Relationship between pre-stroke physical activity and symptoms of post-stroke anxiety and depression: An observational study

Abstract

Depression and anxiety are more common after stroke than in the general population. In non-stroke patients, physical activity and exercise is associated with less psychological distress. This study found that pre-stroke physical activity was associated with fewer depressive symptoms 3 months after stroke. However, being physically active was not related to symptoms of anxiety. In addition, most patients reported performing approximately the same level of physical activity before and after stroke. Despite the lack of causality, these findings indicate that pre-stroke physical activity might be protective against post-stroke depression, but not against anxiety. Objectives: To explore mechanisms affecting mental health in patients with stroke. The aims were to investigate the association between pre-stroke physical activity and symptoms of anxiety and depression 3 months after stroke, and to investigate how self-reported physical activity changed from before to 3 months after the stroke. Design: Secondary analyses of a prospective observational multicentre study. Patients: Stroke patients from 11 Norwegian stroke units. Methods: Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale, and physical activity was assessed by self-report. Negative binomial regression was used to analyse associations. Results: The analysed sample consisted of 205 patients; mean age was 74 years (standard deviation (SD) 11.5); 46% were women. Higher activity levels before stroke were associated with fewer symptoms of depression in multivariable analyses with regression coefficient of 0.84 (95% confidence interval 0.73-0.97), p = 0.015. Eighty-five (41.5%) patients reported similar activity levels before and after stroke. Conclusion: In this group of patients with mild symptoms of emotional distress, it seems that pre-stroke physical activity might be protective against poststroke depression, but not anxiety. Many patients with mild-to-moderate stroke report being equally active before and after the stroke.

Prestroke Physical Activity and Poststroke Cognitive Performance

“…These findings are in line with previous findings that prestroke participation in physical and leisure activities is associated with better cognitive function after stroke [13]. Cognitive dysfunction is common in depression, and recently, Bovim et al [12, 22] found that prestroke PA level was associated with reduced depressive symptoms after stroke. This is the 1st study to examine the association between prestroke PA and long-term cognitive performance after stroke by using a validated questionnaire on prestroke PA collected in close relation to index stroke.…”

“…Data on the association between prestroke PA and poststroke cognitive function are sparse. Only 2 studies have examined the association between prestroke PA level and poststroke depressive symptoms [12] and cognitive function [13]. Neither of the studies interviewed patients in the acute phase and neither used validated PA assessment tools.…”

Pre-stroke physical activity in relation to post-stroke outcomes – linked to the International Classification of Functioning, Disability and Health (ICF): A scoping review

“…No associations have been found between pre-stroke PA and executive function (Animal Fluency Test; AFT), verbal memory (Word List Delayed Global; WLD), new learning (Word List Learning; WLL), or global cognition (Six-Item Screener; SIS) in the chronic phase of stroke recovery ( 36 ). Symptoms of depression measured with the Hospital Anxiety and Depression Scale (HADS) during late subacute phase of stroke recovery was associated with pre-stroke inactivity ( 29 ). Also, moderate to strenuous exercise before stroke was found to reduce the likelihood of post-stroke fatigue (Fatigue Severity Scale; FSS) ( 49 ).…”

Associations between pre-stroke physical activity and physical quality of life three months after stroke in patients with mild disability

“…Lifestyle factors like obesity, poor diet or physical inactivity are seen as major modifiable risk factors for stroke [5]. Regular physical activity decreases stroke incidence [6,7] and was associated with better cognitive function [8] and even fewer symptoms of depression [9] in those affected. There are a few studies which reported a significant association between pre-stroke physical activity and poststroke functional status as assessed by the National Institutes of Health Stroke Scale (NIHSS), the Modified Ranking Scale (mRS) and the Barthel Index [10][11][12][13].…”