Physical Activity Before and After Stroke - Examining Stroke lncidence and Outcomes

Background: Stroke is a leading cause of death and disability worldwide. A physically active lifestyle may prevent stroke and decrease the consequences of a stroke. Physical activity is also an important component in secondary prevention and rehabilitation after stroke. This thesis investigates the associations between physical activity before and after stroke in relation to stroke incidence, stroke severity, stroke mortality and functional outcomes after stroke. Methods: Study I was conducted using a population-based cohort from western Sweden collected in 2001 to 2004. Physical activity was assessed in four domains: leisure, work, transport, and household activities. Stroke incidence and death or dependency 3 months after stroke were recorded with a follow-up of 20 years. Study II and III utilized data from the local stroke-register at Sahlgrenska University Hospital between 2014 and 2019. Pre-stroke physical activity during the prior year was retrospectively evaluated. In Study II, stroke severity and mortality were assessed in patients with ischemic stroke and intracerebral hemorrhage. In Study III, hematoma volume, stroke severity, 1-week functional outcome, and 3-month survival were assessed in patients with intracerebral hemorrhage. In Study IV, data from a randomized controlled trial conducted between 2014 and 2019 was utilized. Physical activity and functional recovery in patients with acute stroke were followed up for 6 months. Results: In Study I (n=3614) leisure-time and transport physical activity were associated with reduced stroke incidence, and a high level of leisure-time physical activity was associated with a better post-stroke outcome. In Study II (n=5188) pre-stroke physical activity was associated with milder stroke symptoms and post-stroke survival independent of stroke type. In study III (n=686) pre-stroke physical activity was associated with smaller hematoma volumes in deep and lobar intracerebral hemorrhages, which partly mediated milder stroke symptoms, a good 1-week functional outcome and 3-month survival. In Study IV (n=1367), two distinct physical activity patterns were identified in the first 6 months after stroke: increasing or decreasing physical activity. Increased physical activity was associated with better functional recovery 6 months after stroke. Males and those with normal cognition were more likely to be in the increasing group. Conclusions: The results of this thesis indicate that physical activity has an important role in both the prevention and treatment of stroke. Being physically active before and after a stroke can improve outcomes following stroke

Physical Activity Before and After Stroke - Examining Stroke lncidence and Outcomes

Background: Stroke is a leading cause of death and disability worldwide. A physically active lifestyle may prevent stroke and decrease the consequences of a stroke. Physical activity is also an important component in secondary prevention and rehabilitation after stroke. This thesis investigates the associations between physical activity before and after stroke in relation to stroke incidence, stroke severity, stroke mortality and functional outcomes after stroke. Methods: Study I was conducted using a population-based cohort from western Sweden collected in 2001 to 2004. Physical activity was assessed in four domains: leisure, work, transport, and household activities. Stroke incidence and death or dependency 3 months after stroke were recorded with a follow-up of 20 years. Study II and III utilized data from the local stroke-register at Sahlgrenska University Hospital between 2014 and 2019. Pre-stroke physical activity during the prior year was retrospectively evaluated. In Study II, stroke severity and mortality were assessed in patients with ischemic stroke and intracerebral hemorrhage. In Study III, hematoma volume, stroke severity, 1-week functional outcome, and 3-month survival were assessed in patients with intracerebral hemorrhage. In Study IV, data from a randomized controlled trial conducted between 2014 and 2019 was utilized. Physical activity and functional recovery in patients with acute stroke were followed up for 6 months. Results: In Study I (n=3614) leisure-time and transport physical activity were associated with reduced stroke incidence, and a high level of leisure-time physical activity was associated with a better post-stroke outcome. In Study II (n=5188) pre-stroke physical activity was associated with milder stroke symptoms and post-stroke survival independent of stroke type. In study III (n=686) pre-stroke physical activity was associated with smaller hematoma volumes in deep and lobar intracerebral hemorrhages, which partly mediated milder stroke symptoms, a good 1-week functional outcome and 3-month survival. In Study IV (n=1367), two distinct physical activity patterns were identified in the first 6 months after stroke: increasing or decreasing physical activity. Increased physical activity was associated with better functional recovery 6 months after stroke. Males and those with normal cognition were more likely to be in the increasing group. Conclusions: The results of this thesis indicate that physical activity has an important role in both the prevention and treatment of stroke. Being physically active before and after a stroke can improve outcomes following stroke

