct impact on overall health. The interval between the onset of symptoms and arrival at the hospital can greatly influence the effectiveness of treatment and patient prognosis. Stroke survivors are additionally affected by long-term physical and psychosocial well-being. The aim: This study aims to show pre-stroke physical activity in relation to post-stroke outcomes. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2013 and 2023 were taken into account. Several different online reference sources, like Pubmed and SagePub, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search brought up 74 articles, whereas the results of our search on SagePub brought up 77 articles. The results of the search conducted for the last year of 2013 yielded a total 7 articles for PubMed and 54 articles for SagePub. The result from title screening, a total 5 articles for PubMed and 31 articles for SagePub. In the end, we compiled a total of 10 papers. We included five research that met the criteria. Conclusion: People who were physically active before the stroke tended to be more independent in physical functioning after the stroke. Regardless of physical activity before stroke, all patients demonstrated improvements in mobility, walking ability, and upper extremity self-perception during functional treatment.

Pre-stroke physical activity is associated with post-stroke physical activity and sedentary behavior in the acute phase

This study investigated the link between pre-stroke and acute-stage physical activity (PA) and sedentary behavior. Forty individuals with stroke (aged 73.6 ± 8.9 years) were enrolled. Post-stroke activity, including metabolic equivalents (METs), sedentary behavior, light PA, and moderate-to-vigorous PA (MVPA), was measured using a tri-axial accelerometer (ActiGraph wGT3X-BT) over 11 consecutive days starting from the 4th day post-stroke. Pre-stroke PA levels were assessed using the International Physical Activity Questionnaire (IPAQ). We measured skeletal muscle mass index (SMI) and phase angle using a bioelectrical impedance analyzer (Inbody S10) upon admission. Physical therapists assessed the Brunnstrom recovery stage (BRS) within 3 days post-stroke. Total daily activity averaged 1.05 ± 0.05 METs. Throughout the day, 91.2 ± 5.1, 7.6 ± 4.1, and 1.2 ± 1.3% was spent in sedentary behavior, light PA, and MVPA, respectively. Only pre-stroke PA was independently associated with METs (β = 0.66), sedentary behavior (β = −0.58), light PA (β = 0.50), and MVPA (β = 0.71) after adjusting for age, sex, stroke severity, and activities of daily living. This suggests that pre-stroke PA might play a crucial role in reducing sedentary behavior and promoting PA during the acute phase.

Associations between pre-stroke physical activity levels and health-related quality of life 3 months after stroke: A registry-based study (part of PAPSIGOT).

Whether pre-stroke physical activity is associated with health-related quality of life after stroke has been sparsely investigated. To explore associations between pre-stroke physical activity and health-related quality of life 3 months after stroke onset. A consecutively collected cohort study with data from registries. Included were adult patients with first stroke in the period 2014-2018 who were hospitalized at any one of the three stroke units in Gothenburg, Sweden. Pre-stroke physical activity was assessed with the Saltin-Grimby Physical Activity Level Scale (SGPALS) after hospital admission for acute stroke. Health-related quality of life was assessed with the EuroQoL 5 Dimensions 5 Level Version (EQ-5D-5L) 3 months after stroke. Data were analyzed with the Kruskal-Wallis test and binary logistic regression. Data were included from 2044 patients; 91% had ischemic stroke, 46% were female, and mean age was 73 years, with mild stroke severity median National Institute of Health Stroke Scale (NIHSS) of 2. Patients who were pre-stroke physically active reported better overall health-related quality of life by the EQ-5D-5L index value, all the domains in EQ-5D-5L, and the EuroQoL-Visual Analogue Scale (EQ-VAS) compared with pre-stroke physically inactive patients (all p < 0.001). Better health-related quality of life 3 months after stroke was associated with pre-stroke light and moderate physical activity: adjusted odds ratio (95% confidence interval), 1.9 (1.5-2.3) and 2.3 (1.5-3.4), respectively. Pre-stroke physical activity is associated with better health-related quality of life 3 months after stroke. For the domains of mobility, self-care, and pain/discomfort, physical activity with higher intensity is even more beneficial.

