Physical activity after ischemic stroke and its association with adverse outcomes: A nationwide population-based cohort study

Abstract

Background Sufficient physical activity (PA) is highly recommended to improve the prognosis after stroke. However, there have been only a few studies evaluating the changes in PA level after stroke. Aims We aimed to identify the changes in PA level between before and after stroke, and to determine the association between PA and adverse outcomes. Methods This observational, retrospective cohort study was performed using the Nationwide Health Insurance Service (NHIS) database in South Korea. Subjects between the ages of 20 to 80 years, who had a first-ever ischemic stroke from 2010 to 2013, were included. Subjects were divided into either the "sufficient" or "insufficient" subgroups, depending on the result of the self-reported PA questionnaire. Adverse outcomes, including all-cause mortality, stroke recurrence, and myocardial infarction (MI), were collected from a post-stroke health checkup to 2017. Results Of the 34,243 subjects with ischemic stroke, only 21.24% had sufficient PA level after stroke. Among those with insufficient PA level, only 17.34% improved their PA level after stroke. Subjects with sufficient PA level after stroke, regardless of their PA level prior to stroke, showed a lower risk of composite adverse outcomes (adjusted Hazard Ratio [HR], 95% CI: 0.85, 0.80-0.90). Subjects who went from insufficient to sufficient PA level (HR 0.87, 95% CI: 0.81-0.93) showed a significantly lower risk of composite adverse outcomes. Conclusions Achieving a sufficient PA level after ischemic stroke appears to significantly reduce major adverse events. Further effort is needed to promote the PA level after ischemic stroke.