Prestroke Physical Activity Is Associated with Good Functional Outcome and Arterial Recanalization after Stroke due to a Large Vessel Occlusion

Abstract

Background: Although multiple studies and meta-analyses have consistently suggested that regular physical activity (PhA) is associated with a decreased stroke risk and recurrence, there is limited data on the possible preconditioning effect of prestroke PhA on stroke severity and prognosis. We aimed to study the association of prestroke PhA with different outcome variables in patients with acute ischemic stroke due to an anterior large vessel occlusion. Methods: The Prestroke Physical Activity and Functional Recovery in Patients with Ischemic Stroke and Arterial Occlusion trial is an observational and longitudinal study that included consecutive patients with acute ischemic stroke admitted to a single tertiary stroke center. Main inclusion criteria were: anterior circulation ischemic stroke within 12 h from symptom onset; presence of a confirmed anterior large vessel occlusion, and functional independence previous to stroke. Prestroke PhA was evaluated with the International Physical Activity Questionnaire and categorized into mild, moderate and high levels by means of metabolic equivalent (MET) minutes per week thresholds. The primary outcome measure was good functional outcome at 3 months (modified Rankin scale ≤2). Secondary outcomes were severity of stroke at admission, complete early recanalization, early dramatic neurological improvement and final infarct volume. Results: During the study period, 159 patients fulfilled the above criteria. The mean age was 68 years, 62% were men and the baseline NIHSS score was 17. Patients with high levels of prestroke PhA were younger, had more frequently distal occlusions and had lower levels of blood glucose and fibrinogen at admission. After multivariate analysis, a high level of prestroke PhA was associated with a good functional outcome at 3 months. Regarding secondary outcome variables and after adjustment for relevant factors, a high level of prestroke PhA was independently associated with milder stroke severity at admission, early dramatic improvement, early arterial recanalization after intravenous thrombolysis and lower final infarct volume. The beneficial association of prestroke PhA with stroke outcomes was already present with a cutoff point of 1,000 MET min/week, a level of PhA easily achieved by walking 1 h/day during 5 days or by doing a vigorous aerobic activity 1 h/day twice a week. Conclusions: Prestroke PhA is independently associated with favorable stroke outcomes after a large vessel occlusion. Future research on the underlying mechanisms is needed to understand this neuroprotective effect of PhA.

Ambulation recovery after stroke

“…In the current study, pre-stroke activity was a significant predictor of ambulation activity at both three and six months post discharge. Higher levels of pre-stroke activity are related to better functional outcomes (Stroud et al, 2009), improved fitness (Baert et al, 2012) and healthier blood sugar and protein composition (Ricciardi et al, 2014) after stroke. Further, individuals who were active prior to stroke are more likely to feel confident with returning to activity after returning home (Ahuja et al, 2013;Barnsley et al, 2012).…”

“…This could be due to the association between pre-stroke activity and improved functional status and independence following stroke (Ricciardi et al, 2014;Stroud et al, 2009;Krarup et al, 2008). Also, stroke survivors who regularly walked within their communities prior to stroke, may feel more comfortable with returning to these activities after returning home, despite not being confident with walking outdoors at hospital discharge (Barnsley et al, 2012).…”

“…Most stroke survivors report low levels of activity prior to stoke onset (Ricciardi et al, 2014;Baert et al, 2012;Krarup et al, 2007). Low activity prior to stroke may also contribute to increased severity of stroke (Ricciardi et al, 2014); reduced early re-canalisation (Ricciardi et al, 2014); reduced independence and functional recovery after stroke (Ricciardi et al, 2014;Baert et al, 2012;Stroud et al, 2009;Krarup et al, 2008;Wendel-Vos et al, 2004).…”

“…Low activity prior to stroke may also contribute to increased severity of stroke (Ricciardi et al, 2014); reduced early re-canalisation (Ricciardi et al, 2014); reduced independence and functional recovery after stroke (Ricciardi et al, 2014;Baert et al, 2012;Stroud et al, 2009;Krarup et al, 2008;Wendel-Vos et al, 2004). These outcomes after stroke could also contribute to reduced ambulation activity and community ambulation after stroke.…”

“…Thus, improvements in cardiorespiratory fitness and exercise tolerance, and resultant improvements in gait endurance are rarely achieved during inpatient rehabilitation. This is especially important after stroke, as many stroke survivors demonstrate poor activity behaviours prior to stroke onset (Ricciardi et al, 2014;Baert et al, 2012), and are likely to return to sedentary behaviours without appropriate intervention (English et al, 2014). Gait endurance is strongly related to beneficial activity behaviours (e.g.…”