Pre-stroke physical activity is related to good functional outcomes in stroke patients after endovascular thrombectomy.

Abstract. Studies have shown that regular physical activity (PA) may re-duce the risk of stroke. Nevertheless, the protective effect of pre-stroke PA on the post-stroke functional status in patients treated with endovascular throm-bectomy (EVT) is still uncertain. For this study, hospitalized patients with acute ischemic stroke were selected, all of whom underwent EVT after occlusion of the large vessels in the anterior circulation. The PA levels before the stroke were assessed by the International Physical Activity Questionnaire, and the outcome indicators (the modified Rankin scale score and the Barthel index) were evalu-ated. A total of 144 patients were included in this study. Among the patients with high PA levels before the stroke, men were more active than women, and the proportion of patients with smoking and alcohol abuse was high before admission. Also, the patients with a high PA level were more likely to have no history of hypertension and atrial fibrillation, and had lower triglyceride levels at admission. We determined that a high pre-stroke PA level is independently related to a favorable functional outcome at three months. In addition, there was no correlation between a high pre-stroke PA and a good functional outcome at two weeks. A high pre-stroke PA level is independently associated with sat-isfactory activities of daily living at three months. Regular PA before a stroke is an independent predictor of a favorable functional outcome in patients with anterior circulation strokes who receive EVT, and it has a protective effect on the functional prognosis.

Prestroke physical activity is associated with admission haematoma volume and the clinical outcome of intracerebral haemorrhage

BackgroundPrestroke physical activity (PA) has been linked to improved outcomes after intracerebral haemorrhage (ICH), but its association with ICH volume is unknown. We aimed to investigate associations of prestroke PA...

Association between exercise habit changes and incident dementia after ischemic stroke

We aimed to investigate the effects of exercise habit changes on the risk of incident dementia after ischemic stroke using the Korean National Health Insurance Services Database. This study included 223,426 patients with a new diagnosis of ischemic stroke between 2010 and 2016 who underwent two serial ambulatory health checkups. The participants were divided into four categories according to their habit change or regular exercise: persistent non-exercisers, new exercisers, exercise dropouts, and exercise maintainers. The primary outcome was new diagnosis of dementia. Multivariate Cox proportional models were used to assess the effects of changes in exercise habits on the risk of incident dementia. After a median of 4.02 years of follow-up, 22,554 (10.09%) dementia cases were observed. After adjusting for covariates, exercise dropouts, new exercisers, and exercise maintainers were significantly associated with a lower risk of incident dementia than persistent non-exercisers (adjusted hazard ratio [aHR] 0.937; 95% confidence interval [CI] 0.905–0.970, aHR 0.876; 95% CI 0.843–0.909, aHR 0.705; 95% CI 0.677–0.734, respectively). The impact of changes in exercise habit was more prominent in the 40–65 years age group. An energy expenditure ≥ 1000 metabolic equivalents of task-min/wk post-stroke, regardless of pre-stroke physical activity status, was mostly associated with a lower risk of each outcome. In this retrospective cohort study, initiating or continuing moderate-to-vigorous exercise after ischemic stroke was associated with a lower risk of dementia development. Further, pre-stroke regular physical activity also reduced the risk of incident dementia. The promotion of exercise in ambulatory stroke patients may reduce their future risk of incident dementia.

Impact of prestroke physical activity and citalopram treatment on poststroke depressive symptoms: a secondary analysis of data from the TALOS randomised controlled trial in Denmark

ObjectivesTo investigate the association between prestroke physical activity and depressive symptoms up to 6 months after stroke and examine if citalopram treatment modified the association.DesignA secondary analysis of data from...

