Is there an association between physical activity trajectories and functional recovery during the first six months after stroke?

Sub Levels


In a recent study published in JAMA network openinvestigators conducted a cohort study using prospectively collected longitudinal data of 1,500 participants in the Fluoxetine Efficacy-Randomized Controlled Trials in Stroke (EFFECTS) study.

The aim of this study was to assess the level of physical activity in stroke patients within 6 months after stroke in patients with similar levels of physical activity to investigate the association between physical activity and functional recovery. was.

study: Physical activity trajectory and functional recovery after acute stroke in Swedish adults. Image Credit: NewAfrica/Shutterstock.com

Background

To assess the safety and efficacy of fluoxetine for functional recovery after stroke, we conducted a multicenter, placebo-controlled, two-part study conducted between October 2014 and June 2019 in 35 stroke rehabilitation centers in Sweden. EFFECTS, a double-blind RCT.

In this study, researchers recruited participants aged 18 and older between 2 and 15 days after stroke onset and followed them for 6 months. They performed data analysis between August 15, 2022 and he October 28, 2022.

They assessed levels of physical activity during the first 6 months after stroke among individuals with similar physical activity patterns over time. We investigated the relationship with functional recovery.

prologue

Most stroke survivors (~40%) become physically inactive and have poor recovery. Physical inactivity also prevents patients from benefiting from post-hospital rehabilitation interventions.

Conversely, if stroke survivors maintain good physical activity levels despite chronic illness, it may promote better functional recovery.

Longitudinal studies have shown that several clinical factors may help restore previous levels of physical activity after stroke. was initially active, but was shown to be less active after discharge. However, they did not consider all temporal and interpersonal variability in the long run.

Investigating the temporal trajectory of physical activity to capture its long-term heterogeneity and its association with functional recovery is therefore clinically relevant but remains unclear.

Insight into when and why potential post-stroke decline in physical activity occurs may help target the right people with targeted interventions at the right intensity and duration to enhance functional outcomes. there is.

About research

In this study, investigators recruited adult participants from the EFFECTS study who had a clinical diagnosis of hemorrhagic/ischemic stroke and at least one neuropathy in the previous 2-15 days.

They used the National Institutes of Health Stroke Scale (NIHSS) to assess stroke severity. He helped classify stroke into three sublevels (very mild, mild, moderate to severe) as indicated by NIHSS scores of 0–3, 4–5, and ≥6, respectively.

In addition, they recorded whether participants had aphasia, the ability to lift both arms and walk without support, and cognitive impairment.

A Montreal Cognitive Assessment (MoCA) score at least 1 standard deviation (SD) below the mean indicated mild neurocognitive impairment compared to the Swedish population after accounting for age, gender, and educational status. .

Physiotherapists affiliated with the research team assessed each participant’s physical activity at 1 week, 1 month, and 3 months after stroke through face-to-face or telephone interviews, using group-based trajectory modeling. Evaluated at 6 months.

They assessed their physical activity level using the 4-point Saltin-Grimby Physical Activity Level Scale (SGPALS). SGPALS 1-4 demonstrated inactivity, light-, moderate-, and vigorous-intensity exercise for at least 4 hours per week.

As a secondary outcome of the study, the team monitored each participant’s functional recovery after 6 months using the 7-point Modified Rankin Scale (mRS). An mRS score ranging from 0 to 6 indicated no severe disability and permanent death.

However, researchers used dichotomous scores into two groups, as indicated by scores of 0–2 and 3–6, respectively. Good results and bad results.

Finally, researchers used multivariate logistic regression to assess the relationship between participants’ physical activity trajectories and functional recovery.

We also performed subgroup analyzes to explore interaction effects between each subgroup and study group in this model and presented results as odds ratios (OR) and 99% confidence intervals (CI).

result

The authors identified two different physical activity trajectories and a clear association between increased physical activity and favorable functional outcomes 6 months after stroke. Overall, the study population had low levels of physical activity, with approximately half of the participants inactive.

The increase and decrease groups increased or decreased their physical activity levels. The former maintained it at light intensity, while the latter eventually became inactive.

The maximum rate of decline ranged from 1 to 3 months before leveling off. This suggests that even knowing the importance of physical activity after stroke, motivation may decline after hospital discharge.

Regardless of stroke severity, male participants and participants with normal cognitive function were more likely to increase physical activity.

Early intervention and establishment of appropriate physical activity behaviors may enhance the functional benefits achieved during rehabilitation, particularly among potentially attenuated participants, e.g., female participants with cognitive impairment. .

In other words, you can make it easier to put knowledge into action before entering the plateau phase. In this regard, identifying gender differences in physical activity after stroke is important to reduce disability and effect behavioral changes among women who are typically less active than men.

Healthy cognition is essential for sustaining higher levels of physical activity after stroke, as reported in previous studies.

The present study also demonstrated that increased physical activity and having normal cognitive function were independently but significantly associated with better functional outcome. patients need specific interventions to improve functional outcomes.

Conclusion

Overall, the results of the study suggest that increasing physical activity levels of at least 4 hours per week in the subacute phase after stroke, at least light intensity, had an effect on covariate characteristics at 6 months, long before spontaneous recovery was diminished. It was confirmed that functional recovery was improved without

Men and patients with normal cognitive function were more likely to increase physical activity after stroke, regardless of stroke severity at admission.

Therefore, early rehabilitation was beneficial to increase the likelihood of functional recovery before the optimal window narrows with time. These interventions may play a role in functional recovery.

Increased physical activity may also improve neuroprotection and neuroplasticity in stroke survivors, as several studies have shown at the molecular level.

written by

Neha Mathur

Neha is a digital marketing professional based in Gurugram, India. She completed her master’s degree in Biotechnology in 2008 from the University of Rajasthan. She has her preclinical research experience as part of her research project at the prestigious Central Pharmaceutical Research Institute (CDRI) Department of Toxicology. India. She also holds a C++ programming certification.

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