The impact of pre-stroke physical activity on outcomes after stroke: a scoping review protocol

Scoping review protoco

The impact of pre-stroke physical activity on outcomes after stroke: a scoping review protocol

Scoping review protoco

Predictors of do-not-attempt-resuscitation decisions in patients with infratentorial or large supratentorial intracerebral hemorrhages and consequences thereafter: a register-based, longitudinal study in Sweden

Abstract Objectives Do-not-attempt-resuscitation (DNAR) decisions for patients with infratentorial or large supratentorial intracerebral hemorrhages (ICHs) pose clinical and ethical challenges. We aimed to investigate factors associated with DNAR decisions in patients with infratentorial or large (≥30 mL) supratentorial ICH, and differences in complications, treatment, and mortality. Materials &amp; methods This longitudinal, observational study comprised all patients treated for ICH at three stroke units in Gothenburg, Sweden, between November 2014 and June 2019. Patients were identified in the local stroke register, and additional data were collected from medical records and national registries. Mortality rates were followed 1 year after incident ICHs. Factors associated with DNAR decisions, and one-year mortality were explored. Results Of 307 included patients, 164 received a DNAR decision. Most (75%) decisions were made within 24 h. DNAR decisions were associated with higher age, pre-stroke dependency, stroke severity, and intraventricular hemorrhage. Patients without DNAR decisions received thrombosis prophylaxis, oral antibiotics, and rehabilitative evaluations more frequently. The one-year survival probability was 0.16 (95% confidence interval [CI] 0.11–0.23) in patients with DNAR decisions, and 0.87 (95% CI 0.81–0.92) in patients without DNAR decision. DNAR decisions, higher age, stroke severity, hematoma volume, and comorbidities were associated with increased one-year mortality. Thrombosis prophylaxis and living alone were associated with a lower hazard. Conclusion The majority of DNAR decisions for patients with infratentorial or large supratentorial ICH were made within 48 h. Higher age, pre-stroke dependency, high stroke severity, and intraventricular hemorrhage predicted receiving a DNAR decision. DNAR decisions were strongly associated with increased short- and long-term mortality. </jats:sec

Prestroke physical activity and outcomes after intracerebral haemorrhage in comparison to ischaemic stroke: protocol for a matched cohort study (part of PAPSIGOT)

IntroductionPiling 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 analysisThis 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.EthicsData 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.</jats:sec

Predictors of do-not-attempt-resuscitation decisions in patients with infratentorial or large supratentorial intracerebral hemorrhages and consequences thereafter: a register-based, longitudinal study in Sweden

Abstract Objectives Do-not-attempt-resuscitation (DNAR) decisions for patients with infratentorial or large supratentorial intracerebral hemorrhages (ICHs) pose clinical and ethical challenges. We aimed to investigate factors associated with DNAR decisions in patients with infratentorial or large (≥30 mL) supratentorial ICH, and differences in complications, treatment, and mortality. Materials & methods This longitudinal, observational study comprised all patients treated for ICH at three stroke units in Gothenburg, Sweden, between November 2014 and June 2019. Patients were identified in the local stroke register, and additional data were collected from medical records and national registries. Mortality rates were followed 1 year after incident ICHs. Factors associated with DNAR decisions, and one-year mortality were explored. Results Of 307 included patients, 164 received a DNAR decision. Most (75%) decisions were made within 24 h. DNAR decisions were associated with higher age, pre-stroke dependency, stroke severity, and intraventricular hemorrhage. Patients without DNAR decisions received thrombosis prophylaxis, oral antibiotics, and rehabilitative evaluations more frequently. The one-year survival probability was 0.16 (95% confidence interval [CI] 0.11–0.23) in patients with DNAR decisions, and 0.87 (95% CI 0.81–0.92) in patients without DNAR decision. DNAR decisions, higher age, stroke severity, hematoma volume, and comorbidities were associated with increased one-year mortality. Thrombosis prophylaxis and living alone were associated with a lower hazard. Conclusion The majority of DNAR decisions for patients with infratentorial or large supratentorial ICH were made within 48 h. Higher age, pre-stroke dependency, high stroke severity, and intraventricular hemorrhage predicted receiving a DNAR decision. DNAR decisions were strongly associated with increased short- and long-term mortality

