Abstract
Objective
To identify the prognostic value of physical activity-related factors as well as known
vascular risk factors for vascular events in mild ischemic stroke (MIS).
Design
Single-center prospective cohort study.
Setting
University hospital.
Participants
Consecutive patients (N=255) (175 men, median age 70.0y) with acute ischemic stroke
and transient ischemic attack (TIA) with modified Rankin scale scores ranging from
0 to 2 were enrolled in this study.
Interventions
Not applicable.
Main Outcome Measures
Enrolled patients were followed up for composite vascular events as primary outcomes
up to 3 years postdischarge. Primary outcomes included stroke and cardiovascular death,
hospitalization due to stroke or TIA recurrence, cardiovascular disease, and peripheral
artery disease. During hospitalization, known vascular risk factors such as previous
history of vascular events, stroke subtype, white matter lesions, and ankle-brachial
index were assessed. Moreover, at the time of discharge, physical activity-related
factors such as maximum walking speed (MWS), handgrip strength, knee extensor isometric
muscle strength, anxiety, and depression were assessed as potential predictors.
Results
The Kaplan-Meier estimates of cumulative risk of composite vascular events at 1, 2,
and 3 years were 9.6%, 14.4%, and 15.2%, respectively. After multivariate analysis,
cerebral white matter lesions of periventricular hyperintensity (PVH) (grade=3; hazard
ratio: 2.904; 95% confidence interval: 1.160 to 7.266; P=.023) and MWS (<1.45m/s; hazard ratio: 2.232; 95% confidence interval: 1.010 to 4.933;
P=.047) were identified as significant independent predictors of composite vascular
events.
Conclusions
The results of this study indicate that MWS could be an independent prognostic factor
for composite vascular events in MIS.
Keywords
List of Abbreviations:
BMI (body mass index), DBP (diastolic blood pressure), DWMH (deep white matter hyperintensity), HbA1c (hemoglobin A1c), HDL-C (high-density lipoprotein cholesterol), LDL-C (low-density lipoprotein cholesterol), MIS (mild ischemic stroke), mRS (modified Rankin Scale), MWS (maximum walking speed), PA (physical activity), PVH (periventricular hyperintensity), SBP (systolic blood pressure), TG (triglycerides), TIA (transient ischemic attack)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Heart disease and stroke statistics—2016 update: a report from the American Heart Association.Circulation. 2016; 133: e38-e360
- Update on the global burden of ischemic and hemorrhagic stroke in 1990-2013: the GBD 2013 Study.Neuroepidemiology. 2015; 45: 161-176
- Stroke data bank 2009.Nakayama Shoten, Tokyo2009
- Long-term survival and vascular event risk after transient ischaemic attack or minor ischaemic stroke: a cohort study.Lancet. 2005; 365: 2098-2104
- Predictive impact of daily physical activity on new vascular events in patients with mild ischemic stroke.Int J Stroke. 2015; 10: 219-223
- One-year risk of stroke after transient ischemic attack or minor stroke.N Engl J Med. 2016; 374: 1533-1542
- Recurrence risk after noncardioembolic mild ischemic stroke in a Japanese population.Cerebrovasc Dis. 2011; 31: 365-372
- Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2014; 45: 2160-2236
- Inter-society consensus for the management of peripheral arterial disease (TASC II).J Vasc Surg. 2007; 45: S5-S67
- Guidelines for the primary prevention of stroke: a statement for health care professionals from the American Heart Association/American Stroke Association.Stroke. 2014; 45: 3754-3832
- Special report from the National Institute of Neurological Disorders and Stroke. Classification of cerebrovascular diseases III.Stroke. 1990; 21: 637-676
- Definition and evaluation of transient ischemic attack: a scientific statement for health care professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists.Stroke. 2009; 40: 2276-2293
- MR signal abnormalities at 1.5 T in alzheimer’s, dementia, and normal aging.AJR Am J Roentgenol. 1987; 149: 351-356
- The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2009).Hypertens Res. 2009; 32: 3-107
- Executive summary of the Japan Atherosclerosis Society (JAS) guidelines for the diagnosis and prevention of atherosclerotic cardiovascular diseases in Japan; 2012 version.J Atheroscler Thromb. 2013; 20: 517-523
- Report of the committee on the classification and diagnostic criteria of diabetes mellitus.J Diabetes Investig. 2010; 1: 212-228
- Metabolic syndrome—definition and diagnostic criteria in Japan.J Atheroscler Thromb. 2005; 12: 301
- Habitual physical activity and physical fitness in older Japanese adults: the Nakanojo Study.Gerontology. 2009; 55: 523-531
- Habitual physical activity levels are associated with performance in measures of physical function and mobility in older men.J Am Geriatr Soc. 2010; 58: 1727-1733
