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van Allen Z, Orsholits D, Boisgontier MP. Pre-stroke physical activity matters for functional limitations: A longitudinal case-control study of 12,860 participants. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.09.14.23295576. [PMID: 37745591 PMCID: PMC10516084 DOI: 10.1101/2023.09.14.23295576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Objective In the chronic phase after a stroke, limitations in activities of daily living (ADLs) and instrumental ADL (IADLs) initially plateau before steadily increasing. The benefits of pre-stroke physical activity on these limitations remain unclear. To clarify this relationship, we examined the effect of physical activity on the long-term evolution of functional limitations in a cohort of stroke survivors and compared it to a cohort of matched stroke-free adults. Methods Longitudinal data from 2,143 stroke survivors and 10,717 stroke-free adults aged 50 years and older were drawn from a prospective cohort study based on the Survey of Health, Ageing and Retirement in Europe (2004-2022; 8 data collection waves). Physical activity was assessed in the pre-stroke wave. Functional limitations were assessed in the post-stroke waves. Each stroke survivor was matched with 5 stroke-free adults who had similar propensity scores computed on the basis of key covariates, including baseline age, sex, body mass index, limitations in ADL and IADL, chronic conditions and country of residence, before any of the participants from either cohort had experienced a stroke. Results 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 effect of physical activity being stronger in stroke survivors (b = -0.345, 95% CI = -0.438 to -0.252) than in stroke-free adults (b = -0.269, 95% CI = -0.269 to -0.241). Conclusion The beneficial effect of pre-stroke physical activity on ADL limitations after stroke is stronger than its effect in matched stroke-free adults followed for a similar number of years. Impact Physical activity, an intervention within the physical therapist's scope of practice, is effective in reducing the risk of functional dependence after stroke. Moreover, pre-stroke levels of physical activity can inform the prognosis of functional dependence in stroke survivors.
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Affiliation(s)
- Zack van Allen
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Canada
- Perley Health Centre of Excellence in Frailty-Informed Care, Ottawa, Canada
| | - Dan Orsholits
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Canada
| | - Matthieu P. Boisgontier
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Canada
- Perley Health Centre of Excellence in Frailty-Informed Care, Ottawa, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Canada
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Romaus-Sanjurjo D, Castañón-Apilánez M, López-Arias E, Custodia A, Martin-Martín C, Ouro A, López-Cancio E, Sobrino T. Neuroprotection Afforded by an Enriched Mediterranean-like Diet Is Modified by Exercise in a Rat Male Model of Cerebral Ischemia. Antioxidants (Basel) 2024; 13:138. [PMID: 38397735 PMCID: PMC10885962 DOI: 10.3390/antiox13020138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/15/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024] Open
Abstract
Ischemic stroke is an important cause of mortality and disability worldwide. Given that current treatments do not allow a remarkably better outcome in patients after stroke, it is mandatory to seek new approaches to preventing stroke and/or complementing the current treatments or ameliorating the ischemic insult. Multiple preclinical and clinical studies highlighted the potential beneficial roles of exercise and a Mediterranean diet following a stroke. Here, we investigated the effects of a pre-stroke Mediterranean-like diet supplemented with hydroxytyrosol and with/without physical exercise on male rats undergoing transient middle cerebral artery occlusion (tMCAO). We also assessed a potential synergistic effect with physical exercise. Our findings indicated that the diet reduced infarct and edema volumes, modulated acute immune response by altering cytokine and chemokine levels, decreased oxidative stress, and improved acute functional recovery post-ischemic injury. Interestingly, while physical exercise alone improved certain outcomes compared to control animals, it did not enhance, and in some aspects even impaired, the positive effects of the Mediterranean-like diet in the short term. Overall, these data provide the first preclinical evidence that a preemptive enriched Mediterranean diet modulates cytokines/chemokines levels downwards which eventually has an important role during the acute phase following ischemic damage, likely mediating neuroprotection.
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Affiliation(s)
- Daniel Romaus-Sanjurjo
- NeuroAging Group (NEURAL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (D.R.-S.); (E.L.-A.); (A.C.); (T.S.)
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - María Castañón-Apilánez
- Departament of Neurology, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain;
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Department of Functional Biology, Universidad de Oviedo, 33003 Oviedo, Spain
| | - Esteban López-Arias
- NeuroAging Group (NEURAL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (D.R.-S.); (E.L.-A.); (A.C.); (T.S.)
| | - Antía Custodia
- NeuroAging Group (NEURAL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (D.R.-S.); (E.L.-A.); (A.C.); (T.S.)
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Cristina Martin-Martín
- Translational Immmunology, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
| | - Alberto Ouro
- NeuroAging Group (NEURAL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (D.R.-S.); (E.L.-A.); (A.C.); (T.S.)
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Elena López-Cancio
- Departament of Neurology, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain;
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Department of Functional Biology, Universidad de Oviedo, 33003 Oviedo, Spain
| | - Tomás Sobrino
- NeuroAging Group (NEURAL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (D.R.-S.); (E.L.-A.); (A.C.); (T.S.)
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, 28029 Madrid, Spain
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Vestergaard SB, Damsbo AG, Blauenfeldt RA, Johnsen SP, Andersen G, Mortensen JK. 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. BMJ Open 2023; 13:e070822. [PMID: 36997260 PMCID: PMC10069592 DOI: 10.1136/bmjopen-2022-070822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES To investigate the association between prestroke physical activity and depressive symptoms up to 6 months after stroke and examine if citalopram treatment modified the association. DESIGN A secondary analysis of data from the multicentre randomised controlled trial The Efficacy of Citalopram Treatment in Acute Ischemic Stroke (TALOS). SETTING AND PARTICIPANTS TALOS was conducted at multiple stroke centres in Denmark from 2013 to 2016. It enrolled 642 non-depressed patients with first-ever acute ischaemic stroke. Patients were eligible for this study if a prestroke physical activity level was assessed by the Physical Activity Scale for the Elderly (PASE). INTERVENTIONS All patients were randomised to citalopram or placebo for 6 months. OUTCOMES Depressive symptoms 1 and 6 months after stroke measured on the Major Depression Inventory (MDI) ranging from 0 to 50. RESULTS A total of 625 patients were included. Median (IQR) age was 69 (60-77) years, 410 (65.6%) were men, 309 (49.4 %) received citalopram and median (IQR) prestroke PASE score was 132.5 (76-197). Higher prestroke PASE quartile, compared with the lowest PASE quartile, was associated with fewer depressive symptoms both after 1 month (mean difference third quartile -2.3 (-4.2, -0.5), p=0.013, mean difference fourth quartile -2.4 (-4.3, -0.5), p=0.015) and 6 months after stroke (mean difference third quartile -3.3 (-5.5, -1.2), p=0.002, mean difference fourth quartile -2.8 (-5.2, -0.3), p=0.027). There was no interaction between citalopram treatment and prestroke PASE score on poststroke MDI scores (p=0.86). CONCLUSIONS A higher prestroke physical activity level was associated with fewer depressive symptoms 1 and 6 months after stroke. Citalopram treatment did not seem to modify this association. TRIAL REGISTRATION NUMBERS NCT01937182 (ClinicalTrials.gov) and 2013-002253-30 (EUDRACT).
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Affiliation(s)
- Sigrid Breinholt Vestergaard
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Andreas Gammelgaard Damsbo
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Rolf Ankerlund Blauenfeldt
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Grethe Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Janne Kaergaard Mortensen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Associations between pre-stroke physical activity and physical quality of life three months after stroke in patients with mild disability. PLoS One 2022; 17:e0266318. [PMID: 35767520 PMCID: PMC9242505 DOI: 10.1371/journal.pone.0266318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 03/18/2022] [Indexed: 11/19/2022] Open
Abstract
Background
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.
Aim
The aim of this study was to investigate the association between pre-stroke physical activity and physical quality of life after three months.
Methods
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.
Results
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.
Conclusion
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.
