Pre-stroke physical activity is related to good functional outcomes in stroke patients after endovascular thrombectomy.

La actividad física previa al ictus se relaciona con un buen resultado funcional en pacientes con ictus tras una trombectomía endovascular.

• Xiangbo Meng Nanjing Medical University, Nanjing, Jiangsu, China. https://orcid.org/0000-0002-5329-8459
• Haiyan Ding Huai’an Fifth People’s Hospital, Huai’an, Jiangsu, China. https://orcid.org/0000-0002-6126-278X
• Congguo Yin Zhejiang University School of Medicine, Hangzhou, Zhejiang, China. https://orcid.org/0000-0002-8026-4174
• Wenqing Xia Zhejiang University School of Medicine, Hangzhou, Zhejiang, China. https://orcid.org/0000-0002-1373-3567
• Yan Wu Zhejiang University School of Medicine, Hangzhou, Zhejiang, China. https://orcid.org/0000-0002-2829-0471
• Jianan Li Nanjing Medical University, Nanjing, Jiangsu, China. https://orcid.org/0000-0003-3177-4335

DOI: https://doi.org/10.54817/IC.v64n2a02

Keywords: physical activity, stroke, endovascular thrombectomy, prognosis, functional outcome

Abstract

Studies have shown that regular physical activity (PA) may reduce the risk of stroke. Nevertheless, the protective effect of pre-stroke PA on the post-stroke functional status in patients treated with endovascular thrombectomy (EVT) is still uncertain. For this study, hospitalized patients with acute ischemic stroke were selected, all of whom underwent EVT after occlusion of the large vessels in the anterior circulation. The PA levels before the stroke were assessed by the International Physical Activity Questionnaire, and the outcome indicators (the modified Rankin scale score and the Barthel index) were evaluated. A total of 144 patients were included in this study. Among the patients with high PA levels before the stroke, men were more active than women, and the proportion of patients with smoking and alcohol abuse was high before admission. Also, the patients with a high PA level were more likely to have no history of hypertension and atrial fibrillation, and had lower triglyceride levels at admission. We determined that a high pre-stroke PA level is independently related to a favorable functional outcome at three months. In addition, there was no correlation between a high pre-stroke PA and a good functional outcome at two weeks. A high pre-stroke PA level is independently associated with satisfactory activities of daily living at three months. Regular PA before a stroke is an independent predictor of a favorable functional outcome in patients with anterior circulation strokes who receive EVT, and it has a protective effect on the functional prognosis.

References

Wu X, Du H. Research on the effect of mdt nursing pattern on the rehabilitation of oral feeding function of stroke patients with tracheotomy and dysphagia in icu. Acta Medica Mediterr 2022; 38: 2683-2689. https://doi. org/10.19193/0393-6384_2022_4_402.

Xu S, Dong X, Zhao M, Zhao C, Wu Y, Luo W, Yang Z. The evaluation value of videofluoroscopic swallowing study in dysphagia after stroke. Acta Medica Mediterr 2022; 38(3): 2187-2192. https://doi. org/10.19193/0393-6384_2022_3_334.

Raminda S, Astuti I, Rahayu UB. Effect of transcranial magnetic stimulation with rehabilitation program on motor function and ADL in upper extremity ischemic stroke: a randomized controlled trials. J Med Chem Sci 2021; 4(4): 308-315. https://doi. org/10.26655/JMCHEMSCI.2021.4.1.

Sun S, Sun X, Gao H, Zhu C. Comparison of risk factors between progressive ischemic stroke and non-progressive ischemic stroke. Acta Medica Mediterr 2022; 38: 2973-2978. https://doi.org/10.19193/0393-6384_2022_5_441.

Hu Y, Wang T, Han S, Zhan X, Feng Z, Du X, Wang C, Wu Y. Impact of anti-aspiration nursing intervention on clinical outcomes in elderly stroke patients with aspiration pneumonia. Acta Medica Mediterr 2022; 38: 2905-2910. https://doi. org/10.19193/0393-6384_2022_4_432.

Wang S, Bao N, Cao X, Zhou J, Jiang G, Wang L. The neuroprotective mechanism of microrna in ischemic stroke. Acta Medica Mediterr 2022; 38(3): 1601-1602. https://doi.org/10.19193/0393-6384_ 2022_3_242.

Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2019; 50(12): e344-e418. https://doi.org/10.1161/STR.0 000000000000211.

Berkhemer OA, Fransen PSS, Beumer D, Van Den Berg, LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn, PJ, Wermer MJH. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372: 11-20. https://doi. org/10.1056/NEJMoa1411587.

Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, Dávalos A, Majoie CB, van der Lugt A, De Miquel MA, Donnan GA. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016; 387(10029): 1723-1731. https://doi. org/10.1016/S0140-6736(16)00163-X.

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(6): 1-9. https://doi.org/10.1007/ s11910-019-0949-4.

Fors M, Enthoven P, Abbott A, Öberg B. Effects of pre-surgery physiotherapy on walking ability and lower extremity strength in patients with degenerative lumbar spine disorder: Secondary outcomes of the PREPARE randomised controlled trial. BMC Musculoskelet Disord 2019; 20(1): 1-11. https:// doi.org/10.1186/s12891-019-2850-3.

Moran J, Guinan E, McCormick P, Larkin J, Mockler D, Hussey J, Moriarty J, Wilson F. The ability of prehabilitation to influence postoperative outcome after intra-abdominal operation: a systematic review and meta-analysis. Surgery 2016; 160(5): 1189-1201. https://doi.org/10.1016/j.surg.2016.05.014.

Zhang F, Wu Y, Jia J. Exercise preconditioning and brain ischemic tolerance. Neuroscience 2011; 177: 170-176. https://doi. org/10.1016/j.neuroscience.2011.01.018.

