Association between pre-stroke physical activity and mobility and walking ability in the early subacute phase: A registry-based study

Authors

  • Malin Reinholdsson Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  • Anna Grimby-Ekman
  • Hanna C. Persson

DOI:

https://doi.org/10.2340/jrm.v53.367

Keywords:

prestroke, stroke, exercise, physical activity, mobility, transfers, walking, upper extremity

Abstract

Objective: To investigate associations between pre-stroke physical activity and mobility, walking ability, and self-perceived upper extremity function during stroke unit care.

Design: A longitudinal, registry-based study with a consecutively collected cohort.

Subjects/patients: A total of 1,092 adults with stroke admitted to 3 Swedish stroke units between 2017 and 2018.

Methods: Logistic mixed effects regression models were performed to investigate associations (adjusted for age and sex). Pre-stroke physical activity was assessed with Saltin-Grimby Physical Activity Level Scale on admission. Mobility, walking ability, and self-perceived upper extremity function were assessed at admission and discharge from the stroke units and compared between pre-stroke physically active (45%) and inactive (55%) groups.

Results: All groups of patients showed improvements in mobility (p < 0.001), walking ability (p < 0.001), and upper extremity function (p < 0.001). The chang-es over time tended to differ between the physically inactive and active groups for mobility (p < 0.062) and walking ability (p < 0.056), but the differences were not significant.

Conclusion: Pre-stroke physically active people show-ed a tendency to be more independent in physical
functioning early after stroke. Regardless of pre-stroke physical activity, all patients showed improvements in mobility, walking ability, and self-perceived upper extremity function during inpatient care.

 

Lay Abstract

To be physically active prior to a stroke may improve the post-stroke recovery process. Therefore, we hypothesized that pre-stroke physical activ-ity might reduce the consequences of a stroke. This study investigated associations between pre-stroke physical activity and post-stroke recovery of mobility, walking ability, and arm and hand function. A total of 1,092 patients were examined; 44% were women, 89% had ischaemic stroke, and 55% were physically inactive before the stroke.
All patients showed improvements during care at the stroke units, regardless of their previous physical activity level. At hospital discharge, 71% of patients showed independent mobility, 68% could walk independently, and 55% reported self-perceived arm and hand impairments. Patients with higher pre-stroke physical activity levels had a tendency of being more independent in mobility and walking compared with inactive patients. However, the frequencies of self-perceived arm and hand impairments were similar between the physically active and physically inactive groups. To be physically active prior to a stroke may improve the post-stroke recovery process.

Downloads

Download data is not yet available.

References

Feigin VL, Norrving B, Mensah GA. Global burden of stroke. Circ Res 2017; 120: 439-448. https://doi.org/10.1161/CIRCRESAHA.116.308413

Stinear CM. Prediction of motor recovery after stroke: advances in biomarkers. Lancet Neurol 2017; 16: 826-836. https://doi.org/10.1016/S1474-4422(17)30283-1

Luengo-Fernandez R, Paul NL, Gray AM, Pendlebury ST, Bull LM, Welch SJ, et al. Population-based study of disability and institutionalization after transient ischemic attack and stroke: 10-year results of the Oxford Vascular Study. Stroke 2013; 44: 2854-2861.

https://doi.org/10.1161/STROKEAHA.113.001584

Bernhardt J, Hayward KS, Kwakkel G, Ward NS, Wolf SL, Borschmann K, et al. Agreed definitions and a shared vision for new standards in stroke recovery research: the stroke recovery and rehabilitation roundtable taskforce. Int J Stroke 2017; 12: 444-450. https://doi.org/10.1177/1747493017711816

Langhorne P, Wu O, Rodgers H, Ashburn A, Bernhardt J. A Very Early Rehabilitation Trial after stroke (AVERT): a phase III, multicentre, randomised controlled trial. Health Technology Assessment (Winchester, England) 2017; 21: 1-120. https://doi.org/10.3310/hta21540

Stroke Unit Trialists C. Organised inpatient (stroke unit) care for stroke. The Cochrane database of systematic reviews 2013; 2013: CD000197.