Associations of Prestroke Physical Activity With Stroke Severity and Mortality After Intracerebral Hemorrhage Compared With Ischemic Stroke.

Prestroke physical activity may protect the brain from severe consequences of stroke. However, previous studies on this subject included mainly ischemic stroke cases, and the association between prestroke physical activity and outcomes after intracerebral hemorrhage is uncertain. Therefore, we sought to examine the associations between prestroke physical activity, stroke severity, and all-cause mortality after intracerebral hemorrhage in comparison with ischemic stroke. This was a longitudinal, register-based cohort study. All adult patients with intracerebral hemorrhage or ischemic stroke admitted to 3 stroke units in Gothenburg, Sweden, between November 1, 2014, and June 30, 2019, were screened for inclusion. Physical activity was defined as light physical activity ≥4 h/wk or moderate physical activity ≥2 h/wk the year before stroke. Stroke severity was assessed on admission using the NIH Stroke Scale. All-cause mortality rates were followed up to 7 years, from the time of incident stroke until death or censoring. Ordinal logit models and Cox proportional hazards models were used to estimate adjusted associations of prestroke physical activity. We included 763 patients with intracerebral hemorrhage and 4,425 with ischemic stroke. Prestroke physical activity was associated with less severe strokes by an adjusted odds ratio of 3.57 (99% CI 2.35-5.47) for intracerebral hemorrhages and 1.92 (99% CI 1.59-2.33) for ischemic strokes. During a median follow-up of 4.7 (interquartile range 3.5-5.9) years, 48.5% of patients with intracerebral hemorrhage died, compared with 37.5% with ischemic stroke. Prestroke physical activity was associated with decreased short-term mortality (0-30 days) by an adjusted hazard ratio of 0.30 (99% CI 0.17-0.54) after intracerebral hemorrhage and 0.22 (99% CI 0.13-0.37) after ischemic stroke. Prestroke physical activity was further associated with decreased long-term mortality (30 days-2 years) by an adjusted hazard ratio of 0.40 (99% CI 0.21-0.77) after intracerebral hemorrhage and 0.49 (99% CI 0.38-0.62) after ischemic stroke. Prestroke physical activity was associated with decreased stroke severity and all-cause mortality after intracerebral hemorrhage and ischemic stroke, independent of other risk factors. Based on current knowledge, health care professionals should promote physical activity as part of primary stroke prevention.

Incidence, early case fatality and determinants of stroke in Iran: Golestan Cohort Study

Objectives: While few studies investigated the incidence of stroke in Iran, no Iranian cohort has estimated the standardized-incidence rate and early fatality of first-ever-stroke subtypes along with associated factors. Methods: Golestan Cohort Study is a prospective study launched in northeastern Iran in 2004, including 50,045 individuals aged 40-75 at baseline. Age-standardized incidence rate of first-ever-stroke was calculated per 100,000 person-years, according to World Standard Population. The 28-day case fatality was calculated by dividing the number of fatal first-ever-stroke during the first 28 days by total events. Cox proportional hazard models were conducted to assess incidence and fatality risk factors. We used Population Attributable Fractions to estimate the incidence and early fatality proportions reduced by ideal risk factor control. Results: 1,135 first-ever-strokes were observed during 8.6 (median) years follow-up. First-ever-stroke standardized incidence rate was estimated 185.2 (95% CI: 173.2-197.2) per 100,000 person-years. The 28-day case fatality was 44.1% (95% CI: 40.4-48.2). Hypertension and pre-stroke physical activity were the strongest risk factors associated with first-ever-stroke incidence (Hazard ratio: 2.83; 2.47-3.23) and 28-day case fatality (Hazard ratio: 0.59; 0.44-0.78), respectively. Remarkably, opium consumption was strongly associated with hemorrhagic stroke incidence (Hazard ratio: 1.52; 1.04-2.23) and ischemic stroke fatality (Hazard ratio: 1.44; 1.01-2.09). Overall, modifiable risk factors contributed to 83% and 61% of first-ever-stroke incidence and early fatality, respectively. Conclusion: Efficient risk factor control can considerably reduce stroke occurrence and fatality in our study. Establishing awareness campaigns and 24-hour stroke units seem necessary for improving the stroke management in this area.

