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Prestroke Physical Activity Leads to Decreased Severity, All-Cause Mortality After Intracerebral Hemorrhage, Ischemic Stroke

After adjusting for stroke severity, prestroke physical activity still accounted for a 52% lowered risk for long-term morality following intracerebral hemorrhage and 48% after ischemic stroke.

Using a longitudinal, register-based cohort study of individuals with intracerebral hemorrhage and ischemic stroke, findings showed that those with increased prestroke physical activity had less severe stroke symptoms at hospital admission, regardless of other risk factors.1

Among 763 patients with intracerebral hemorrhage and 4225 with ischemic stroke, prestroke physical activity was found to be the strongest predictor of stroke severity for intracerebral hemorrhages (adjusted odds ratio [aOR], 3.57; 95% CI, 2.35-5.47; P <.001) and ischemic strokes (aOR, 1.92; 95% CI, 1.59-2.33; P <.001) in ordinal regression models. "Based on current knowledge, health care professionals should promote physical activity as part of primary stroke prevention," lead investigator Adam Viktorisson, doctoral student, University of Gothenberg, and colleagues, concluded.

The Physical Activity Pre-Stroke in GOThenberg (PAPSIGOT) was a register-based project that investigated the association between physical activity and outcomes after stroke. In this analysis, 88.5% (n = 255) of those with intracerebral hemorrhage performed light physical activity for at least 4 h/week, and 11.5% (n = 33) moderate physical activity for at least 2 h/week the year before stroke, compared with 86.8% (n = 1659) and 13.2% (n = 252) of those in the ischemic stroke group.

During a median follow-up of 4.7 years (IQR, 3.5-5.9) after the incident stroke, 39.1% (n = 2029) of the patients had died, with mortality rates higher in the intracerebral hemorrhage group (48.5%; n = 370) than ischemic stroke (37.5%; n = 1659). Of these, cardiovascular death was the cause of death in 58.9% (n = 218) of patients with intracerebral hemorrhage and 48.5% (n = 804) of those with ischemic stroke. All told, prestroke physical activity was associated with 70% lower short-term mortality after intracerebral hemorrhage (adjusted hazard ratio [aHR], 0.30; 99% CI, 0.17-0.54; P <.001) and 78% after ischemic stroke (aHR, 0.22; 99% CI, 0.13-0.37; P <.001).

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"Physical activity is considered a safe intervention and can serve as a counterpart to polypharmacy in elderly and cerebrovascular at-risk populations," Victorisson et al wrote. "The results of this study strengthen the notion that a prestroke habit of physical activity may protect the brain in cases of intracerebral hemorrhage, and provide new incentives to explore related mechanisms. Future research, with prospectively collected data on physical activity is needed to confirm the results of the current study."

Investigators also found that prestroke physical activity associated with a 60% lower risk of long-term mortality after intracerebral hemorrhage (aHR, 0.40; 99% CI, 0.21-0.77; P <.001), and 51% after ischemic stroke (aHR, 0.49; 99% CI, 0.38-0.62; P <.001). After adjusting for stroke severity using the National Institutes of Health Stroke Scales, prestroke physical activity remained associated with a 52% lower risk of long-term mortality after intracerebral hemorrhage and 48% after ischemic stroke.

Although there was no statistically significant difference in the odds of severe stroke symptoms based on amount of physical activity, those who underwent moderate prestroke physical activity were associated with a lower crude HR for poststroke mortality (HR, 0.11; 99% CI, 0.06-0.19; P <.001) compared with those who only completed light physical activity (HR, 0.33; 95% CI, 0.28-0.39; P <.001) in ischemic stroke. Similar, but not statistically significant, trends were observed for intracerebral hemorrhages.

To the investigators’ knowledge, there was only one prior study that reported separate analyses for the association between physical activity and functional outcomes from cerebral vascular events. Using men enrolled in the Physicians Health Study (n = 21,794), those who exercised vigorously at least 5 times/week had an adjusted relative risk of 0.67 (95% CI, 0.53-0.86) for transient ischemic attack compared with those who did not experience a stroke or TIA and who exercised vigorously for less than once per week. Additionally, those on a more rigorous physical activity regimen had adjusted relative risks of 0.84 (95% CI, 0.61-1.14) for stroke with modified Rankin Scale scores between 0 and 1, 0.85 (95% CI, 0.67-1.08) for mRS 2 to 3, and 1.12 (95% CI, 0.78-1.60) for mRS 5 to 6 after total stroke.2

1. Viktorisson A, Buvarp D, Reinholdsson M, Danielsson A, Palmstam A, Sunnerhagen KS. Associations of prestroke physical activity with stroke severity and mortality after intracerebral hemorrhage compared to ischemic stroke. Neurology. Published online August 19, 2022. doi:10.1212/WNL.00000000000201097
2. Rist PM, Lee I, Kase CS, Gaziano JM, Kurth T. Physical activity and functional outcomes from cerebral vascular events in men. Stroke. 2011;42(12):3352-6. doi:10.1161/STROKEAHA.111.619544.