Kwakkel G, Lannin NA, Borschmann K, English C, Ali M, Churilov L, et al. Standardized measurement of sensorimotor recovery in stroke trials: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2017; 12: 451-461.

https://doi.org/10.1177/1747493017711813

World Health Organization. ICF : International Classification of Functioning, Disability and Health. Geneva: World Health Organization; 2001.

Pin-Barre C, Laurin J. Physical exercise as a diagnostic, rehabilitation, and preventive tool: influence on neuroplasticity and motor recovery after stroke. Neural Plast 2015; 2015: 608581. https://doi.org/10.1155/2015/608581

Gallanagh S, Quinn TJ, Alexander J, Walters MR. Physical activity in the prevention and treatment of stroke. ISRN Neurol 2011; 2011: 953818. https://doi.org/10.5402/2011/953818

Dasso NA. How is exercise different from physical activity? A concept analysis. Nurs Forum 2019; 54: 45-52. ttps://doi.org/10.1111/nuf.12296

Ricciardi AC, Lopez-Cancio E, Perez de la Ossa N, Sobrino T, Hernandez-Perez M, Gomis M, et al. Prestroke physical activity is associated with good functional outcome and arterial recanalization after stroke due to a large vessel occlusion. Cerebrovasc Dis 2014; 37: 304-311.

https://doi.org/10.1159/000360809

Reinholdsson M, Palstam A, Sunnerhagen KS. Prestroke physical activity could influence acute stroke severity (part of PAPSIGOT). Neurology 2018; 91: e1461-e1467. https://doi.org/10.1212/WNL.0000000000006354

Krarup LH, Gluud C, Truelsen T, Pedersen A, Lindahl M, Hansen L, et al. The ExStroke pilot trial: rationale, design, and baseline data of a randomized multicenter trial comparing physical training versus usual care after an ischemic stroke. Contemp Clin Trials 2008; 29: 410-417. https://doi.org/10.1016/j.cct.2007.09.008

Deplanque D, Masse I, Lefebvre C, Libersa C, Leys D, Bordet R. Prior TIA, lipid-lowering drug use, and physical activity decrease ischemic stroke severity. Neurology 2006; 67: 1403-1410. https://doi.org/10.1212/01.wnl.0000240057.71766.71

Krarup LH, Truelsen T, Gluud C, Andersen G, Zeng X, Korv J, et al. Prestroke physical activity is associated with severity and long-term outcome from first-ever stroke. Neurology 2008; 71: 1313-1318. https://doi.org/10.1212/01.wnl.0000327667.48013.9f

Ursin MH, Ihle-Hansen H, Fure B, Tveit A, Bergland A. Effects of premorbid physical activity on stroke severity and post-stroke functioning. J Rehabil Med 2015; 47: 612-617. https://doi.org/10.2340/16501977-1972

Stroud N, Mazwi TM, Case LD, Brown RD, Jr., Brott TG, Worrall BB, et al. Prestroke physical activity and early functional status after stroke. J Neurol Neurosurg Psychiatry 2009; 80: 1019-1022. https://doi.org/10.1136/jnnp.2008.170027

Tumasz MT, Trocoli T, de Oliveira MF, Campos RR, Botelho RV. do physically active patients have better functional outcome after stroke? A systematic review. J Stroke Cerebrovasc Dis 2016; 25: 527-532. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.10.034

Yamaguchi T, Yamamura O, Hamano T, Murakita K, Nakamoto Y. Premorbid physical activity is modestly associated with gait independence after a stroke: an exploratory study. Eur Rev Aging Phys Act 2018; 15: 18. https://doi.org/10.1186/s11556-018-0208-8

Mahendran N, Kuys SS, Brauer SG. Which impairments, activity limitations and personal factors at hospital discharge predict walking activity across the first 6 months poststroke? Disabil Rehabil 2020; 42: 763-469. https://doi.org/10.1080/09638288.2018.1508513

Kramer SF, Hung SH, Brodtmann A. The impact of physical activity before and after stroke on stroke risk and recovery: a narrative review. Curr Neurol Neurosci Rep 2019; 19: 28-28. https://doi.org/10.1007/s11910-019-0949-4

The Swedish stroke register (Riksstroke). Annual report for the full year 2018. 2019 [cited 2020 May 15]. Available from: www.riksstroke.se. (In Swedish).