Associations between pre-stroke physical activity and physical quality of life three months after stroke in patients with mild disability.

Much is known about the association between physical activity and the occurrence of stroke. However, the evidence about the correlation between pre-stroke physical activity and post-stroke quality of life remains inconsistent. Thus, there is a high public health relevance to the topic. The aim of this study was to investigate the association between pre-stroke physical activity and physical quality of life after three months. Data arises from 858 patients with stroke included a prospective single-centre observational cohort study in Augsburg, Germany, between September 2018 and November 2019. The participants were recruited at the Department of Neurology and Clinical Neurophysiology, University Hospital of Augsburg after their stroke event. The level of physical activity was determined following the short form of the International Physical Activity Questionnaire at baseline. Physical quality of life was assessed three months after hospital discharge using the German version of the Stroke Impact Scale (SIS). A multiple linear regression model and a quantile regression were carried out. A total of 497 patients were included in the analysis (mean age 69.6, 58.8% male), 26.2% had a high, 18.9% a moderate and 54.9% a low level of pre-stroke physical activity. Patients with high pre-stroke physical activity had a significantly better physical quality of life three months after stroke in the SIS physical domain (beta = 4.1) and in the SIS subdomains hand function (beta = 5.6), mobility (beta = 4.1) and activities of daily living (beta = 3.7). In the physical domain and the subdomain mobility, the effect was especially strong for persons with low physical quality of life after three months. Pre-stroke physical activity seems to have an important and positive association with physical quality of life after three months in patients with mild disability. Further studies are needed to confirm these results.

A register-based study on associations between pre-stroke physical activity and cognition early after stroke (part of PAPSIGOT)

The objective was to investigate if pre-stroke physical activity is associated with intact cognition early after stroke. The study design was a cross-sectional, register-based study. The study sample included 1111 adults with first stroke (mild or moderate severity) admitted to three Swedish stroke units. The main outcome was cognition. The associations of pre-stroke physical activity, age, sex, smoking, diabetes, atrial fibrillation, previous TIA, statin treatment, hypertension treatment, reperfusion therapies, stroke severity, and education on the outcome cognition were analyzed using binary logistic regression. Physical activity was assessed within 48 h of admittance, and cognition was screened during stroke unit care. The results were: mean age 70 years, 40% women, 61% pre-stroke physically active, and 53% with post-stroke cognitive impairment. Patients with pre-stroke light or moderate physical activity have higher odds for intact cognition compared to inactive: odds ratio (95% confidence interval) 1.32 (0.97-1.80) and 2.04 (1.18-3.53), respectively. In addition to pre-stroke physical activity, people with younger age, a higher level of education, less severe stroke (more mild than moderate), being non-diabetic, and non-smoking have higher odds for intact cognition. In conclusion physical activity before stroke is associated with intact cognition in patients with mild and moderate stroke.

Factors Associated With Early and Late Post-stroke Fatigue in Patients With Mild Impairment. Results From the Stroke Cohort Study Augsburg.