- Comparison of the LASA Physical Activity Questionnaire with a 7-day diary and pedometer.J Clin Epidemiol. 2004; 57: 252-258
- Physical activity and common mental disorders.Br J Psychiatry. 2010; 197: 357-364
- The hospital anxiety and depression scale.Acta Psychiatr Scand. 1983; 67: 361-370
- Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for health care professionals from the American Heart Association/American Stroke Association.Stroke. 2011; 42: 227-276
- Overview of the MNA—its history and challenges.J Nutr Health Aging. 2006; 10: 456-463
- Serum albumin level is associated with the recurrence of acute ischemic stroke.Am J Emerg Med. 2016; 34: 1812-1816
- Reduced walking speed and distance as harbingers of the approaching grim reaper.Am J Cardiol. 2015; 116: 313-317
- 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.Circulation. 2014; 129: S76-S99
- Secondary prevention of new vascular events with lifestyle intervention in patients with noncardioembolic mild ischemic stroke: a single-center randomized controlled trial.Cerebrovasc Dis. 2013; 36: 88-97
- Inflammatory markers and physical performance in older persons: the InCHIANTI study.J Gerontol A Biol Sci Med Sci. 2004; 59: 242-248
- High-density lipoprotein cholesterol and objective measures of lower extremity performance in older nondisabled persons: the InChianti study.J Am Geriatr Soc. 2008; 56: 621-629
- Walking speed and subclinical atherosclerosis in healthy older adults: the Whitehall II study.Heart. 2010; 96: 380-384
- Cross-sectional association between homocysteine and motor function in the elderly.Neurology. 2006; 67: 985-990
- Hypertension and lower walking speed in the elderly: the Three-City study.J Hypertens. 2010; 28: 1506-1514
- Quadriceps strength, quadriceps power, and gait speed in older U.S. adults with diabetes mellitus: results from the National Health and Nutrition Examination Survey, 1999-2002.J Am Geriatr Soc. 2013; 61: 769-775
- Common carotid artery intima-media thickness, carotid plaques, and walking speed.Stroke. 2005; 36: 2198-2202
- Association of gait and balance disorders with age-related white matter changes: the LADIS Study.Neurology. 2008; 70: 935-942
- Leg muscle mass and composition in relation to lower extremity performance in men and women aged 70 to 79: the health, aging and body composition study.J Am Geriatr Soc. 2002; 50: 897-904
- Echo intensity is negatively associated with functional capacity in older women.Age (Dordr). 2014; 36: 9708
- Muscles, exercise and obesity: skeletal muscle as a secretory organ.Nat Rev Endocrinol. 2012; 8: 457-465
- Association between regional adipose tissue distribution and both type 2 diabetes and impaired glucose tolerance in elderly men and women.Diabetes Care. 2003; 26: 372-379
- Relationship between sarcopenic obesity and cardiovascular disease risk as estimated by the Framingham risk score.J Korean Med Sci. 2015; 30: 264-271
- Greater skeletal muscle fat infiltration is associated with higher all-cause and cardiovascular mortality in older men.J Gerontol A Biol Sci Med Sci. 2015; 70: 1133-1140
- Association between gait speed as a measure of frailty and risk of cardiovascular events after myocardial infarction.J Am Coll Cardiol. 2013; 61: 1964-1972
- Incremental value of gait speed in predicting prognosis of older adults with heart failure: insights rrom the IMAGE-HF Study.JACC Heart Fail. 2016; 4: 289-298
- Silent brain infarcts and white matter lesions increase stroke risk in the general population: the Rotterdam Scan Study.Stroke. 2003; 34: 1126-1129
- Extensive leukoaraiosis is associated with high early risk of recurrence after ischemic stroke.Stroke. 2014; 45: 479-485
- Cerebral white matter lesions predict both ischemic strokes and myocardial infarctions in patients with established atherosclerotic disease.Atherosclerosis. 2006; 186: 166-172
- Pathologic correlates of incidental MRI white matter signal hyperintensities.Neurology. 1993; 43: 1683-1689
- Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges.Lancet Neurol. 2010; 9: 689-701
- Cerebral white matter lesions and atherosclerosis in the Rotterdam Study.Lancet. 1993; 341: 1232-1237
- High-dose atorvastatin after stroke or transient ischemic attack.N Engl J Med. 2006; 355: 549-559
- Cognitive impairment and risk of stroke: a systematic review and meta-analysis of prospective cohort studies.Stroke. 2014; 45: 1342-1348
Article info
Publication history
Published online: June 26, 2018
Footnotes
Supported partly by the Grant-in-Aid for Challenging Exploratory Research from the Japan Society for the Promotion of Science (grant no. 23650322; Principal Investigator: Sumio Yamada).
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