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A register-based study on associations between pre-stroke physical activity and cognition early after stroke (part of PAPSIGOT). Sci Rep 2022; 12:5779. [PMID: 35388045 PMCID: PMC8986803 DOI: 10.1038/s41598-022-09520-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/23/2022] [Indexed: 01/02/2023] Open
Abstract
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.
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Hung SH, Kramer S, Werden E, Campbell BCV, Brodtmann A. Pre-stroke Physical Activity and Cerebral Collateral Circulation in Ischemic Stroke: A Potential Therapeutic Relationship? Front Neurol 2022; 13:804187. [PMID: 35242097 PMCID: PMC8886237 DOI: 10.3389/fneur.2022.804187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Stanley Hughwa Hung
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Sharon Kramer
- Centre for Quality and Patient Safety Research, Alfred Health Partnership, Melbourne, VIC, Australia.,Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
| | - Emilio Werden
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia.,Melbourne Dementia Research Centre, The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Bruce C V Campbell
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia.,Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Amy Brodtmann
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia.,Melbourne Dementia Research Centre, The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
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7
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Okon M, Blum B, Nathaniel TI. Risk factors and ambulatory outcome in ischemic stroke patients with pre-stroke depression. JOURNAL OF VASCULAR NURSING 2021; 39:91-99. [PMID: 34865727 DOI: 10.1016/j.jvn.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/25/2021] [Accepted: 07/19/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE It is well known that post-stroke depression might be a negative factor for stroke recovery, however there is limited evidence to establish the link between pre-stroke depression and stroke outcome such motor recovery. The objective is to determine clinical risk factors in ischemic stroke patients with pre-stroke depression that are associated functional ambulatory outcome. METHODS Data from acute ischemic patients from a regional stroke registry were collected for consecutive recombinant tissue plasminogen activator(rtPA)-treated acute ischemic stroke patients between January 2010 and June 2016. Logistic regression model was used to predict risk factors that served as predictive variables, while the increase or reduce odds of improvement in ambulatory outcome was considered as the primary outcome. Multicollinearity and possible interactions among the independent variables were analyzed using the variance inflation factor. RESULTS A total of 1446 patients were eligible for recombinant tissue plasminogen activator (rtPA) and 596 of these patients received rtPA. Of the 596 ischemic stroke patients, 286 patients presented with recent pre-stroke depression, 310 had no pre-stroke depression. Carotid artery stenosis (OR = 11.577, 95% CI, 1.281-104.636, P = 0.029) and peripheral vascular disease (OR = 18.040, 95% CI, 2.956-110.086, P = 0.002) were more likely to be associated with increase odds of improvement in ambulation in patients with no pre-stroke depression treated with rtPA, while antihypertensive medications (OR = 0.192, 95% CI, 0.035-1.067, P = 0.050),previous TIA (OR = 0.177, 95% CI, 0.038-0.818, P = 0.027), and congestive heart failure (OR = 0. 0.160, 95% CI, 0.030-0.846, P = 0.031) were associated with reduced odds of improvement in ambulation. In addition, carotid artery stenosis (OR = 0.078, 95% CI, 0.10-0.614, P = 0.015, congestive heart failure (OR = 0.217, 95% CI, 0.318-0.402, P = 0.030), previous TIA (OR = 0.444, 95% CI, 0.517-0.971, P = 0.012), higher NIHSS scores ((OR = 0.887, 95% CI, 0.830-0.948, P < 0.001), and antihypertensive medications (OR = 0.810, 95% CI, 0.401-0.529, P = 0.019) were associated with the reduced odd of improvement in ambulation in an ischemic stroke population with pre-stroke depression treated with rtPA. CONCLUSION Our findings indicate that more risk factors were associated with the decreased odds of an improvement in ambulation following thrombolytic therapy in an ischemic stroke population with pre-stroke depression when compared with those without pre-stroke depression. This finding maybe helpful in the development of management strategies to increase the use of thrombolytic therapy for pre-stroke depressed ischemic stroke to increased their eligibility for rtPA.
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Affiliation(s)
- Marvin Okon
- Department of Public Health, Clemson University, Clemson, SC 29631
| | - Brice Blum
- University of South Carolina School of Medicine, School of Medicine-Greenville, Greenville, SC 29605, USA
| | - Thomas I Nathaniel
- University of South Carolina School of Medicine, School of Medicine-Greenville, Greenville, SC 29605, USA.
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Viktorisson A, Buvarp D, Sunnerhagen KS. Prestroke physical activity and outcomes after intracerebral haemorrhage in comparison to ischaemic stroke: protocol for a matched cohort study (part of PAPSIGOT). BMJ Open 2021; 11:e053067. [PMID: 34799363 PMCID: PMC8606775 DOI: 10.1136/bmjopen-2021-053067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Piling evidence suggests that a higher level of prestroke physical activity can decrease stroke severity, and reduce the risk of poststroke mortality. However, prior studies have only included ischaemic stroke cases, or a majority of such. We aim to investigate how premorbid physical activity influences admission stroke severity and poststroke mortality in patients with intracerebral haemorrhage, compared with ischaemic stroke. A prespecified analysis plan counteract some inherent biases in observational studies, and promotes transparency. METHODS AND ANALYSIS This is a statistical analysis protocol for a matched cohort study, including all adult patients with intracerebral haemorrhage, and matched ischaemic stroke controls, treated at Sahlgrenska University Hospital in Sweden between 1 November 2014 and 30 June 2019. All patients have been identified in the Väststroke register, and the data file has been sent for merging with national registries. The follow-up of time for survival will be approximately 2-7 years. The sample size calculation indicates that a minimum of 628 patients with intracerebral haemorrhage is needed for power of 80% at an alpha level of 0.01. Multiple imputation by chained equations will be used to handle missing data. The entire cohort of patients with intracerebral haemorrhage will be matched with consecutive ischaemic stroke controls (1:3 ratio) using nearest neighbour propensity score matching. The association between prestroke physical activity and admission stroke severity will be evaluated using multivariable ordinal regression models, and risk for all-cause mortality will be analysed using multivariable Cox proportional-hazards models. Potential confounders include age, ethnicity, income, educational level, comorbidity, medical treatments, alcohol-related disorders, drug abuse and smoking. ETHICS Data collection for the Physical Activity Pre-Stroke In GOThenburg project was approved by the Regional Ethical Board on 4 May 2016. An additional application was approved by the National Ethical Review Authority on 7 July 2021.
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Affiliation(s)
- Adam Viktorisson
- Inst of Neuroscience and Physiology, Univ of Gothenburg, Gothenburg, Sweden
| | - Dongni Buvarp
- Inst of Neuroscience and Physiology, Univ of Gothenburg, Gothenburg, Sweden
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Hafez S, Eid Z, Alabasi S, Darwiche Y, Channaoui S, Hess DC. Mechanisms of Preconditioning Exercise-Induced Neurovascular Protection in Stroke. J Stroke 2021; 23:312-326. [PMID: 34649377 PMCID: PMC8521252 DOI: 10.5853/jos.2020.03006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/13/2021] [Indexed: 12/27/2022] Open
Abstract
Ischemic stroke is a leading cause of death and disability. Tissue plasminogen activator is the only U.S. Food and Drug Administration approved thrombolytic therapy for ischemic stroke patients till date. However, its use is limited due to increased risk of bleeding and narrow therapeutic window. Most of the preclinically tested pharmacological agents failed to be translated to the clinic. This drives the need for alternative therapeutic approaches that not only provide enhanced neuroprotection, but also reduce the risk of stroke. Physical exercise is a sort of preconditioning that provides the body with brief ischemic episodes that can protect the body from subsequent severe ischemic attacks like stroke. Physical exercise is known to improve cardiovascular health. However, its role in providing neuroprotection in stroke is not clear. Clinical observational studies showed a correlation between regular physical exercise and reduced risk and severity of ischemic stroke and better outcomes after stroke. However, the underlying mechanisms through which prestroke exercise can reduce the stroke injury and improve the outcomes are not completely understood. The purpose of this review is to: demonstrate the impact of exercise on stroke outcomes and show the potential role of exercise in stroke prevention and recovery; uncover the underlying mechanisms through which exercise reduces the neurovascular injury and improves stroke outcomes aiming to develop novel therapeutic approaches.