BackgroundPost-stroke fatigue is a common symptom after stroke. However, studies on the factors associated with early and late fatigue are scarce. The objective of this study was to identify variables associated with early and late fatigue.MethodsIn the German Stroke Cohort Augsburg (SCHANA) study, participants were interviewed during their hospital stay and completed a postal questionnaire 3 and 12 months post-stroke. Fatigue was assessed using the Fatigue Assessement Scale (FAS). In addition, depression was measured by the Patient Health Questionnaire (PHQ-9), general health status by the EQ-5D visual analog scale, and physical activity by the International Physical Activity Questionnaire (IPAQ). Multivariable regression models were used to determine the associations between FAS scores at 3 and 12 months post-stroke and demographic, psychosocial and health-related covariables.ResultsAmong 505 participants, the frequency of fatigue was 31.1% 3 months and 29.1% 12 months post-stroke. Prior stroke (ß = 2.37, p = 0.0076), prior diagnosis of depression (ß = 5.04, p = 0.0001), higher NIHSS (ß = 0.25, p = 0.0360) and higher PHQ-9 scores (ß = 0.55, p < 0.0001) were significantly associated with higher fatigue levels 3 months post-stroke. Additionally, younger age (ß = −0.07, p = 0.0219), a worse rating of general health at baseline (ß = −0.04, p = 0.0287) and low pre-stroke physical activity (ß = −0.0004, p = 0.0089) were significantly associated with higher fatigue levels 12 months after stroke.ConclusionsFatigue is a common and persisting symptom even in patients with mild impairment. Prior depressive disorder and early depressive symptoms were the most relevant predictors of both early and late fatigue.

Pre-stroke Physical Inactivity and Stroke Severity in Male and Female Patients.

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.

Pre-stroke Physical Activity and Cerebral Collateral Circulation in Ischemic Stroke: A Potential Therapeutic Relationship?

Favorable cerebral collateral circulation contributes to hindering penumbral tissue from progressing to infarction and is associated with positive clinical outcomes after stroke. Given its clinical importance, improving cerebral collateral circulation is considered a therapeutic target to reduce burden after stroke. We provide a hypothesis-generating discussion on the potential association between pre-stroke physical activity and cerebral collateral circulation in ischemic stroke. The recruitment of cerebral collaterals in acute ischemic stroke may depend on anatomical variations, capacity of collateral vessels to vasodilate, and individual risk factors. Physical activity is associated with improved cerebral endothelial and vascular function related to vasodilation and angiogenic adaptations, and risk reduction in individual risk factors. More research is needed to understand association between cerebral collateral circulation and physical activity. A presentation of different methodological considerations for measuring cerebral collateral circulation and pre-stroke physical activity in the context of acute ischemic stroke is included. Opportunities for future research into cerebral collateral circulation, physical activity, and stroke recovery is presented.

Abstract 3: Higher Pre-stroke Physical Activity Is Associated With Fewer Post-stroke Depressive Symptoms In Patients Treated With Citalopram As Compared To Placebo

Introduction: Post-stroke depression affects one in three stroke patients and is associated with increased mortality and disability. Physical activity (PA) has been associated with fewer depressive symptoms after stroke, however, the long-term effect of pre-stroke PA and how Selective Serotonin Reuptake Inhibitors may affect this association is unknown. Methods: The study was conducted as a secondary analysis of data from The Efficacy of Citalopram Treatment in Acute Ischemic Stroke (TALOS) trial, where consecutive non-depressed acute ischemic stroke patients were randomized to Citalopram 20 mg or placebo for 6 months. Pre-stroke PA was measured using the Physical Activity Scale for the Elderly (PASE) and dichotomized by overall median value. Depressive symptoms were measured using the Major Depression Inventory (MDI) at one and six months after stroke. We used multivariable linear regression models to evaluate the interaction of pre-stroke PASE score and post-stroke MDI score. Results: We included 543 patients with complete PASE and MDI data at one month. Of these, 257 (47.3%) were in the SSRI group, 75% were men, and median (interquartile range) age was 69 (60 to 77). Overall, high PASE score was associated with lower MDI scores both one month (mean difference [confidence interval (CI)] -2.02 [-3.28 to -0.75]) and six months (-1.71 [-3.21 to -0.2]) after stroke. At one-month, a high PASE score was associated with lower MDI scores in the placebo group (mean difference -2.14 [-3.74 to -0.54]). After six months, an association between high pre-stroke PASE and lower MDI score was only found in the Citalopram group (mean difference -1.71 [-3.21 to -0.2]). Among patients with high pre-stroke PASE score the Citalopram group had lower MDI scores than the placebo group at six months (mean diff 2.01 [0.25 to 3.77]). Conclusions: High pre-stroke PA was independently associated with fewer depressive symptoms one and six months after stroke, however at six months the association was only present among those treated with Citalopram, suggesting an effect modification by Citalopram on the effect of PA on depressive symptoms. Further trials are warranted to verify these results.