Diep L, Kwagyan J, Kurantsin-Mills J, Weir R, Jayam-Trouth A. Association of physical activity level and stroke outcomes in men and women: a meta-analysis. J Women’s Health 2010; 19(10): 1815-1822. https:// doi.org/10.1089/jwh.2009.1708.

Wang X, Zhang M, Yang SD, Li WB, Ren SQ, Zhang J, Zhang F. Pre-ischemic treadmill training alleviates brain damage via GLT-1-mediated signal pathway after ischemic stroke in rats. Neuroscience 2014; 274: 393-402. https://doi.org/10.1016/j.neuros- cience.2014.05.053.

Gertz K, Priller J, Kronenberg G, Fink KB, Winter B, Schröck H, Ji S, Milosevic M, Harms C, Bohm M, Dirnagl U. Physical activity improves long-term stroke outcome via endothelial nitric oxide synthase–dependent augmentation of neovascularization and cerebral blood flow. Circ Res 2006; 99(10): 1132-1140. https://doi.org/10.1161/01. RES.0000250175.14861.77.

Otsuka S, Sakakima H, Sumizono M, Takada S, Terashi T, Yoshida Y. The neuroprotective effects of preconditioning exercise on brain damage and neurotrophic factors after focal brain ischemia in rats. Behav Brain Res 2016; 303: 9-18. https://doi.org/10.1016/j.bbr.2016.01.049.

Zhu L, Ye T, Tang Q, Wang Y, Wu X, Li H, Jiang Y. Exercise preconditioning regulates the toll-like receptor 4/nuclear factor-κB signaling pathway and reduces cerebral ischemia/reperfusion inflamma- tory injury: a study in rats. J Stroke Cerebrovasc Dis 2016; 25(11): 2770-2779. https://doi.org/10.1016/j.jstrokecerebro- vasdis.2016.07.033.

Naderi S, Alimohammadi R, Hakimizadeh E, Roohbakhsh A, Shamsizadeh A, Allahtavakoli M. The effect of exercise preconditioning on stroke outcome in ovariectomized mice with permanent middle cerebral artery occlusion. Can J Physiol Pharmacol 2018; 96(3): 287-294. https:// doi.org/10.1139/cjpp-2017-0157.

Lin C, Chang C, Chang C, Hsu Y, Lin M, Lin J. Protecting against ischaemic strokein rats by heat shock protein 20‐mediated exercise. Eur J Clin Invest 2015; 45(12):1297-1305. https://doi.org/10.1111/eci.12551.

Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, Fang MC, Fisher M, Furie KL, Heck DV, Johnston SC. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45(7): 2160-2236. https:// doi.org/10.1161/STR.0000000000000024.

McDonnell MN, Hillier SL, Hooker SP, Le A, Judd SE, Howard VJ. Physical activity frequency and risk of incident stroke in a national US study of blacks and whites. Stroke 2013; 44(9): 2519-2524. https://doi. org/10.1161/STROKEAHA.113.001538.

Investigators WHOMPP. The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. J Clin Epidemiol 1988; 41(2): 105-114. https://doi.org/10.1016/0895-4356(88)90084-4.

Reinholdsson M, Palstam A, Sunnerhagen KS. Pre-stroke physical activity could influence acute stroke severity (part of PAP- SIGOT). Neurology 2018; 91(16): e146-e1467. https://doi.org/10.1212/WNL.0000 000000006354.

Urbanek C, Gokel V, Safer A, Becher H, Grau AJ, Buggle F, Palm F. Low self-reported sports activity before stroke predicts poor one-year-functional outcome after first-ever ischemic stroke in a population- based stroke register. BMC Neurol 2018; 18(1): 1-10. https://doi.org/10.1186/s128 83-018-1189-y.

Decourcelle A, Moulin S, Sibon I, Murao K, Ronzière T, Godefroy O, Poli M, Cordonnier C, Sagnier S, Lassalle V, Okada Y. Influence of previous physical activity on the outcome of patients treated by thrombolytic therapy for stroke. J Neurol 2015; 262(11): 2513-2519. https://doi. org/10.1007/s00415-015-7875-4.

Morovatdar N, Di Napoli M, Stranges S, G. Thrift A, Kapral M, Behrouz R, Farzadfard MT, Sheikh Andalibi MS, Rahimzadeh Oskooie R, Sawant A, Mokhber N, Azarpa- zhooh MR. Regular physical activity post-
pones age of occurrence of first-ever stroke and improves long-term outcomes. Neurol Sci 2021; 42(8): 3203-3210. https://doi. org/10.1007/s10072-020-04903-7.

Deng HB, Macfarlane DJ, Thomas GN, Lao XQ, Jiang CQ, Cheng KK, Lam TH. Reliability and validity of the IPAQ-Chinese: the Guangzhou Biobank Cohort study. Med Sci Sports Exerc 2008; 40(2): 303-307. https:// doi.org/10.1249/mss.0b013e31815b0db5.

Macfarlane DJ, Lee CCY, Ho EYK, Chan KL, Chan DTS. Reliability and validity of the Chinese version of IPAQ (short, last 7 days). J Sci Med Sport 2007; 10(1): 45-51. https:// doi.org/10.1016/j.jsams.2006.05.003.

Deplanque D, Masse I, Libersa C, Leys D, Bordet R. Previous leisure-time physical activity dose dependently decreases ischemic stroke severity. Stroke Res Treat 2012; 2012. https://doi.org/10.1155/2012/614925.

Stranahan AM, Zhou Y, Martin B, Maudsley S. Pharmacomimetics of exercise: novel approaches for hippocampally-targeted neuroprotective agents. Curr Med Chem 2009; 16(35): 4668-4678. https://doi. org/10.2174/092986709789878292.