Moderate Exercise Found to Lower All-cause Mortality After Stroke, Particularly in Younger Patients

A new study suggests that walking even 3 or 4 hours a week may reduce long-term mortality from any cause in patients with a history of stroke.

Exercise was associated with lower all-cause mortality in a dose-dependent manner among patients with a history of stroke, especially younger individuals, according to a new study published in Neurology.

“Our results are exciting, because just three to four hours a week of walking was associated with big reductions in mortality, and that may be attainable for many community members with prior stroke,” said lead author Raed A. Joundi, MD, DPhil, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Canada, in a press release. “In addition, we found people achieved even greater benefit with walking six to seven hours per week. These results might have implications for guidelines for stroke survivors in the future.”

Joundi and colleagues aimed to determine the association between physical activity and mortality in community-dwelling persons after a stroke. The Canadian Community Health Survey (CCHS) was used to obtain self-reported exercise across 4 survey cycles (2009, 2010, 2013, and 2014), and was linked to administrative databases so researchers could obtain prior data on diagnosis of stroke and subsequent all-cause mortality.

Physical activity was measured as metabolic equivalents (METs) per week, with 10 MET-hours a week as the threshold for meeting minimal physical activity guidelines. Researchers used Cox proportional hazard regression models and restricted cubic splines to examine the link between exercise and all-cause mortality among participants with prior stroke and controls, adjusting for sociodemographic factors, comorbidities, and functional health limitations.

The study cohort included 895 individuals with prior stroke (mean age, 71.7 years; 42% women) and 97 805 control participants (mean age, 63 years; 51.5% women). Median follow-up was 4.8 years in the control group and 4.2 years for those with prior stroke.

The majority of participants with prior stroke experienced an ischemic stroke (92%), according to the study.

Researchers found a higher proportion of deaths in the study period among participants with prior stroke (24.6%) compared to the control group (5.7%).

Adherence to the exercise guidelines of 10 MET-hours per week was associated with a reduction in mortality in participants with prior stroke (adjusted hazard ratio [aHR], 0.46; 95% CI, 0.29-0.73) and those in the control group (aHR, 0.69; 95% CI, 0.62-0.76), according to the study.

Researchers observed a strong dose-response relationship in both cohorts, “with a steep early slope and the vast majority of associated risk reduction occurring between 0 and 20 MET-hours/week,” wrote authors.

Among participants with prior stroke, physical activity was associated with a greater risk reduction in those aged <75 years (aHR, 0.21; 95% CI, 0.10-0.43) compared to those aged ≥75 years (aHR, 0.68; 95% CI, 0.42-1.12).

“Our results suggest that getting a minimum amount of physical activity may reduce long-term mortality from any cause in stroke survivors,” said Joundi in the press release. “We should particularly emphasize this to stroke survivors who are younger in age, as they may gain the greatest health benefits from walking just thirty minutes each day.”

The researchers did note that a limitation to the study was that self-reported exercise levels may be associated with response biases.

Reference: Joundi RA, Patten SB, Lukmanji A, Va Williams J, Smith EE. Association between physical activity and mortality among community-dwelling stroke survivors. Neurology. Online ahead of print. DOI: 10.1212/WNL.0000000000012535.