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Affiliation(s)
- Sherif Hafez
- Department of Pharmaceutical Sciences, College of Pharmacy Mercer University, Atlanta, GA, USA.,Neurology Department, Augusta University, Augusta, GA, USA
| | - Zeina Eid
- College of Pharmacy Larkin University, Miami, FL, USA
| | - Sara Alabasi
- College of Pharmacy Larkin University, Miami, FL, USA
| | | | | | - David C Hess
- Neurology Department, Augusta University, Augusta, GA, USA
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Lin Y, Zhang B, Hu M, Xu M, Qin C, Zhu C. [Causal relationship between physical exercise and risk of ischemic stroke recurrence based on the potential outcome theory]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:1191-1197. [PMID: 34549710 DOI: 10.12122/j.issn.1673-4254.2021.08.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To explore the causal relationship between physical exercise and ischemic stroke recurrence using a multiple imputation approach based on the potential outcomes framework. METHODS We collected data from 636 patients who were diagnosed with first-ever ischemic stroke between July, 2010 and December, 2018 at West China Hospital, Sichuan University.All the patients had motor ability and were followed up at least for 1 year.According to the intensity of physical exercise, the patients were divided into low-level physical exercise (LPE) group (n=244) and moderate-to high-intensity exercise (MHPE) group (n=392).With both the result and the time of recurrence as the potential outcomes, a multiple imputation method was used to impute the missing values based on a predictive matrix.Based on the imputed datasets, a causal inference model was built to estimate the average causal effect of physical exercise on the risk of stroke recurrence. RESULTS Among the enrolled patients, 148 experienced recurrent stroke with a median recurrence time of 24.0 months and a cumulative recurrence rate of 23.3%during follow-up.As there were no outliers and the marginal distributions of the potential outcomes were basically consistent, both the Strip plots and Kenel density plots indicated that the imputed values could have been plausible measurements if they had not been missing.The average causal effect (ACE) of physical exercise on stroke recurrence was 0.578 (95%CI: 0.186-0.970, P=0.012). CONCLUSION There is a causal relationship between physical exercise and the risk of ischemic stroke recurrence, indicating the value of moderate or high-level exercise after stroke in reducing the risk of stroke recurrence.
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Affiliation(s)
- Y Lin
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - B Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - M Hu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - M Xu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - C Qin
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - C Zhu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
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Otsuka S, Sakakima H, Tani A, Nakanishi K, Takada S, Norimatsu K, Maejima H, Maruyama I. Effects of detraining on preconditioning exercise-induced neuroprotective potential after ischemic stroke in rats. Brain Struct Funct 2021; 226:2169-2180. [PMID: 34114048 DOI: 10.1007/s00429-021-02317-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/07/2021] [Indexed: 11/24/2022]
Abstract
Preconditioning exercise prior to stroke exerts neuroprotection, which is an endogenous strategy that leads the brain cells to express several intrinsic factors and inhibits their apoptosis. However, it is unclear how long these benefits last after exercise cessation. The aim of this study was to investigate the effects of detraining on preconditioning exercise-induced neuroprotective potential after stroke. Rats were trained using a treadmill for aerobic exercise 5 days each week for 3 weeks, and their neuroprotective effects were examined until 3 weeks after exercise cessation. Stroke was induced by 60 min of left middle cerebral artery occlusion at 3 days, 1, 2, and 3 weeks after exercise cessation. Infarct volume, neurological deficits, sensorimotor function, expression levels of brain-derived neurotrophic factor (BDNF), hypoxia-induced factor-1α (HIF-1α), glial fibrillary acidic protein (GFAP), and P2X7 receptors, and apoptosis activity were examined using immunohistochemical and western blot analyses. Preconditioning exercise significantly reduced infarct volume and ameliorated sensorimotor function after stroke, and its beneficial effects were observed until 2 weeks after exercise cessation. The expression level of BDNF in the ischemic brain was significantly upregulated at 3 days after exercise cessation; however, the expression levels of HIF-1α, GFAP, and P2X7 receptor were significantly increased until 2 weeks after exercise cessation; thereby, significant anti-apoptotic effects were lost at 3 weeks of detraining. Our findings suggest that preconditioning exercise-induced neuroprotective potential may be lost shortly after exercise cessation. Neuroprotection through intrinsic protective factors, such as BDNF and HIF-1α, may provide different neuroprotective mechanisms in a time-dependent manner during detraining.
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Affiliation(s)
- Shotaro Otsuka
- Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Science, Kagoshima, Japan
| | - Harutoshi Sakakima
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan.
| | - Akira Tani
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Kazuki Nakanishi
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Seiya Takada
- Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Science, Kagoshima, Japan
| | - Kosuke Norimatsu
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Hiroshi Maejima
- Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Ikuro Maruyama
- Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Science, Kagoshima, Japan
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Mediano MFF, Mok Y, Coresh J, Kucharska-Newton A, Palta P, Lakshminarayan K, Rosamond WD, Matsushita K, Koton S. Prestroke Physical Activity and Adverse Health Outcomes After Stroke in the Atherosclerosis Risk in Communities Study. Stroke 2021; 52:2086-2095. [PMID: 33784831 PMCID: PMC8154698 DOI: 10.1161/strokeaha.120.032695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/26/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE The association of physical activity (PA) before stroke (prestroke PA) with long-term prognosis after stroke is still unclear. We examined the association of prestroke PA with adverse health outcomes in the ARIC study (Atherosclerosis Risk in Communities). METHODS We included 881 participants with incident stroke occurring between 1993 and 1995 (visit 3) and December 31, 2016. Follow-up continued until December 31, 2017 to allow for at least 1-year after incident stroke. Prestroke PA was assessed using a modified version of the Baecke questionnaire in 1987 to 1989 (visit 1) and 1993 to 1995 (visit 3), evaluating PA domains (work, leisure, and sports) and total PA. We used Cox proportional hazards models to quantify the association between tertiles of accumulated prestroke PA levels over the 6-year period between visits 1 and 3 and mortality, risk of cardiovascular disease, and recurrent stroke after incident stroke. RESULTS During a median follow-up of 3.1 years after incident stroke, 676 (77%) participants had adverse outcomes. Highest prestroke total PA was associated with decreased risks of all-cause mortality (hazard ratio, 0.78 [95% CI, 0.63-0.97]) compared with lowest tertile. In the analysis by domain-specific PA, highest levels of work PA were associated with lower risk for all-cause (hazard ratio, 0.77 [95% CI, 0.62-0.96]) and cardiovascular mortality (hazard ratio, 0.45 [95% CI, 0.29-0.70]), and highest levels of leisure PA were associated with lower all-cause mortality (hazard ratio, 0.72 [95% CI, 0.58-0.89]) compared with lowest tertile of PA. No significant associations for sports PA were observed. CONCLUSIONS Higher levels of total prestroke PA as well as work and leisure PA were associated with lower risk of mortality after incident stroke. Public health strategies to increase lifetime PA should be encouraged to decrease long-term mortality after stroke.