Sex Differences and 2‐Year Mortality in Patients With Atrial Fibrillation Diagnosed After Stroke and Known Atrial Fibrillation: A Register‐Based Study in Sweden

Background The objective of this study was to determine associations between atrial fibrillation diagnosed after stroke (AFDAS) and known atrial fibrillation with 2‐year mortality among men and women. Methods and Results This longitudinal, register‐based study included patients with ischemic stroke admitted to 3 hospitals in Gothenburg, Sweden, between November 1, 2014 and June 30, 2019. The exposures were known atrial fibrillation and AFDAS detected at the stroke units. The outcome was all‐cause mortality 2 years after stroke. Cox‐regression analyses were conducted to assess sex differences in relation to the adjusted mortality risk. Of 5468 patients with ischemic stroke, 2583 (47%) were women, and the mean age was 74 years (SD 14). Overall, 19% had known atrial fibrillation, and 10% had AFDAS. Women were older and had more severe strokes compared with men. Within the first month, women with AFDAS did not have an increased risk of mortality compared with women with no atrial fibrillation (hazard ratio, 0.93 [95% CI, 0.46–1.88]), in contrast to men with AFDAS who had an increased risk (hazard ratio, 2.14 [95% CI, 1.07–4.26]). Men and women with AFDAS had an increased risk of long‐term mortality (31 days to 2 years) compared with those with no atrial fibrillation. Known atrial fibrillation was associated with the highest poststroke mortality irrespective of sex and time interval. Conclusions Our findings suggest that underlying sex differences exist in the association between the occurrence of AFDAS and poststroke mortality. Sex differences related to the timing of atrial fibrillation diagnosis should be considered when developing preventive measures and medical care after stroke

A control for the day‐to‐day normalization of the flow cytometry γ‐H2AX assay for clinical routine

The phosphorylation of histone H2AX (γ-H2AX) at the DNA double-strand break (DSB) site is frequently used for quantifying DSBs and may be useful as a biomarker for clinical applications. We have previously reported a flow cytometry-based quantification of γ-H2AX for clinical routine. One major challenge, however, is the lack of a control sample for normalization of the day-to-day variation of the flow cytometry γ-H2AX assay.Here, we report development of a mix-control sample containing peripheral blood mononuclear cells (PBMC) from 10 control individuals, for normalization of day-to-day variation of the flow cytometry-γ-H2AX assay.We showed that control individuals sampled on different days show an average day-to-day variation (CV) of 34%, which was reduced to 12% after normalization to the control sample. The normalization allowed detection of radiosensitivity of lymphoblastoid cell lines from ataxia telangiectasia patients, sampled over three days.The mix-control sample, consisting of 10 control individuals' PBMC, can be used as a control sample to normalize for day-to-day variation of the γ-H2AX assay. The use of this sample will facilitate integration of the γ-H2AX assay into clinical routine. © 2018 International Clinical Cytometry Society

Levels of physical activity before and after stroke in relation to early cognitive function

AbstractRegular physical activity is widely recommended in the primary and secondary prevention of stroke. Physical activity may enhance cognitive performance after stroke, but cognitive impairments could also hinder a person to take part in physical activity. However, a majority of previous studies have not found any association between post-stroke cognitive impairments and a person’s subsequent level of activity. In this explorative, longitudinal study, we describe the intraindividual change in physical activity from before to 6 months after stroke, in relation to early screening of post-stroke cognitive impairments. Participants were recruited at 2 to 15 days after stroke, and screened for cognitive impairments using the Montreal Cognitive Assessment tool. Information on pre-stroke physical activity was retrospectively collected at hospital admittance by physiotherapists. Post-stroke physical activity was evaluated after 6 months. Of 49 participants included, 44 were followed up. The level of physical activity changed in more than half of all participants after stroke. Participants who were physically active 6 months after stroke presented with significantly less cognitive impairments. These results highlight that many stroke survivors experience a change in their physical activity level following stroke, and that unimpaired cognition may be important for a stroke survivors’ ability to be physically active.</jats:p