Physical activity associated with intact cognition after mild or moderate stroke

A Swedish register-based study finds that patients who engage in light or moderate physical activity are more likely to retain their cognitive function after a mild or moderate stroke vs inactive counterparts.

“Physical activity promotes neuroprotection and neuroplasticity, and allows interaction between neurogenesis and angiogenesis, which stimulates regeneration and repair, reduces inflammation, and increases levels of growth factor,” wrote the researchers. “Higher levels of pre-stroke activity have been associated with lower severity of acute stroke. The objective of our study was to investigate if pre-stroke physical activity is also associated with intact cognition early after stroke.” [Curr Neurol Neurosci Rep 2019;19:28-28]

The study sample consisted of 1,111 patients (mean age, 69.8 years; female, 39.4 percent) admitted to Sahlgrenska University Hospital with first stroke between November 2014 and August 2018. Most patients (61.5 percent) were physically active pre-stroke (51.6 percent lightly active and 9.9 percent moderately active), and 53.1 percent had possible cognitive impairment when screened with the Montreal Cognitive Assessment (MoCA). [Sci Rep 2022;12:doi:10.1038/s41598-022-09520-2]

Light physical activity was defined as being physically active for ≥4 hours per week (for example, riding a bicycle or walking to work, walking with the family, gardening, fishing, table tennis, bowling, etc), while moderate physical activity was defined as spending time on heavy gardening, running, swimming, playing tennis, badminton, calisthenics, and similar activities for ≥2–3 hours week. Physical inactivity was defined as reading, watching television, using computers, or doing other sedentary activities during leisure time.

Compared with patients with intact cognition (MoCA score ≥26), patients with impaired cognition (MoCA score ≤25) were significantly older (p<0.001), more likely to have cerebral haemorrhage vs ischaemic stroke (p=0.006), had increased length of hospital stay at the stroke unit (p<0.001), and more often had a moderate vs mild stroke (p<0.001), diabetes (p=0.002), hypertension (p=0.004), statin  treatment (p=0.017), a lower level of pre-stroke physical activity (p<0.001), and shorter education (p=0.007).

In multivariable binary logistic regression analysis, pre-stroke physical activity was associated with intact cognition with odds ratios (OR) of 1.32 (95 percent confidence interval [CI], 0.97 to 1.80) for light physical activity, and 2.04 (95 percent CI, 1.18 to 3.53) for moderate physical activity.

“Moderate physical activity, such as 2–3 hours of exercise a week, seems to be more beneficial compared with light physical activity, such as walking ≥4 hours a week, but different aspects of physical activity, such as the intensity, frequency, duration, and type of exercise need further exploration,” noted the researchers.