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Affiliation(s)
- Mauro F. F. Mediano
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Department of Research and Education, National Institute of Cardiology, Rio de Janeiro, Brazil
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Yejin Mok
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Anna Kucharska-Newton
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Priya Palta
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Kamakshi Lakshminarayan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Wayne D. Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Silvia Koton
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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13
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Hung SH, Ebaid D, Kramer S, Werden E, Baxter H, Campbell BC, Brodtmann A. Pre-stroke physical activity and admission stroke severity: A systematic review. Int J Stroke 2021; 16:1009-1018. [PMID: 33527883 DOI: 10.1177/1747493021995271] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Admission stroke severity is an important clinical predictor of stroke outcomes. Pre-stroke physical activity contributes to stroke prevention and may also be associated with reduced stroke severity. Summarizing the evidence to date will inform strategies to reduce burden after stroke. AIMS To summarize the published evidence for the relationship between pre-stroke physical activity 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 14 February 2020 using search terms related to stroke and pre-stroke physical activity in adult stroke survivors. We screened 8,152 references and assessed 172 full-text references for eligibility. We included seven studies (n = 41,800 stroke survivors). All studies were observational, assessed pre-stroke physical activity using self-reported questionnaires, and assessed admission stroke severity using the National Institute of Health Stroke Scale. Analyses were categorized as the presence of pre-stroke physical activity (four studies) or dose-response (five studies). In three studies, presence of pre-stroke physical activity was associated with milder stroke severity, and no association in one study. Greater pre-stroke physical activity duration and intensity (two studies) or amount (three studies) were associated with milder stroke severity. Studies ranged between moderate to critical risk of bias, primarily due to confounding factors. Pre-stroke physical activity may be associated with reduced risk factors for severe stroke, distal occlusion, smaller infarcts, and shorter time-to-treatment delivery. CONCLUSION Pre-stroke physical activity may be associated with reduced admission stroke severity. Lack of randomized controlled trials limited causality conclusions. Future research recommendations were provided.
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Affiliation(s)
- Stanley H Hung
- 56369The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Deena Ebaid
- 56369The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Sharon Kramer
- 56369The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.,NHMRC Centre of Excellence in Stroke Rehabilitation and Recovery, Melbourne, Australia.,School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Australia
| | - Emilio Werden
- 56369The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.,Melbourne Dementia Research Centre, Melbourne, Australia
| | - Helen Baxter
- 3805Austin Health Sciences Library, Heidelberg, Australia
| | - Bruce Cv Campbell
- 56369The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.,Department of Medicine and Neurology, Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Amy Brodtmann
- 56369The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.,Melbourne Dementia Research Centre, Melbourne, Australia
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14
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Damsbo AG, Mortensen JK, Kraglund KL, Johnsen SP, Andersen G, Blauenfeldt RA. Prestroke Physical Activity and Poststroke Cognitive Performance. Cerebrovasc Dis 2020; 49:632-638. [PMID: 33176308 DOI: 10.1159/000511490] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/08/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Physical activity (PA) is associated with a lower risk of stroke and stroke mortality as well as a favorable stroke outcome. PA may also prevent general cognitive decline. Poststroke cognitive impairment is both common and disabling, and focusing on all possible preventive measures is important. Studies on the effect of PA on poststroke cognitive performance are sparse, however. We therefore aimed to examine the association between prestroke PA and poststroke cognitive performance. METHODS We studied the correlation between prestroke PA and poststroke cognitive performance in a prespecified analysis in The Efficacy of Citalopram Treatment in Acute Ischemic Stroke (TALOS) trial. We used the Physical Activity Scale for the Elderly (PASE) to collect information on PA during the 7-day period before stroke. PA was quantified, and patients were stratified into quartiles based on their PASE score. Cognitive performance was measured using the Symbol Digit Modalities Test (SDMT) at 1 and 6 months and the Mini-Mental State Examination (MMSE) at 6 months. The functional outcome was assessed using the modified Rankin Scale (mRS). RESULTS In total, 625 of 642 patients (97%) completed the PASE questionnaire. The median age was 69 (interquartile range [IQR]: 60-77), and the median PASE score was 137 (82-205). Higher prestroke PASE quartiles (2nd, 3rd, and 4th, each compared to the 1st) were independently associated with a higher SDMT score at 1 month in the both the univariable and multivariable analyses (2nd: 3.99 points, 95% confidence interval [CI]: 1.01-6.97; 3rd: 3.6, CI: 0.6-6.61; 4th: 4.1, CI: 0.95-7.24). This association remained at 6 months. PA was not statistically associated with the MMSE score or mRS. CONCLUSION Higher prestroke PA was associated with a better cognitive performance as measured by the SDMT at 1 and 6 months poststroke. We found no significant association between prestroke PA and functional outcome. Our results are encouraging and support further investigations of PA as a protective measure against poststroke cognitive impairment.
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Affiliation(s)
| | | | | | - Søren Paaske Johnsen
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University, Aalborg, Denmark
| | - Grethe Andersen
- Department of Neurology, Danish Stroke Centre, Aarhus University Hospital, Skejby, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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15
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Lavados PM, Mazzon E, Rojo A, Brunser AM, Olavarría VV. Pre-stroke adherence to a Mediterranean diet pattern is associated with lower acute ischemic stroke severity: a cross-sectional analysis of a prospective hospital-register study. BMC Neurol 2020; 20:252. [PMID: 32576150 PMCID: PMC7310482 DOI: 10.1186/s12883-020-01824-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/05/2020] [Indexed: 12/13/2022] Open
Abstract
Background High adherence to a Mediterranean Diet is associated with reduced incidence and mortality of acute ischemic stroke (AIS) but may also be associated with severity. Our purpose was to investigate the association of adherence to a Mediterranean diet and severity in a prospective hospital register of AIS patients. Methods We included AIS patients admitted from February 2017 to July 2019. All were assessed by a neurologist with a standard stroke protocol, including NIHSS. Adherence to Mediterranean diet was prospectively measured by the 14-point Mediterranean Diet Adherence Screener (MEDAS) and defined as low (0–6 points) or high (7–14 points). Demographic and clinical characteristics were compared by group with univariate analysis. A Generalized Linear Model (GLM) was used to investigate the association of admission NIHSS as a continuous ordinal variable and an ordinal logistic regression (OLR) analysis to determine the independent association of the NIHSS quartiles with adherence to Mediterranean diet. Results Three hundred sixty-eight patients were included, mean age 68.3 (17.7), 158 (42.9%) females. The median NIHSS score was 3 (IQR 1–9) and the median MEDAS score was 6 (IQR 4.5–8). Patients with high MEDAS scores had significantly lower; admission NIHSS scores, sedentary lifestyle, body mass index, total and LDL cholesterol levels, but higher alcohol consumption. After adjustments, high adherence to Mediterranean diet remained independently associated with lower stroke severity both in the GLM (β coefficient = − 0.19, p = 0.01) and in the OLR model (OR for lower NIHSS quartiles 0.6 (95% CI 0.37–0.98, p = 0.04). Conclusions Higher pre-stroke adherence to a Mediterranean diet is independently associated with lower AIS severity.
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Affiliation(s)
- Pablo M Lavados
- Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Unidad de Neurología Vascular, Servicio de Neurología, Santiago, Chile
| | - Enrico Mazzon
- Departamento de Neurología y Psiquiatría y Departamento de Paciente Critico, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Unidad de Neurología Vascular, Servicio de Neurología, Avenida Vitacura 5951, Vitacura, 7650568, Santiago, Chile
| | - Alexis Rojo
- Servicio de Neurología, Hospital Clínico Herminda Martin de Chillán, Servicio de Salud Ñuble, Chillán, Chile
| | - Alejandro M Brunser
- Departamento de Neurología y Psiquiatría y Departamento de Urgencia, Clínica Alemana de Santiago, Facultad de Medicina, Universidad del Desarrollo, Clínica Alemana, Unidad de Neurología Vascular, Servicio de Neurología, Santiago, Chile
| | - Verónica V Olavarría
- Departamento de Neurología y Psiquiatría y Departamento de Paciente Critico, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Unidad de Neurología Vascular, Servicio de Neurología, Avenida Vitacura 5951, Vitacura, 7650568, Santiago, Chile.
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16
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Abstract
Stroke is a leading cause of mortality and morbidity all around the world. Identification of stroke risk factors and protective lifestyles is necessary for optimizing personalized treatment and reducing mortality. Sedentary lifestyle is a well-known modifiable risk factor in primary and secondary stroke prevention. Also, in recent years, exercise has been described as a neuroprotective and neuroreparative factor. Here we summarized the existing available evidence of the relationship between physical activity and stroke.
