Negar Morovatdar1, Mario Di Napoli2,3, Saverio Stranges4,5,6, Amanda G Thrift7, Moira Kapral8,9, Reza Behrouz10, Mohammad Taghi Farzadfard11, Mohammad Sobhan Sheikh Andalibi12, Reza Rahimzadeh Oskooie12, Anuradha Sawant13, Naghmeh Mokhber14,15, M Reza Azarpazhooh16,17,18. 1. Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. 2. Department of Neurology and Stroke Unit, San Camillo de' Lellis General Hospital, Rieti, Italy. 3. Neurological Section, Neuro-epidemiology Unit, SMDN-Centre for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Sulmona, L'Aquila, Italy. 4. Department of Epidemiology & Biostatistics, Western University, London, Canada. 5. Department of Family Medicine, Western University, London, Canada. 6. Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg. 7. Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia. 8. Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. 9. Institute for Clinical Evaluative Sciences, Toronto, Canada. 10. Department of Neurology, Lozano-Long School of Medicine, University of Texas Health, San Antonio, TX, USA. 11. Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. 12. Student Research Committee, Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. 13. Department of Clinical Neurological Science, University Hospital, Western University, London, Canada. 14. Department of Psychiatry, Mashhad University of Medical Sciences, Mashhad, Iran. 15. Department of Psychiatry & Behavioral Neurosciences, Western University, London, Canada. 16. Department of Epidemiology & Biostatistics, Western University, London, Canada. reza.azarpazhooh@lhsc.on.ca. 17. Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. reza.azarpazhooh@lhsc.on.ca. 18. Department of Clinical Neurological Science, University Hospital, Western University, London, Canada. reza.azarpazhooh@lhsc.on.ca.
Abstract
OBJECTIVE: Few data are available on the associations between the level of pre-stroke physical activity and long-term outcomes in patients with stroke. This study is designed to assess the associations between pre-stroke physical activity and age of first-ever stroke occurrence and long-term outcomes. METHODS: Six hundred twenty-four cases with first-ever stroke were recruited from the Mashhad Stroke Incidence Study a prospective population-based cohort in Iran. Data on Physical Activity Level (PAL) were collected retrospectively and were available in 395 cases. According to the PAL values, subjects were classified as inactive (PAL < 1.70) and active (PAL ≥ 1.70). Age at onset of stroke was compared between active and inactive groups. Using logistic model, we assessed association between pre-stroke physical activity and long-term (5-year) mortality, recurrence, disability, and functional dependency rates. We used multiple imputation to analyze missing data. RESULTS: Inactive patients (PAL < 1.70) were more than 6 years younger at their age of first-ever-stroke occurrence (60.7 ± 15.5) than active patients (67.0 ± 13.2; p < 0.001). Patients with PAL< 1.7 also had a greater risk of mortality at 1 year [adjusted odds ratio (aOR) = 2.31; 95%CI: 1.14-4.67, p = 0.02] and 5 years after stroke (aOR = 1.81; 95%CI: 1.05-3.14, p = 0.03) than patients who were more physically active. Recurrence rate, disability, and functional dependency were not statistically different between two groups. Missing data analysis also showed a higher odds of death at one and 5 years for inactive patients. CONCLUSIONS: In our cohort, we observed a younger age of stroke and a higher odds of 1- and 5-year mortality among those with less physical activity. This is an important health promotion strategy to encourage people to remain physically active.
OBJECTIVE: Few data are available on the associations between the level of pre-stroke physical activity and long-term outcomes in patients with stroke. This study is designed to assess the associations between pre-stroke physical activity and age of first-ever stroke occurrence and long-term outcomes. METHODS: Six hundred twenty-four cases with first-ever stroke were recruited from the Mashhad Stroke Incidence Study a prospective population-based cohort in Iran. Data on Physical Activity Level (PAL) were collected retrospectively and were available in 395 cases. According to the PAL values, subjects were classified as inactive (PAL < 1.70) and active (PAL ≥ 1.70). Age at onset of stroke was compared between active and inactive groups. Using logistic model, we assessed association between pre-stroke physical activity and long-term (5-year) mortality, recurrence, disability, and functional dependency rates. We used multiple imputation to analyze missing data. RESULTS: Inactive patients (PAL < 1.70) were more than 6 years younger at their age of first-ever-stroke occurrence (60.7 ± 15.5) than active patients (67.0 ± 13.2; p < 0.001). Patients with PAL< 1.7 also had a greater risk of mortality at 1 year [adjusted odds ratio (aOR) = 2.31; 95%CI: 1.14-4.67, p = 0.02] and 5 years after stroke (aOR = 1.81; 95%CI: 1.05-3.14, p = 0.03) than patients who were more physically active. Recurrence rate, disability, and functional dependency were not statistically different between two groups. Missing data analysis also showed a higher odds of death at one and 5 years for inactive patients. CONCLUSIONS: In our cohort, we observed a younger age of stroke and a higher odds of 1- and 5-year mortality among those with less physical activity. This is an important health promotion strategy to encourage people to remain physically active.