High Prestroke Physical Activity Is Associated with Reduced Infarct Growth in Acute Ischemic Stroke Patients Treated with Intravenous tPA and Randomized to Remote Ischemic Perconditioning

Blauenfeldt, Rolf Ankerlund; Hougaard, Kristina Dupont; Mouridsen, Kim; Andersen, Grethe

doi:10.1159/000477359

Cited by 19 publications

(15 citation statements)

References 32 publications

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“…Whether our results reflect an improved cognitive performance fueled by prestroke PA and thus resilience against cognitive decline after stroke, or a protective/“preconditioning” effect of being active before a stroke occurs, is unknown. Unfortunately, baseline cognitive assessment and follow-up neuroimaging with measurement of acute infarct growth/final infarct size were not obtained, but could have proven valuable in exploring both the temporal effects and the mechanistic link behind a potential protective effect of prestroke PA [3, 5]. Further studies are thus needed to disentangle these aspects.…”

Section: Discussionmentioning

confidence: 99%

“…Physical activity (PA) is associated with lower stroke risk and mortality as well as a favorable stroke outcome and appears to be a potential general preventive measure against cognitive decline [1][2][3]. Accumulating evidence indicates a possible brain protective effect of prestroke PA [4,5]. The mechanism is largely unknown; however, it seems to go beyond modification of traditional risk factors and may include reduced oxidative damage, inflammation, and capillary dysfunction following a stroke [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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Prestroke Physical Activity and Poststroke Cognitive Performance

et al. 2020

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Introduction: Physical activity (PA) is associated with a lower risk of stroke and stroke mortality as well as a favorable stroke outcome. PA may also prevent general cognitive decline. Poststroke cognitive impairment is both common and disabling, and focusing on all possible preventive measures is important. Studies on the effect of PA on poststroke cognitive performance are sparse, however. We therefore aimed to examine the association between prestroke PA and poststroke cognitive performance. Methods: We studied the correlation between prestroke PA and poststroke cognitive performance in a prespecified analysis in The Efficacy of Citalopram Treatment in Acute Ischemic Stroke (TALOS) trial. We used the Physical Activity Scale for the Elderly (PASE) to collect information on PA during the 7-day period before stroke. PA was quantified, and patients were stratified into quartiles based on their PASE score. Cognitive performance was measured using the Symbol Digit Modalities Test (SDMT) at 1 and 6 months and the Mini-Mental State Examination (MMSE) at 6 months. The functional outcome was assessed using the modified Rankin Scale (mRS). Results: In total, 625 of 642 patients (97%) completed the PASE questionnaire. The median age was 69 (interquartile range [IQR]: 60–77), and the median PASE score was 137 (82–205). Higher prestroke PASE quartiles (2nd, 3rd, and 4th, each compared to the 1st) were independently associated with a higher SDMT score at 1 month in the both the univariable and multivariable analyses (2nd: 3.99 points, 95% confidence interval [CI]: 1.01–6.97; 3rd: 3.6, CI: 0.6–6.61; 4th: 4.1, CI: 0.95–7.24). This association remained at 6 months. PA was not statistically associated with the MMSE score or mRS. Conclusion: Higher prestroke PA was associated with a better cognitive performance as measured by the SDMT at 1 and 6 months poststroke. We found no significant association between prestroke PA and functional outcome. Our results are encouraging and support further investigations of PA as a protective measure against poststroke cognitive impairment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prestroke Physical Activity and Poststroke Cognitive Performance

et al. 2020

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“…Overall, the study showed RIPerC to be safe and feasible in the setting of AIS, with the likely benefit of greater tissue survival in the penumbra than the control ( 62 ). Another randomized trial also found that high prestroke physical activity is associated with reduced infarct size after IV tPA treatment only in patients receiving adjuvant RIPerC ( 97 ). While a French multicentric trial of RIC for ischemic stroke within 6 h of symptom onset is currently underway.…”

Section: Clinical Applicationsmentioning

confidence: 99%

Remote Ischemic Conditioning in Cerebral Diseases and Neurointerventional Procedures: Recent Research Progress

Zhou

Tudor

et al. 2018

Front. Neurol.