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17
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Sakakima H. Endogenous neuroprotective potential due to preconditioning exercise in stroke. Phys Ther Res 2019; 22:45-52. [PMID: 32015940 DOI: 10.1298/ptr.r0006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/12/2019] [Indexed: 01/14/2023]
Abstract
Stroke is a leading cause of serious long-term physical disability due to insufficient neurorepair mechanisms. In general, physical activity is an important modifiable risk factor, particularly for stroke and cardiovascular diseases. Physical exercise has shown to be neuroprotective in both animal experiments and clinical settings. Exercise can be considered a mild stressor and follows the prototypical preconditioning stimulus. It has beneficial effects on brain health and cognitive function. Preconditioning exercise, which is prophylactic exercise prior to ischemia, can protect the brain from subsequent serious injury through promotion of angiogenesis, mediation of inflammatory responses, inhibition of glutamate over-activation, protection of the blood-brain barrier, and inhibition of apoptosis. Preconditioning exercise appears to induce brain ischemic tolerance and it has been shown to exert beneficial effects. It is clinically safe and feasible and represents an exciting new paradigm in endogenous neuroprotection for patients with acute stroke. In this review, we describe the neuroprotective potential of preconditioning exercise and clinical applications in patients with acute ischemic stroke.
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Affiliation(s)
- Harutoshi Sakakima
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University
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18
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The Impact of Physical Activity Before and After Stroke on Stroke Risk and Recovery: a Narrative Review. Curr Neurol Neurosci Rep 2019; 19:28. [PMID: 31011851 DOI: 10.1007/s11910-019-0949-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF THE REVIEW Summarising the evidence for pre- and post-stroke physical activity (PA) and exercise to reduce stroke risk, and improve recovery and brain health. RECENT FINDINGS Pre-stroke PA reduces the risk of stroke, and post-stroke PA and exercise reduce cardiovascular risk factors, which can moderate the risk of recurrent strokes. Pre-clinical evidence indicates that exercise enhances neuroplasticity. The results from clinical studies showed that exercise changes brain activity patterns in stroke survivors, which can be a signal neuroplasticity. The intensity of pre- and post-stroke PA and exercise is a key factor with higher intensities leading to greater benefits, including improvement in fitness. Having low fitness levels is an independent predictor for increased risk of stroke. Higher intensity leads to greater benefits; however, the optimum intensity of PA and exercise is yet unknown and needs to be further investigated. Strategies to decrease sedentary behaviour and improve fitness need to be considered.
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19
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Reinholdsson M, Palstam A, Sunnerhagen KS. Prestroke physical activity could influence acute stroke severity (part of PAPSIGOT). Neurology 2018; 91:e1461-e1467. [PMID: 30232251 PMCID: PMC6202943 DOI: 10.1212/wnl.0000000000006354] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 07/05/2018] [Indexed: 12/15/2022] Open
Abstract
Objective To investigate the influence of prestroke physical activity (PA) on acute stroke severity. Methods Data from patients with first stroke were retrieved from registries with a cross-sectional design. The variables were PA, age, sex, smoking, diabetes, hypertension and statin treatment, stroke severity, myocardial infarction, new stroke during hospital stay, and duration of inpatient care at stroke unit. PA was assessed with Saltin-Grimby's 4-level Physical Activity Level Scale, and stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). Logistic regression was used to predict stroke severity, and negative binomial regression was used to compare the level of PA and stroke severity. Results The study included 925 patients with a mean age of 73.1 years, and 45.2% were women. Patients who reported light or moderate PA levels were more likely to present a mild stroke (NIHSS score 0 to 5) compared with physically inactive patients in a model that also included younger age as a predictor (odds ratio = 2.02 for PA and odds ratio = 0.97 for age). The explanatory value was limited at 6.8%. Prestroke PA was associated with less severe stroke, and both light PA such as walking at least 4 h/wk and moderate PA 2–3 h/wk appear to be beneficial. Physical inactivity was associated with increased stroke severity. Conclusions This study suggests that PA and younger age could result in a less severe stroke. Both light PA such as walking at least 4 h/wk and moderate PA 2–3 h/wk appear to be beneficial.
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Affiliation(s)
- Malin Reinholdsson
- From the Department of Clinical Neuroscience (M.R., A.P., K.S.S.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg; Department of Occupational Therapy and Physiotherapy (M.R.), Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Annie Palstam
- From the Department of Clinical Neuroscience (M.R., A.P., K.S.S.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg; Department of Occupational Therapy and Physiotherapy (M.R.), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- From the Department of Clinical Neuroscience (M.R., A.P., K.S.S.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg; Department of Occupational Therapy and Physiotherapy (M.R.), Sahlgrenska University Hospital, Gothenburg, Sweden
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Aggio D, Papachristou E, Papacosta O, Lennon LT, Ash S, Whincup PH, Wannamethee SG, Jefferis BJ. Trajectories of self-reported physical activity and predictors during the transition to old age: a 20-year cohort study of British men. Int J Behav Nutr Phys Act 2018; 15:14. [PMID: 29415729 PMCID: PMC5803992 DOI: 10.1186/s12966-017-0642-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 12/21/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Maintenance of physical activity (PA) during later life is associated with optimal health; however, the long-term trajectories of PA into old age and their predictors have not been extensively researched using latent class methods. This study aimed to identify trajectories of self-reported PA and their predictors in men transitioning from midlife to old age. METHODS 7735 men (aged 40-59 years) recruited in 1978-80 were followed up after 12, 16 and 20 years, reporting PA, health status, lifestyle behaviours and socio-demographic characteristics. Group-based trajectory modelling identified the trajectories of PA and associations with time-stable and time-varying covariates. We considered a range of sociodemographic and health and lifestyle factors as potential covariates. RESULTS 4952 men (mean baseline age 49.1 ± 5.6 years) providing PA data at ≥3 time points were included in analyses. Three distinct 20-year trajectories were identified: low decreasing (24.6%, n = 1218), light stable (51.1%, n = 2530) and moderate increasing (24.3%, n = 1204). Being older, having a manual occupation, having never married or had children, residing in the midlands or North of England, suffering from a range of health conditions, being a smoker/ex-smoker and never consuming breakfast cereal or alcohol were independently associated with reduced odds of belonging to the moderate increasing trajectory group compared to the low decreasing group. Of the time-varying covariates considered, leaving employment was associated with a decrease in PA in the low decreasing group (β -0.306, p < 0.001) but an increase in the light stable (β 0.324, p < 0.001) and moderate increasing groups (β 0.847, p < 0.001). Developing cardiovascular-related conditions was associated with a decrease in PA in the low decreasing (β -0.408, p < 0.001) and light stable groups (β -0.118, p < 0.001) but no association was observed in the moderate increasing group (β -0.060, p = 0.313). CONCLUSIONS Three distinct trajectories of PA were identified in men transitioning from midlife to old age, of which nearly a quarter had persistently low levels of PA. Promotion efforts may need to focus attention prior to middle age and consider a number of sociodemographic, health and lifestyle factors to sustain PA into old age. The effects of retirement and development of cardiovascular disease may vary according to PA trajectories.
