Pre-stroke physical activity and admission stroke severity: A systematic review

Abstract

Background Admission stroke severity is an important clinical predictor of stroke outcomes. Pre-stroke physical activity (PA) contributes to stroke prevention and may also be associated with reduced stroke severity. Summarising the evidence to-date will inform strategies to reduce burden after stroke. Aims To summarise the published evidence for the relationship between pre-stroke physical activity (PA) and admission stroke severity and to provide recommendations for future research. Summary of Review MEDLINE, Embase, Emcare, CENTRAL and gray literature databases were searched on February 14, 2020 using search terms related to stroke and pre-stroke PA. We screened 8,152 references and assessed 172 full-text references for eligibility. The final review included seven studies (n=41,800 stroke patients). All studies were observational, assessed pre-stroke PA using self-reported questionnaires, and assessed admission stroke severity using the National Institute of Health Stroke Scale. Pre-stroke PA was associated with milder stroke severity (4/7 studies). Greater pre-stroke PA duration (1/7 studies), intensity (1/7 studies), or amount (3/7 studies) were independently associated with milder stroke severity. Studies ranged between moderate to critical risk of bias, primarily due to confounding factors. Pre-stroke PA was associated with reduced risk factors for severe stroke, distal occlusion, smaller infarcts, and treatment delays. Conclusion Pre-stroke PA may be associated with reduced admission stroke severity. Lack of randomised controlled trials limited causality conclusions. Further investigation is needed to understand the effect of pre-stroke PA on admission stroke severity.  

Mechanisms of Preconditioning Exercise-Induced Neurovascular Protection in Stroke

“…26 A recent systematic study in 2021 showed that pre-stroke physical exercise may be associated with reduction in admission stroke severity. 27 The study showed that pre-stroke exercise was associated with reduction in infarct size, reduced risk factors for stroke and distal occlusion. 27 In 2020, Damsbo et al 28 showed that pre-stroke exercise was associated with better cognitive performance at 1 and 6 months after stroke.…”

“…27 The study showed that pre-stroke exercise was associated with reduction in infarct size, reduced risk factors for stroke and distal occlusion. 27 In 2020, Damsbo et al 28 showed that pre-stroke exercise was associated with better cognitive performance at 1 and 6 months after stroke. In 2018, Reinholdsson et al 29 showed that light exercise like walking 4 hours/week or moderate exercise of 2 to 3 hours/ week, both were associated with less severe stroke and better functional outcomes as indicated by lower NIHSS scores.…”

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

“…Measuring pre-stroke physical activity is challenging with inherent limitations based on study design ( 103 , 129 ). Based on a recent systematic review we conducted, along with other studies measuring pre-stroke physical activity ( 23 , 130 – 132 ), most studies were retrospective and case-control designs and relied on self-reported physical activity questionnaires to recall pre-stroke activities ( 17 , 18 ). Questionnaires are relatively inexpensive, low resource burden, convenient to administer, and ideal for clinical settings ( 102 ).…”

“…As such, few prospective cohort studies have been conducted, including the Physician's Health Study ( 132 ) and Women's Health Initiative cohorts ( 23 ), but neither studies included objective measures of physical activity. Nevertheless, self-reported questionnaires remains a feasible, cost-effective and pragmatic method to measure pre-stroke physical activity in acute or subacute settings, as demonstrated by many investigators ( 17 , 18 ).…”

“…Increasing physical activity, among other lifestyle factors, may also be a potential strategy to optimize pre-stroke collateral circulation ( 16 ). Pre-stroke physical activity has been associated with lower admission stroke severity, reduced infarct volume, lower risk of mortality, and favorable functional outcomes after stroke ( 17 – 23 ). Yet our understanding of the association between pre-stroke physical activity and collateral circulation in acute ischemic stroke is limited.…”