Pre-stroke physical activity in relation to post-stroke outcomes - linked to the International Classification of Functioning, Disability and Health (ICF): A scoping review.

ObjectiveThis scoping review aims to identify how pre-stroke physical activity has been studied in relation to outcomes after stroke using the International Classification of Functioning, Disability and Health (ICF) framework.MethodsMEDLINE, CINAHL, Scopus, and grey literature databases were systematically searched from inception to 15 March 2021, with no language restrictions. Risk of bias was evaluated for all included studies. Identified outcome measures were linked to ICF components using linking rules, and the main findings were summarized.ResultsOf 3,664 records screened, 35 studies were included. The risk of bias was graded as moderate to critical for all studies. A total of 60 unique outcome measures were identified, covering the hyperacute to chronic phases of stroke recovery. Outcome measures linked to body functions were most common (n = 19), followed by activities and participation (n = 14), body structures (n = 7), environmental factors (n = 4) and personal factors (n = 2). The majority of studies collected data on pre-stroke physical activity retrospectively, and no study used objective methods to measure physical activity. Only one study analysed haemorrhagic cases separately.ConclusionPre-stroke physical activity has been studied in relation to a variety of outcome measures linked to ICF after stroke. However, this review highlights the high risk of bias, and limited quality of the current literature.LAY ABSTRACTWe used the International Classification of Functioning, Disability and Health (ICF) to categorise the outcome measures of 35 studies. The ICF includes the following domains of health: body functions, body structures, activities, participation, and environmental factors. We identified 60 outcome measures, covering all domains of the ICF. Most common were measures related to body functions such as stroke symptoms, cognition or respiratory function, and activities or participation, such as functional recovery and walking ability. Few studies evaluated personal and environmental factors. Most studies collected information on physical activity before the stroke after the stroke had occurred, and all studies used self-reported information which is problematic from a scientific point of view and can lead to erroneous results. Future studies are needed to determine the true impact of physical activity on outcomes after stroke.

Association between pre-stroke physical activity and mobility and walking ability in the early subacute phase: A registry-based study.

ObjectiveTo investigate associations between prestroke physical activity and mobility, walking ability, and self-perceived upper extremity function during stroke unit care.DesignA longitudinal, registry-based study with a consecutively collected cohort.Subjects/patientsA total of 1,092 adults with stroke admitted to 3 Swedish stroke units between 2017 and 2018.MethodsLogistic mixed effects regression models were performed to investigate associations (adjusted for age and sex). Pre-stroke physical activity was assessed with Saltin-Grimby Physical Activity Level Scale on admission. Mobility, walking ability, and self-perceived upper extremity function were assessed at admission and discharge from the stroke units and compared between pre-stroke physically active (45%) and inactive (55%) groups.ResultsAll groups of patients showed improvements in mobility (p < 0.001), walking ability (p < 0.001), and upper extremity function (p < 0.001). The changes over time tended to differ between the physically inactive and active groups for mobility (p < 0.062) and walking ability (p < 0.056), but the differences were not significant.ConclusionPre-stroke physically active people showed a tendency to be more independent in physical functioning early after stroke. Regardless of prestroke physical activity, all patients showed improvements in mobility, walking ability, and self-perceived upper extremity function during inpatient care.LAY ABSTRACTTo be physically active prior to a stroke may improve the post-stroke recovery process. Therefore, we hypothesized that pre-stroke physical activity might reduce the consequences of a stroke. This study investigated associations between pre-stroke physical activity and post-stroke recovery of mobility, walking ability, and arm and hand function. A total of 1,092 patients were examined; 44% were women, 89% had ischaemic stroke, and 55% were physically inactive before the stroke. All patients showed improvements during care at the stroke units, regardless of their previous physical activity level. At hospital discharge, 71% of patients showed independent mobility, 68% could walk independently, and 55% reported self-perceived arm and hand impairments. Patients with higher pre-stroke physical activity levels had a tendency of being more independent in mobility and walking compared with inactive patients. However, the frequencies of self-perceived arm and hand impairments were similar between the physically active and physically inactive groups. To be physically active prior to a stroke may improve the post-stroke recovery process.