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Affiliation(s)
- Daniel Aggio
- UCL Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, UCL Medical School, Rowland Hill Street, London, NW3 2PF UK
- UCL Physical Activity Research Group, London, UK
| | - Efstathios Papachristou
- UCL Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, UCL Medical School, Rowland Hill Street, London, NW3 2PF UK
- Department of Psychology & Human Development, UCL Institute of Education, London, WC1H 0 AA UK
| | - Olia Papacosta
- UCL Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, UCL Medical School, Rowland Hill Street, London, NW3 2PF UK
| | - Lucy T. Lennon
- UCL Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, UCL Medical School, Rowland Hill Street, London, NW3 2PF UK
| | - Sarah Ash
- UCL Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, UCL Medical School, Rowland Hill Street, London, NW3 2PF UK
| | - Peter H. Whincup
- Population Health Research Institute, St George’s University of London, Cranmer Terrace, London, SW17 0RE UK
| | - S. Goya Wannamethee
- UCL Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, UCL Medical School, Rowland Hill Street, London, NW3 2PF UK
- UCL Physical Activity Research Group, London, UK
| | - Barbara J. Jefferis
- UCL Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, UCL Medical School, Rowland Hill Street, London, NW3 2PF UK
- UCL Physical Activity Research Group, London, UK
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Wen CP, Liu CH, Jeng JS, Hsu SP, Chen CH, Lien LM, Chen AC, Lee JT, Chen PK, Hsu CS, Chern CM, Chen CC, Hsu MC, Lu K, Chen HJ, Wang HK, Muo CH, Hsu CY. Pre-stroke physical activity is associated with fewer post-stroke complications, lower mortality and a better long-term outcome. Eur J Neurol 2017; 24:1525-1531. [PMID: 28926165 DOI: 10.1111/ene.13463] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 09/11/2017] [Indexed: 11/29/2022]
Affiliation(s)
- C.-P. Wen
- Institute of Population Health Sciences; National Health Research Institutes; Zhunan Taiwan
- Graduate Institute of Biomedical Sciences; College of Medicine; China Medical University; Taichung Taiwan
- Department of Medical Research; China Medical University Hospital; Taichung Taiwan
| | - C.-H. Liu
- Department of Neurology; China Medical University Hospital; Taichung Taiwan
| | - J.-S. Jeng
- Department of Neurology; National Taiwan University Hospital; Taipei Taiwan
| | - S.-P. Hsu
- Department of Neurology; E-Da Hospital / I-Shou University; Kaohsiung Taiwan
| | - C.-H. Chen
- Department of Neurology; College of Medicine; National Cheng Kung University; Tainan Taiwan
| | - L.-M. Lien
- Department of Neurology; Shin Kong Wu Ho-Su Memorial Hospital; Taipei Medical University College of Medicine; Taipei Taiwan
| | - A.-C. Chen
- Department Neurology; Chung Shan Medical University Hospital; Taichung Taiwan
| | - J.-T. Lee
- Department of Neurology; Tri-Service General Hospital; National Defense Medical Center; Taipei Taiwan
| | - P.-K. Chen
- Department of Neurology; Lin Shin Hospital; Taichung Taiwan
| | - C.-S. Hsu
- China Medical University Beigang Hospital; Yunlin Taiwan
| | - C.-M. Chern
- Taipei Veterans General Hospital; School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - C.-C. Chen
- St. Martin De Porres Hospital; Chiayi Taiwan
| | - M.-C. Hsu
- Buddhist Dalin Tzu Chi General Hospital; Chiayi Taiwan
| | - K. Lu
- Department of Neurosurgery; E-Da Hospital/ I-Shou University; Kaohsiung Taiwan
| | - H.-J. Chen
- Department of Neurosurgery; E-Da Hospital/ I-Shou University; Kaohsiung Taiwan
| | - H.-K. Wang
- Department of Neurosurgery; E-Da Hospital/ I-Shou University; Kaohsiung Taiwan
| | - C.-H. Muo
- Department of Medical Research; China Medical University Hospital; Taichung Taiwan
| | - C.-Y. Hsu
- Department of Neurology; China Medical University Hospital; Taichung Taiwan
- Graduate Institute of Clinical Medical Science; China Medical University; Taichung Taiwan
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22
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Blauenfeldt RA, Hougaard KD, Mouridsen K, Andersen G. High Prestroke Physical Activity Is Associated with Reduced Infarct Growth in Acute Ischemic Stroke Patients Treated with Intravenous tPA and Randomized to Remote Ischemic Perconditioning. Cerebrovasc Dis 2017; 44:88-95. [PMID: 28554177 DOI: 10.1159/000477359] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 05/06/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND A high prestroke physical activity (PA) level is associated with reduced stroke rate, stroke mortality, better functional outcome, and possible neuroprotective abilities. The aim of the present study was to examine the possible neuroprotective effect of prestroke PA on 24-h cerebral infarct growth in a cohort of acute ischemic stroke patients treated with intravenous tPA and randomized to remote ischemic perconditioning. METHODS In this predefined subanalysis, data from a randomized clinical trial investigating the effect of remote ischemic perconditioning (RIPerC) on AIS was used. Prestroke (7 days before admission) PA was quantified using the PA Scale for the Elderly (PASE) questionnaire at baseline. Infarct growth was evaluated using MRI (acute, 24-h, and 1-month). RESULTS PASE scores were obtained from 102 of 153 (67%) patients with a median (interquartile range) age of 66 (58-73) years. A high prestroke PA level correlated significantly with reduced acute infarct growth (24 h) in the linear regression model (4th quartile prestroke PA level compared with the 1st quartile), β4th quartile = -0.82 (95% CI -1.54 to -0.10). However, the effect of prestroke PA was present mainly in patients randomized to RIPerC, β4th quartile = -1.14 (95% CI -2.04 to -0.25). In patients randomized to RIPerC, prestroke PA was a predictor of final infarct size (1-month infarct volume), β4th quartile = -1.78 (95% CI -3.15 to -0.41). CONCLUSION In AIS patients treated with RIPerC, as add-on to intravenous thrombolysis, the level of PA the week before the stroke was associated with decreased 24-h infarct growth and final infarct size. These results are highly encouraging and stress the need for further exploration of the potentially protective effects of both PA and remote ischemic conditioning.
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Affiliation(s)
- Rolf A Blauenfeldt
- Department of Neurology, Aarhus University Hospital and Center for Functionally Integrative Neuroscience, Aarhus University Hospital, Aarhus, DenmarK
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23
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Rist PM, Capistrant BD, Mayeda ER, Liu SY, Glymour MM. Physical activity, but not body mass index, predicts less disability before and after stroke. Neurology 2017; 88:1718-1726. [PMID: 28381510 PMCID: PMC5409841 DOI: 10.1212/wnl.0000000000003888] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 02/13/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether physical activity and body mass index (BMI) predict instrumental or basic activities of daily living (I/ADL) trajectories before or after stroke compared to individuals who remained stroke-free. METHODS Using a prospective cohort, the Health and Retirement Study, we followed adults without a history of stroke in 1998 (n = 18,117) for up to 14 years. We estimated linear regression models of I/ADL trajectories comparing individuals who remained stroke-free throughout follow-up (n = 16,264), those who survived stroke (n = 1,374), and those who died after stroke and before the next interview wave (n = 479). We evaluated whether I/ADL trajectories differed by physical activity or BMI at baseline (before stroke), adjusting for demographic and socioeconomic covariates. RESULTS Compared to those who were physically active, stroke survivors who were physically inactive at baseline had a lower probability of independence in ADLs and IADLs 3 years after stroke (risk difference = -0.18 and -0.16 for ADLs and IADLs, respectively). However, a similar difference in the probability of independence was also present 3 years before stroke, and we observed no evidence that physical activity slowed the rate of decline in independence before or after stroke. Unlike the results for physical activity, we did not observe a consistent pattern for the probability of independence in ADLs or IADLs comparing obese stroke survivors to normal-weight or to overweight stroke survivors 3 years before stroke or 3 years after stroke. CONCLUSIONS Physical inactivity predicts a higher risk of being dependent both before and after stroke.
