EXPRESS: Pre-Stroke Physical Activity and Admission Stroke Severity: A Systematic Review.

Abstract

Background: Admission stroke severity is an important clinical predictor of stroke outcomes. Pre-stroke physical activity (PA) contributes to stroke prevention and may also be associated with reduced stroke severity. Summarising the evidence to-date will inform strategies to reduce burden after stroke. Aims: To summarise the published evidence for the relationship between pre-stroke physical activity (PA) and admission stroke severity and to provide recommendations for future research.Summary of Review MEDLINE, Embase, Emcare, CENTRAL and gray literature databases were searched on February 14, 2020 using search terms related to stroke and pre-stroke PA. We screened 8,152 references and assessed 172 full-text references for eligibility. The final review included seven studies (n=41,800 stroke patients). All studies were observational, assessed pre-stroke PA using self-reported questionnaires, and assessed admission stroke severity using the National Institute of Health Stroke Scale. Pre-stroke PA was associated with milder stroke severity (4/7 studies). Greater pre-stroke PA duration (1/7 studies), intensity (1/7 studies), or amount (3/7 studies) were independently associated with milder stroke severity. Studies ranged between moderate to critical risk of bias, primarily due to confounding factors. Pre-stroke PA was associated with reduced risk factors for severe stroke, distal occlusion, smaller infarcts, and treatment delays. Conclusion: Pre-stroke PA may be associated with reduced admission stroke severity. Lack of randomised controlled trials limited causality conclusions. Further investigation is needed to understand the effect of pre-stroke PA on admission stroke severity. â.