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Cerebral ischemia and stroke are increasing in prevalence and are among the leading causes of morbidity and mortality in both developed and developing countries. Despite the progress in endovascular treatment, ischemia/reperfusion (IR) injury is an important contributor to post-surgical mortality and morbidity affecting a wide range of neurointerventional procedures. However, pharmacological recruitment of effective cerebral protective signaling has been largely disappointing to date. In remote ischemic conditioning (RIC), repetitive transient mechanical obstruction of vessels at a limb remote from the IR injury site protects vital organs from IR injury and confers infarction size reduction following prolonged arterial occlusion. Results of pharmacologic agents appear to be species specific, while RIC is based on the neuroprotective influences of phosphorylated protein kinase B, signaling proteins, nitric oxide, and transcriptional activators, the benefits of which have been confirmed in many species. Inducing RIC protection in patients undergoing cerebral vascular surgery or those who are at high risk of brain injury has been the subject of research and has been enacted in clinical settings. Its simplicity and non-invasive nature, as well as the flexibility of the timing of RIC stimulus, also makes it feasible to apply alongside neurointerventional procedures. Furthermore, despite nonuniform RIC protocols, emerging literature demonstrates improved clinical outcomes. The aims of this article are to summarize the potential mechanisms underlying different forms of conditioning, to explore the current translation of this paradigm from laboratory to neurovascular diseases, and to outline applications for patient care.

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“…Interestingly, it showed for every 60 minutes/day increase in total physical activity there was a reduction of 28% of all-cause mortality related to stroke [ 8 ]. Additional validation for the positive impact of physical activity on stroke risk, as well as the degree of insult, was revealed in a subanalysis of data from a randomized clinical trial done in 2017 where patients with high pre-stroke physical activity (mainly treated with t-PA) had a reduction in the size of infarct growth in 24 hours, as well as the final infarct size [ 9 ].…”

Section: Reviewmentioning

confidence: 99%

Occupational Physical Activity in Young Adults and Stroke: Was It Due to My Job?

Abdalla

Rutkofsky

Syeda

et al. 2018

Cureus

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The association of physical activity and stroke among working young adults and vice versa has increasingly empathized in recent years. Lack of physical activity, along with many other modifiable risk factors, such as hypertension, obesity, atherosclerosis, and diabetes, contributes through vascular dysfunction to the development of adverse cerebrovascular events in the future and has always been a topic of interest in the fields of neurology and stroke rehabilitation. We wrote this review article to elaborate on this relationship in detail. This article suggests that the physical activity role in stroke development and the rehabilitation process has a diverse role, where individuals with low physically active occupations are prone to develop a stroke more readily in comparison with other workers who have a moderate amount of physical activity in their jobs; however, less mobility appeared to be harmful too soon after stroke. In addition, we elucidate the effects of physical activity on sympathetic activity and remodeling of vascular response. Alterations in the neuroendocrine system include several factors. This includes harmful changes caused by increasing levels of epinephrine and norepinephrine. These changes are seen with stress-induced cerebrovascular injury and are often elevated in post-stroke patients. In contrast, post-stroke patients engaged in physical activity may prevent these harmful neurotrophic factors by reducing the elevated levels of epinephrine and norepinephrine. However, we need more studies in the near future to further explore this association process. Therefore, we recommend more research to explore the relationship of occupation-related factors and adverse stroke outcomes.

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High Prestroke Physical Activity Is Associated with Reduced Infarct Growth in Acute Ischemic Stroke Patients Treated with Intravenous tPA and Randomized to Remote Ischemic Perconditioning

Cited by 19 publications

References 32 publications

Prestroke Physical Activity and Poststroke Cognitive Performance

Prestroke Physical Activity and Poststroke Cognitive Performance

Remote Ischemic Conditioning in Cerebral Diseases and Neurointerventional Procedures: Recent Research Progress

Occupational Physical Activity in Young Adults and Stroke: Was It Due to My Job?

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