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Affiliation(s)
- Pamela M Rist
- From the Division of Preventive Medicine (P.M.R), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology (P.M.R.) and Social and Behavioral Sciences (M.M.G.), Harvard T. H. Chan School of Public Health, Boston; Harvard Center for Population and Development Studies (S.Y.L.), Harvard University, Cambridge, MA; Division of Epidemiology and Community Health (B.D.C), University of Minnesota, Minneapolis; and Department of Epidemiology and Biostatistics (E.R.M., M.M.G), University of California, San Francisco.
| | - Benjamin D Capistrant
- From the Division of Preventive Medicine (P.M.R), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology (P.M.R.) and Social and Behavioral Sciences (M.M.G.), Harvard T. H. Chan School of Public Health, Boston; Harvard Center for Population and Development Studies (S.Y.L.), Harvard University, Cambridge, MA; Division of Epidemiology and Community Health (B.D.C), University of Minnesota, Minneapolis; and Department of Epidemiology and Biostatistics (E.R.M., M.M.G), University of California, San Francisco
| | - Elizabeth Rose Mayeda
- From the Division of Preventive Medicine (P.M.R), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology (P.M.R.) and Social and Behavioral Sciences (M.M.G.), Harvard T. H. Chan School of Public Health, Boston; Harvard Center for Population and Development Studies (S.Y.L.), Harvard University, Cambridge, MA; Division of Epidemiology and Community Health (B.D.C), University of Minnesota, Minneapolis; and Department of Epidemiology and Biostatistics (E.R.M., M.M.G), University of California, San Francisco
| | - Sze Y Liu
- From the Division of Preventive Medicine (P.M.R), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology (P.M.R.) and Social and Behavioral Sciences (M.M.G.), Harvard T. H. Chan School of Public Health, Boston; Harvard Center for Population and Development Studies (S.Y.L.), Harvard University, Cambridge, MA; Division of Epidemiology and Community Health (B.D.C), University of Minnesota, Minneapolis; and Department of Epidemiology and Biostatistics (E.R.M., M.M.G), University of California, San Francisco
| | - M Maria Glymour
- From the Division of Preventive Medicine (P.M.R), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology (P.M.R.) and Social and Behavioral Sciences (M.M.G.), Harvard T. H. Chan School of Public Health, Boston; Harvard Center for Population and Development Studies (S.Y.L.), Harvard University, Cambridge, MA; Division of Epidemiology and Community Health (B.D.C), University of Minnesota, Minneapolis; and Department of Epidemiology and Biostatistics (E.R.M., M.M.G), University of California, San Francisco
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24
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López-Cancio E, Ricciardi AC, Sobrino T, Cortés J, de la Ossa NP, Millán M, Hernández-Pérez M, Gomis M, Dorado L, Muñoz-Narbona L, Campos F, Arenillas JF, Dávalos A. Reported Prestroke Physical Activity Is Associated with Vascular Endothelial Growth Factor Expression and Good Outcomes after Stroke. J Stroke Cerebrovasc Dis 2016; 26:425-430. [PMID: 28029607 DOI: 10.1016/j.jstrokecerebrovasdis.2016.10.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 08/28/2016] [Accepted: 10/03/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Physical activity (PhA) prior to stroke has been associated with good outcomes after the ischemic insult, but there is scarce data on the involved molecular mechanisms. METHODS We studied consecutive acute ischemic stroke patients admitted to a single tertiary stroke center. Prestroke PhA was evaluated with the International Physical Activity Questionnaire (metabolic equivalent of minutes/week). We studied several circulating angiogenic and neurogenic factors at different time points: vascular endothelial growth factor (VEGF), granulocyte colony-stimulating factor (G-CSF), and brain-derived neurotrophic factor (BDNF) at admission, day 7, and at 3 months. We considered good functional outcome at 3 months (modified Rankin scale ≤ 2) as primary end point, and final infarct volume as secondary outcome. RESULTS We studied 83 patients with at least 2 time point serum determinations (mean age 69.6 years, median National Institutes of Health Stroke Scale 17 at admission). Patients more physically active before stroke had a significantly higher increment of serum VEGF on the seventh day when compared to less active patients. This increment was an independent predictor of good functional outcome at 3 months and was associated with smaller infarct volume in multivariate analyses adjusted for relevant covariates. We did not find independent associations of G-CSF or BDNF levels neither with level of prestroke PhA nor with stroke outcomes. CONCLUSIONS Although there are probably more molecular mechanisms by which PhA exerts its beneficial effects in stroke outcomes, our observation regarding the potential role of VEGF is plausible and in line with previous experimental studies. Further research in this field is needed.
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Affiliation(s)
- Elena López-Cancio
- Department of Neuroscience, Hospital Germans Trias i Pujol, Universidad Autónoma Barcelona (UAB), Badalona, Barcelona, Spain.
| | - Ana Clara Ricciardi
- Department of Neuroscience, Hospital Germans Trias i Pujol, Universidad Autónoma Barcelona (UAB), Badalona, Barcelona, Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratory, Department of Neurology, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jordi Cortés
- Department of Biostatistics, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Natalia Pérez de la Ossa
- Department of Neuroscience, Hospital Germans Trias i Pujol, Universidad Autónoma Barcelona (UAB), Badalona, Barcelona, Spain
| | - Mónica Millán
- Department of Neuroscience, Hospital Germans Trias i Pujol, Universidad Autónoma Barcelona (UAB), Badalona, Barcelona, Spain
| | - María Hernández-Pérez
- Department of Neuroscience, Hospital Germans Trias i Pujol, Universidad Autónoma Barcelona (UAB), Badalona, Barcelona, Spain
| | - Meritxell Gomis
- Department of Neuroscience, Hospital Germans Trias i Pujol, Universidad Autónoma Barcelona (UAB), Badalona, Barcelona, Spain
| | - Laura Dorado
- Department of Neuroscience, Hospital Germans Trias i Pujol, Universidad Autónoma Barcelona (UAB), Badalona, Barcelona, Spain
| | - Lucía Muñoz-Narbona
- Department of Neuroscience, Hospital Germans Trias i Pujol, Universidad Autónoma Barcelona (UAB), Badalona, Barcelona, Spain
| | - Francisco Campos
- Clinical Neurosciences Research Laboratory, Department of Neurology, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Juan F Arenillas
- Department of Neurology, Hospital Clínico, University of Valladolid, Valladolid, Spain
| | - Antoni Dávalos
- Department of Neuroscience, Hospital Germans Trias i Pujol, Universidad Autónoma Barcelona (UAB), Badalona, Barcelona, Spain
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25
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Lacroix J, Daviet JC, Borel B, Kammoun B, Salle JY, Mandigout S. Physical Activity Level Among Stroke Patients Hospitalized in a Rehabilitation Unit. PM R 2016; 8:97-104. [DOI: 10.1016/j.pmrj.2015.06.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 06/12/2015] [Accepted: 06/13/2015] [Indexed: 01/04/2023]
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26
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Physical Exercise as a Diagnostic, Rehabilitation, and Preventive Tool: Influence on Neuroplasticity and Motor Recovery after Stroke. Neural Plast 2015; 2015:608581. [PMID: 26682073 PMCID: PMC4670869 DOI: 10.1155/2015/608581] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 06/03/2015] [Accepted: 06/18/2015] [Indexed: 01/19/2023] Open
Abstract
Stroke remains a leading cause of adult motor disabilities in the world and accounts for the greatest number of hospitalizations for neurological disease. Stroke treatments/therapies need to promote neuroplasticity to improve motor function. Physical exercise is considered as a major candidate for ultimately promoting neural plasticity and could be used for different purposes in human and animal experiments. First, acute exercise could be used as a diagnostic tool to understand new neural mechanisms underlying stroke physiopathology. Indeed, better knowledge of stroke mechanisms that affect movements is crucial for enhancing treatment/rehabilitation effectiveness. Secondly, it is well established that physical exercise training is advised as an effective rehabilitation tool. Indeed, it reduces inflammatory processes and apoptotic marker expression, promotes brain angiogenesis and expression of some growth factors, and improves the activation of affected muscles during exercise. Nevertheless, exercise training might also aggravate sensorimotor deficits and brain injury depending on the chosen exercise parameters. For the last few years, physical training has been combined with pharmacological treatments to accentuate and/or accelerate beneficial neural and motor effects. Finally, physical exercise might also be considered as a major nonpharmacological preventive strategy that provides neuroprotective effects reducing adverse effects of brain ischemia. Therefore, prestroke regular physical activity may also decrease the motor outcome severity of stroke.
