Poststroke White Matter Hyperintensities and Physical Activity: A CANVAS Study Exploratory Analysis

Abstract

Purpose: White matter hyperintensities (WMHs) are associated with poststroke cognitive decline and mortality. Physical activity (PA) may decrease WMH risk by reducing vascular risk factors and promoting cerebral perfusion. However, the association between poststroke PA and WMH progression remains unclear. We examined the association between PA and WMH volume 12 months after stroke, and between PA and change in WMH volume between 3 and 12 months after stroke. Methods: We included ischemic stroke survivors from the Cognition And Neocortical Volume After Stroke cohort with available brain magnetic resonance imaging and objective PA data. Total, periventricular, and deep WMH volumes (in milliliters) were estimated with manually edited, automated segmentations (Wisconsin White Matter Hyperintensities Segmentation toolbox). Moderate-to-vigorous intensity PA (MVPA) was estimated using the SenseWear® Armband. Participants with MVPA ≥30 min•d −1 were classified as "meeting PA guidelines." We used quantile regression to estimate the associations between PA (MVPA and meeting PA guidelines) with WMH volume at 12 months and change in WMH volume between 3 and 12 months after stroke. Results: A total of 100 participants were included (median National Institutes of Health Stroke Scale 2; interquartile range, 1-4). MVPA was not associated with WMH volume. In univariable analysis, meeting PA guidelines was associated with lower total, periventricular, and deep WMH volumes by 3.0 mL (95% confidence interval (CI), 0.5-9.7 mL), 2.8 mL (95% CI, 0.5-7.1 mL), and 0.9 mL (95% CI, 0.1-3.0 mL), respectively. However, in multivariable analysis, meeting PA guidelines was not associated with WMH volume, and older age was associated with greater WMH volume at 12 months. PA was not associated with change in WMH volume. Conclusions: Meeting PA guidelines was associated with lower WMH volume at 12 months in univariable analysis, but not in multivariable analysis. Age consistently predicted greater WMH volume.

Executive Function Poststroke: Concepts, Recovery, and Interventions

“…There is evidence that more aggressive risk factor management and secondary prevention strategies following stroke may reduce the emergence of further white matter disease or cause regression. 84,85 However, the nature of our testing strategies mean that it is difficult to distinguish the contributions of native mechanisms of recovery from practice effects caused by the very tests we use. Future cognitive rehabilitation studies examining the executive function domain will need to include tests designed for repeated administration and ideally a control group to test against natural trajectories.…”

Association of physical activity and PM2.5-attributable cardiovascular disease mortality in the United States

“…While some research studies have reported that outdoor PA may exacerbate PM2.5-attributable CVD risks ( 8 , 9 ), other studies have suggested that PA benefits may outweigh risks across all levels of PM2.5 exposures ( 10 ). However, existing studies have been limited to specific cohorts, providing inadequate evidence to guide public health policies on balancing the benefits and risks of promoting PA in polluted areas.…”

Editorial: The impact of physical activity on white matter during healthy aging

“…In addition to lowering the dementia risk factors, physical activity also impacts on brain neuroplasticity, neurogenesis and angiogenesis. Namely physical activity, via reducing vascular risk factors and promoting cerebral perfusion, decreases white matter damage, which is associated with (post-stroke) cognitive decline and mortality (Hung et al, 2022 ).…”