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BACKGROUND AND OBJECTIVES: Pre-stroke physical activity may protect the brain from severe consequences of stroke. However, prior studies on this subject included mainly ischemic stroke cases, and the association between pre-stroke physical activity and outcomes after intracerebral hemorrhage is uncertain. Therefore, we sought to examine the associations between pre-stroke physical activity, stroke severity, and all-cause mortality after intracerebral hemorrhage in comparison to ischemic stroke.

METHODS: This was a longitudinal, register-based, cohort study. All adult patients with intracerebral hemorrhage or ischemic stroke admitted to three stroke units in Gothenburg, Sweden between 1 November 2014 and 30 June 2019 were screened for inclusion. Physical activity was defined as light physical activity ≥4 h/week, or moderate physical activity ≥2 h/week the year before stroke. Stroke severity was assessed on admission using the National Institutes of Health Stroke Scale. All-cause mortality rates were followed up to 7 years, from the time of incident stroke until death or censoring. Ordinal logit models and Cox proportional-hazards models were used to estimate adjusted associations of pre-stroke physical activity.

RESULTS: We included 763 patients with intracerebral hemorrhage and 4225 with ischemic stroke. Pre-stroke physical activity was associated with less severe strokes by an adjusted odds ratio of 3.57 (99% CI, 2.35-5.47) for intracerebral hemorrhages and 1.92 (99% CI 1.59-2.33) for ischemic strokes. During a median follow-up of 4.7 (IQR 3.5-5.9) years, 48.5% of patients with intracerebral hemorrhage died, compared to 37.5% with ischemic stroke. Pre-stroke physical activity was associated with decreased short-term mortality (0 to 30 days) by an adjusted hazard ratio of 0.30 (99% CI 0.17-0.54) after intracerebral hemorrhage, and 0.22 (99% CI 0.13-0.37) after ischemic stroke. Pre-stroke physical activity was further associated with decreased long-term mortality (30 days to 2 years) by an adjusted hazard ratio of 0.40 (99% CI 0.21-0.77) after intracerebral hemorrhage, and 0.49 (99% CI 0.38-0.62) after ischemic stroke.

DISCUSSION: Pre-stroke physical activity was associated with decreased stroke severity and all-cause mortality after intracerebral hemorrhage and ischemic stroke, independent of other risk factors. Based on current knowledge, health care professionals should promote physical activity as part of primary stroke prevention.