Journal of Rehabilitation Medicine 51-10 | Page 35

J Rehabil Med 2019; 51: 755–760 ORIGINAL REPORT RELATIONSHIP BETWEEN PRE-STROKE PHYSICAL ACTIVITY AND SYMPTOMS OF POST-STROKE ANXIETY AND DEPRESSION: AN OBSERVATIONAL STUDY Martina Reiten BOVIM, PhD 1 , Bent INDREDAVIK, MD, PhD 1,2 , Anne HOKSTAD, MD, PhD 1 , Toby CUMMING, PhD 3 , Julie BERNHARDT, PhD 3 and Torunn ASKIM, PhD 1,2 From the 1 Department of Neuromedicine and Movement Science, NTNU – Norwegian University of Science and Technology, 2 Stroke Unit, Department of Medicine, St Olavs Hospital, Trondheim, Norway and 3 Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia Objectives: To explore mechanisms affecting men- tal health in patients with stroke. The aims were to investigate the association between pre-stroke phy- sical activity and symptoms of anxiety and depres- sion 3 months after stroke, and to investigate how self-reported physical activity changed from before to 3 months after the stroke. Design: Secondary analyses of a prospective obser- vational multicentre study. Patients: Stroke patients from 11 Norwegian stroke units. Methods: Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale, and physical activity was assessed by self-re- port. Negative binomial regression was used to ana- lyse associations. Results: The analysed sample consisted of 205 pa- tients; mean age was 74 years (standard deviation (SD) 11.5); 46% were women. Higher activity levels before stroke were associated with fewer symptoms of depression in multivariable analyses with regres- sion coefficient of 0.84 (95% confidence interval 0.73–0.97), p  = 0.015. Eighty-five (41.5%) patients reported similar activity levels before and after stroke. Conclusion: In this group of patients with mild symp- toms of emotional distress, it seems that pre-stroke physical activity might be protective against post- stroke depression, but not anxiety. Many patients with mild-to-moderate stroke report being equally active before and after the stroke. Key words: cerebrovascular disease; mental health; exer- cise; depression; physical activity. Accepted Sep 18; 2019; Epub ahead of print Sep 30, 2019 J Rehabil Med 2019; 51: 755–760 Correspondence address: Martina Reiten Bovim, Norwegian University of Science and Technology (NTNU), Department of Medicine and Health Science, 7491 Trondheim, Norway. E-mail: [email protected] T he Global Burden of Disease studies state that de- pression and anxiety are among the leading causes of disability worldwide (1). Results from systematic reviews show that stroke patients are even more vulne- rable to emotional distress than the general population (2–5). The higher prevalence of post-stroke anxiety and depression might be a consequence of the life-changing LAY ABSTRACT Depression and anxiety are more common after stroke than in the general population. In non-stroke patients, physical activity and exercise is associated with less psychological distress. This study found that pre-stroke physical activity was associated with fewer depressive symptoms 3 months after stroke. However, being phy- sically active was not related to symptoms of anxiety. In addition, most patients reported performing approx- imately the same level of physical activity before and after stroke. Despite the lack of causality, these findings indicate that pre-stroke physical activity might be pro- tective against post-stroke depression, but not against anxiety. event of having a stroke (2, 6). However, evidence implies that underlying biological changes could have some importance, at least in the development of post- stroke depression (2). Both depression and anxiety are associated with poor outcome after stroke, affecting independence in activities of daily living, reducing quality of life and, in the case of depression, increasing mortality (7–10). There is some evidence of the beneficial effects of physical activity (PA) and exercise in stroke patients, as it reduces disability and the risk of subsequent car- diovascular events (11–14). Exercise seems to have a therapeutic effect in people with depression and anx- iety without stroke (15–17). Furthermore, epidemio- logical studies have found that higher levels of PA are associated with fewer symptoms of depression in the general population, while there is conflicting evidence of its association with anxiety symptoms (18–20). In the case of stroke, we know less about the potential relationship between PA and depression or anxiety. The aetiology of anxiety and mood disorders in stroke pa- tients might differ from that in non-stroke patients (2). While PA appears to be associated with less depressive symptoms after stroke, at least during maintenance of activity (21), it is unknown how post-stroke exercise influences anxiety. Importantly, most PA and exercise studies have failed to consider whether activity levels before the stroke may influence the prevalence of anx- iety and depression among stroke survivors. The primary aim of this study was to investigate the association between PA in the time before stroke, and This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2610