Kasner SE. Clinical interpretation and use of stroke scales. Lancet Neurol 2006; 5: 603-612. https://doi.org/10.1016/S1474-4422(06)70495-1

Lindley RI, Wardlaw JM, Whiteley WN, Cohen G, Blackwell L, Murray GD, et al. Alteplase for acute ischemic stroke: outcomes by clinically important subgroups in the Third International Stroke Trial. Stroke 2015; 46: 746-756. https://doi.org/10.1161/STROKEAHA.114.006573

Saltin B, Grimby G. Physiological analysis of middle-aged and old former athletes. Comparison with still active athletes of the same ages. Circulation 1968; 38: 1104-1115. https://doi.org/10.1161/01.CIR.38.6.1104

Rodjer L, Jonsdottir IH, Rosengren A, Bjorck L, Grimby G, Thelle DS, et al. Self-reported leisure time physical activity: a useful assessment tool in everyday health care. BMC Public Health 2012; 12: 693. https://doi.org/10.1186/1471-2458-12-693

Hankey GJ. Stroke. Lancet 2017; 389: 641-654. https://doi.org/10.1016/S0140-6736(16)30962-X

National Board of Health and Welfare in Sweden. National guidelines for stroke care. Support for governance and management. 2020. [cited 2020 May 15]. Available from: https://www.socialstyrelsen.se/regler-och-riktlinjer/nationella-riktlinjer/riktlinjer-och-utvarderingar/stroke/. (in Swedish).

Alt Murphy M, Björkdahl A, Forsberg-Wärleby G, Persson CU. Implementation of evidence-based assessment of upper extremity in stroke rehabilitation: from evidence to clinical practice. J Rehabil Med 2021; 53: jrm00148. https://doi.org/10.2340/16501977-2790

Agresti A. Categorical data analysis. New York: Wiley, 1990.

Ganesh A, Luengo-Fernandez R, Pendlebury ST, Rothwell PM. Long-term consequences of worsened poststroke status in patients with premorbid disability. Stroke 2018; 49: 2430-2436. https://doi.org/10.1161/STROKEAHA.118.022416

Stinear C, Ackerley S, Byblow W. Rehabilitation is initiated early after stroke, but most motor rehabilitation trials are not: a systematic review. Stroke 2013; 44: 2039-2045. https://doi.org/10.1161/STROKEAHA.113.000968

Wang Y, Li M, Dong F, Zhang J, Zhang F. Physical exercise-induced protection on ischemic cardiovascular and cerebrovascular diseases. Int J Clin Exp Med 2015; 8: 19859.

Hatakeyama M, Ninomiya I, Kanazawa M. Angiogenesis and neuronal remodeling after ischemic stroke. Neural regeneration research 2020; 15: 16-19. https://doi.org/10.4103/1673-5374.264442

Ding D, Lawson KD, Kolbe-Alexander TL, Finkelstein EA, Katzmarzyk PT, Van Mechelen W, et al. The economic burden of physical inactivity: a global analysis of major non-communicable diseases. The Lancet 2016; 388: 1311-1324. https://doi.org/10.1016/S0140-6736(16)30383-X

Published

2021-10-15

How to Cite

Reinholdsson, M., Grimby-Ekman, A., & Persson, H. C. (2021). Association between pre-stroke physical activity and mobility and walking ability in the early subacute phase: A registry-based study. Journal of Rehabilitation Medicine, 53(10), jrm00233. https://doi.org/10.2340/jrm.v53.367

Issue

Section

Original Report

Categories