Train the Vessel, Gain the Brain: Physical Activity and Vessel Function and the Impact on Stroke Prevention and Outcome in Cerebrovascular Disease

Abstract

The burden of cerebrovascular disease (CVD) is huge and therapeutic options are limited. Physical activity is effective in preventing coronary heart and peripheral artery disease both experimentally and clinically. It is likely that the protective effects of exercise can be extended to both CVD and cognitive impairment. The pleiotropic protective and preventive mechanisms induced by physical activity include increased perfusion as well as mechanisms of collateral recruitment and neovascularization mediated by arterio- and angiogenesis. Physical activity increases the bioavailability of nitric oxide, bone marrow-derived CD34+ cells and growth factors, all of which promote neovascularization. Additionally, shear stress is discussed as a potential mechanism for vessel growth. Moreover, physical activity plays a role in endothelial function and cerebral autoregulation in small- and large-artery CVD. The vascular niche hypothesis highlights the complex interactions of neuro- and angiogenesis for regenerative and repair mechanisms in the human brain. Experimental and clinical studies demonstrate the positive impact of prior physical activity on stroke lesion size and on outcome after stroke. Clinical trials are necessary to further address the impact of physical activity on primary and secondary stroke prevention, outcome and cognitive function.

Cardiovascular risk factors cause premature rarefaction of the collateral circulation and greater ischemic tissue injury

“…Prior exercise training is associated with improved outcome and reduced infarct size in the setting of stroke. 68 While the coronary effects might reflect improved remodeling in collaterals already recruited by CAD, whether the latter results in stroke reflect improved remodeling, less rarefaction, better autoregulation of blood flow within trees adjacent to the occluded territory or enhanced neuroprotective mechanisms were not addressed. Our findings suggest that the beneficial effects of exercise in the above studies may reflect greater outward remodeling of collaterals and angiogenesis in the downstream tissues, rather than from preservation of native collaterals, although metabolic changes could also contribute.…”

Prestroke Physical Activity Is Associated with Good Functional Outcome and Arterial Recanalization after Stroke due to a Large Vessel Occlusion

“…Regular exercise is a promising preconditioning strategy that may improve brain tolerance to ischemia. The proposed mechanisms involved, among others, may include the release of angiogenic factors, reduction in the inflammatory response, increase in NO expression improving endothelial function, inhibition of overexpression of glutamate, protection of the blood-brain barrier and the mitigation of neuronal apoptosis [13,30]. In this line, we found that patients with higher levels of prestroke PhA presented with a significantly lower stroke severity, even after adjusting by site of arterial occlusion, a fact that may be related to a better collateral circulation in physically active patients.…”

A systematic review of the effect of physical exercise on cognition in stroke and traumatic brain injury patients

“…The idea that physical exercise can influence our brain is more recent, as scientific research into its plasticity only started around the 1940's (Hebb, 1949). During the last few decades, a large body of nonhuman animal research and a growing number of studies on humans show structural differences in the brain such as increases in growth factors (Szuhany, Bugatti, & Otto, 2015), higher levels of neurogenesis (van Praag, 2008), longer dendrites with a more complex morphology (Redila & Christie, 2006), enhanced long-term potentiation (van Praag, Christie, Sejnowski, & Gage, 1999), alterations in neurotransmitter systems (Meeusen, 2005), changes in cerebral blood flow (Ogoh & Ainslie, 2009), greater grey matter volume (Erickson, Leckie, & Weinstein, 2014), increased angiogenesis (Schmidt, Endres, Dimeo, & Jungehulsing, 2013) and higher levels of synaptogenesis (Ambroginia et al, 2013). These structural changes go hand in hand with changes in everyday living such as positive effects on mood (Duman, 2005), improved sleep quality (Yang, Ho, Chen, & Chien, 2012) and enhanced cognitive function (Hötting & Röder, 2013).…”