Abstract 059: Pre-stroke Physical Activity Is Associated With Lower Mortality Risk After Stroke In The Atherosclerosis Risk In Communities (ARIC) Study

Background: The association between pre-stroke PA and long-term stroke outcomes is still unclear. We examined the association of pre-stroke PA with adverse health outcomes after incident stroke in the ARIC study. Methods: We included 881 participants with incident ischemic or hemorrhagic stroke occurring between 1993-1995 and December 31 st , 2016. Follow-up for all-cause and cardiovascular disease (CVD) mortality, CVD or recurrent stroke occurred through December 31 st , 2017, allowing for at least 1-year of follow-up after incident stroke. Pre-stroke total and domain-specific (work, sports and leisure) PA was assessed with the modified Baecke questionnaire at the baseline visit (1987-1989) and in 1993-1995. The total PA score was calculated by summing scores at both visits. Distribution-based tertiles of the summed score were derived. Cox proportional hazards models estimated the hazard ratios of adverse outcomes by tertiles of pre-stroke PA, adjusted for demographic and clinical characteristics. Results: During a median follow-up of 3.1 years after incident stroke, 77% participants developed adverse outcome. Compared to low pre-stroke PA, high pre-stroke PA was associated with a lower risk of all-cause mortality (HR=0.78; 95% CI: 0.63-0.97, Table). In the analysis by domain-specific PA, the risk of all-cause mortality was lowest among participants in the highest tertile of work PA (HR; 95% CI=0.77; 0.62-0.96) and leisure PA (HR=0.72; 95% CI: 0.58 to 0.89) compared to the lowest tertiles. The risk of CVD mortality was also lower in the highest tertile of work PA (HR=0.45; 95% CI: 0.29-0.70) compared to the lowest tertile. Conclusions: Higher levels of total pre-stroke PA, as well as work and leisure PA, were associated with a lower risk of mortality after incident stroke. Strategies to increase lifetime PA should be encouraged to decrease long-term mortality after stroke.

Levels of physical activity before and after stroke in relation to early cognitive function

Regular physical activity is widely recommended in the primary and secondary prevention of stroke. Physical activity may enhance cognitive performance after stroke, but cognitive impairments could also hinder a person to take part in physical activity. However, a majority of previous studies have not found any association between post-stroke cognitive impairments and a person’s subsequent level of activity. In this explorative, longitudinal study, we describe the intraindividual change in physical activity from before to 6 months after stroke, in relation to early screening of post-stroke cognitive impairments. Participants were recruited at 2 to 15 days after stroke, and screened for cognitive impairments using the Montreal Cognitive Assessment tool. Information on pre-stroke physical activity was retrospectively collected at hospital admittance by physiotherapists. Post-stroke physical activity was evaluated after 6 months. Of 49 participants included, 44 were followed up. The level of physical activity changed in more than half of all participants after stroke. Participants who were physically active 6 months after stroke presented with significantly less cognitive impairments. These results highlight that many stroke survivors experience a change in their physical activity level following stroke, and that unimpaired cognition may be important for a stroke survivors’ ability to be physically active.