Moderate to Vigorous Physical Activity Pivotal in Managing Cardiovascular Risk Post-Stroke

December 23, 2020
Victoria Johnson
Victoria Johnson

Victoria Johnson, Assistant Editor for NeurologyLive, joined the MJH Life Sciences team in October 2020. Follow her on Twitter @VictoriaJNeuro or email her at

Annual reviews of moderate to vigorous physical activity may help patients maintain adequate levels of activity after stroke.

Data from a recent study suggest that improving levels of moderate to vigorous physical activity (MVPA) and increasing bouts of MVPA is key for stroke management and important for managing future cardiovascular risk in those who experience stroke.

Associations were found between higher physical activity (MVPA duration, number and duration of MVPA bouts) and lower body mass index (BMI; P <.001). Faster gait speed at baseline was associated with higher MVPA (+1.51 m/s; 95% CI, 0.63–2.68; P = .001) at 24 months and higher endurance at baseline was associated with greater step count (+10; 95% CI, 5–14; P <.001) at 24 months. Additionally, higher cognition at baseline was associated with both higher MVPA and steps taken at 24 months (P ≤.003).1

Natalie Fini, PhD, Physiotherapy Department, Alfred Health, and lecturer, physiotherapy, University of Melbourne, and colleagues wrote that “increasing MVPA and bouts of MVPA may be a valuable treatment goal to reduce cardiovascular risk in survivors of stroke... Understanding these associations could be useful for developing effective treatments to prevent recurrent stroke.”

Fini and colleagues analyzed data from 79 patients enrolled in the single center, prospective longitudinal observational study (ACTRN12613000196741) with a mean age of 65 years (standard deviation [SD], 14), 54 (68.4%) of which were male. The patients had a median gait speed of 1.2 m/s (interquartile range [IQR], 0.8–1.4). Physical activity outcomes were assessed by use of the SenseWear MF Armband (SWAB).

Fini and colleagues saw several associations between metrics of physical activity and lower BMI over 24 months. MVPA duration yielded a mean −0.0003 (95% CI, –0.0004 to –0.0001; P <.001) change in BMI, number of MVPA bouts per day yielded a mean −0.0091 (95% CI, −0.0138 to −0.0043; P <.001) change in BMI, and MVPA duration in bouts of ≥10 minutes yielded a mean –0.0004 (95% CI, −0.0007 to −0.0002; P = .001).

READ MORE: Light to Moderate Physical Activity Can Lower Stroke Severity

No significant association was seen between MVPA duration and systolic blood pressure at 12 months after rehabilitation discharge in an age-adjusted model (mean change, −0.03 mm Hg; 95% CI, −0.07 to 0.02; P = .30). Similarly, no significant associations were seen between any physical activity variable and blood pressure, plasma glucose or total cholesterol over the 2 years. Step count, light physical activity, or sedentary time was not significantly associated with any cardiovascular outcome. 

“It is possible that starting with light physical activity may be required in order for survivors of stroke to build up their tolerance towards MVPA. These goals surrounding MVPA may be important steppingstones to help reduce cardiovascular risk in survivors of stroke and prevent future stroke and cardiovascular disease,” Fini and colleagues concluded.

Fini and colleagues also published a related article that investigated patients’ adherence to MVPA recommendations during the study and found that no visible change in physical activity levels were maintained over the 2 years. Step count and time spent in bouts of MVPA remained low. Many participants (72%; n = 57) achieved the recommended 30 min daily MVPA at baseline, but this decreased by the 2-year mark (65%; n = 37).2

Adherence to cardiovascular recommendations decreased over time, notably for body mass index, plasma glucose and triglyceride levels. Waist circumference increased by a mean of 3.2 cm and body mass index increased by a mean of 1.2 kgm2 at 2 years (P <.01). 

Fini and colleagues wrote that “this is the largest longitudinal study of objectively measured physical activity after stroke. Adherence to cardiovascular risk recommendations decreased over time post-stroke, and physical activity levels remained low. Stroke survivors may benefit from annual multidisciplinary reviews to identify increasing risk and initiate appropriate interventions.”

1. Fini NA, Bernhardt J, Churilov L, Clark R, Holland A. A 2-year longitudinal study of physical activity and cardiovascular risk in survivors of stroke. Phys. Ther. Published online December 11, 2020. doi: 10.1093/ptj/pzaa205
2. Fini NA, Bernhardt J, Churilov L, Clark R, Holland A. Adherence to physical activity and cardiovascular recommendations during the 2 years after stroke rehabilitation discharge. Ann. Phys. Rehabil. Med. Published online November 28, 2020. doi: 10.1016/