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27
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Boo S, Duru UB, Smith MS, Rai AT. Successful endovascular stroke therapy in a 103-year-old woman. J Neurointerv Surg 2015; 8:e43. [PMID: 26553879 DOI: 10.1136/neurintsurg-2015-012012.rep] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2015] [Indexed: 11/04/2022]
Abstract
People older than 80 years of age constitute the most rapidly growing age group in the world. Several trials confirming superior efficacy of endovascular therapy did not have an upper age limit and showed favorable treatment effects, regardless of age. Current American Heart Association/American Stroke Association guidelines do not restrict treatment based on age as long as other eligibility criteria are met. A 103-year-old woman presented 2 h after stroke onset secondary to a left internal carotid artery terminus (ICA-T) occlusion. Admission National Institutes of Health Stoke Scale (NIHSS) score was 38, with no early ischemic changes on imaging, pre-stroke modified Rankin Scale score was 0, and she lived independently with minimal help. After initiation of intravenous thrombolysis, the patient underwent successful mechanical thrombectomy with Thombosis in Cerebral Infaction-3 recanalization. She showed remarkable recovery (NIHSS score of 1 at 48 h). Stroke onset to recanalization was 3 h 40 min. Our objective in documenting the oldest patient to successfully undergo stroke intervention is to corroborate that with the current evidence, appropriate patients undergoing rapid treatment may allow us to advance the limits of endovascular therapy.
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Affiliation(s)
- SoHyun Boo
- Department of Interventional Neuroradiology, West Virginia University, Morgantown, West Virginia, USA
| | - Uzoma B Duru
- Department of Neurology, West Virginia University, Morgantown, West Virginia, USA
| | - Matthew S Smith
- Department of Neurology, West Virginia University, Morgantown, West Virginia, USA
| | - Ansaar T Rai
- Department of Interventional Neuroradiology, West Virginia University, Morgantown, West Virginia, USA
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28
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Boo S, Duru UB, Smith MS, Rai AT. Successful endovascular stroke therapy in a 103-year-old woman. BMJ Case Rep 2015; 2015:bcr-2015-012012. [PMID: 26531731 DOI: 10.1136/bcr-2015-012012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
People older than 80 years of age constitute the most rapidly growing age group in the world. Several trials confirming superior efficacy of endovascular therapy did not have an upper age limit and showed favorable treatment effects, regardless of age. Current American Heart Association/American Stroke Association guidelines do not restrict treatment based on age as long as other eligibility criteria are met. A 103-year-old woman presented 2 h after stroke onset secondary to a left internal carotid artery terminus (ICA-T) occlusion. Admission National Institutes of Health Stoke Scale (NIHSS) score was 38, with no early ischemic changes on imaging, pre-stroke modified Rankin Scale score was 0, and she lived independently with minimal help. After initiation of intravenous thrombolysis, the patient underwent successful mechanical thrombectomy with Thombosis in Cerebral Infaction-3 recanalization. She showed remarkable recovery (NIHSS score of 1 at 48 h). Stroke onset to recanalization was 3 h 40 min. Our objective in documenting the oldest patient to successfully undergo stroke intervention is to corroborate that with the current evidence, appropriate patients undergoing rapid treatment may allow us to advance the limits of endovascular therapy.
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Affiliation(s)
- SoHyun Boo
- Department of Interventional Neuroradiology, West Virginia University, Morgantown, West Virginia, USA
| | - Uzoma B Duru
- Department of Neurology, West Virginia University, Morgantown, West Virginia, USA
| | - Matthew S Smith
- Department of Neurology, West Virginia University, Morgantown, West Virginia, USA
| | - Ansaar T Rai
- Department of Interventional Neuroradiology, West Virginia University, Morgantown, West Virginia, USA
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29
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Decourcelle A, Moulin S, Sibon I, Murao K, Ronzière T, Godefroy O, Poli M, Cordonnier C, Sagnier S, Lassalle V, Okada Y, Mas JL, Bordet R, Leys D. Influence of previous physical activity on the outcome of patients treated by thrombolytic therapy for stroke. J Neurol 2015; 262:2513-9. [PMID: 26275566 DOI: 10.1007/s00415-015-7875-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 08/01/2015] [Accepted: 08/03/2015] [Indexed: 01/21/2023]
Abstract
Physical activity prevents stroke and is associated with less severe strokes. The neuroprotective effect in patients treated with intravenous (i.v.) recombinant tissue plasminogen activator (rt-PA), remains uncertain. We aimed at evaluating the relationship between previous physical activity and outcomes in stroke patients treated with i.v. rt-PA. OPHELIE-SPORT was a prospective observational multicenter study conducted in French and Japanese stroke patients treated with i.v. rt-PA. We evaluated the presence, weekly duration (<2, 2-5, >5 h) and intensity (light, moderate, heavy) of previous leisure-time physical activity according to standardized criteria. The primary end-point was an excellent outcome [modified Rankin Scale (mRS) 0-1 or similar to the pre-stroke mRS] after 3 months. Secondary end-points were good outcome (mRS 0-2 or similar to the pre-stroke mRS), and death. Of 519 patients, 74 (14.3 %) had regular physical activity before stroke. They were 14 years younger (p < 0.001), treated 25 min earlier (p = 0.004) and more likely to be men, free of pre-stroke handicap (mRS = 0), atrial fibrillation, arterial hypertension, and diabetes mellitus. National Institutes of Health Stroke Scale scores, at baseline (p = 0.183) and 24 h later (p = 0.203), did not differ between patients with and without physical activity. After adjustment on confounders, there was no association between previous leisure-time physical activity and outcome. Outcomes 3 months after treatment of cerebral ischaemia with i.v. rt-PA are not influenced by previous physical activity.
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Affiliation(s)
- Amélie Decourcelle
- Department of Neurology, Stroke Centre, Lille University Hospital, Lille, France.,INSERM U 1171, University of Lille, Lille, France.,STROKAVENIR Network, 59000, Lille, France
| | - Solène Moulin
- Department of Neurology, Stroke Centre, Lille University Hospital, Lille, France.,INSERM U 1171, University of Lille, Lille, France.,STROKAVENIR Network, 59000, Lille, France
| | - Igor Sibon
- STROKAVENIR Network, 59000, Lille, France.,Department of Neurology, Stroke Center, University of Bordeaux, Bordeaux, France
| | - Kei Murao
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Thomas Ronzière
- STROKAVENIR Network, 59000, Lille, France.,Department of Neurology, Stroke Unit, University of Rennes, Rennes, France
| | - Olivier Godefroy
- STROKAVENIR Network, 59000, Lille, France.,Department of Neurology, Amiens University Hospital, Amiens, France
| | - Mathilde Poli
- STROKAVENIR Network, 59000, Lille, France.,Department of Neurology, Stroke Center, University of Bordeaux, Bordeaux, France
| | - Charlotte Cordonnier
- Department of Neurology, Stroke Centre, Lille University Hospital, Lille, France.,INSERM U 1171, University of Lille, Lille, France.,STROKAVENIR Network, 59000, Lille, France
| | - Sharmila Sagnier
- STROKAVENIR Network, 59000, Lille, France.,Department of Neurology, Stroke Center, University of Bordeaux, Bordeaux, France
| | - Veronica Lassalle
- STROKAVENIR Network, 59000, Lille, France.,Department of Neurology, Stroke Unit, University of Rennes, Rennes, France
| | - Yasushi Okada
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jean-Louis Mas
- STROKAVENIR Network, 59000, Lille, France.,Department of Neurology, Stroke Centre, Sainte-Anne Hospital, University Paris Descartes, Sorbonne Paris Cité, INSERM UMR S783, Paris, France
| | - Régis Bordet
- INSERM U 1171, University of Lille, Lille, France.,STROKAVENIR Network, 59000, Lille, France.,Pharmacological Department, Lille University Hospital, Lille, France
| | - Didier Leys
- Department of Neurology, Stroke Centre, Lille University Hospital, Lille, France. .,INSERM U 1171, University of Lille, Lille, France. .,STROKAVENIR Network, 59000, Lille, France.
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