Journal of Rehabilitation Medicine 51-10 | Page 37

Physical activity before stroke
Patients screened
for inclusion
n=547
Did not meet inclusion
criteria n=136
Palliative care (n=9)
Planned early discharge (n=59)
Not Norwegian speaking (n=3)
More than 14 days post-stroke (n=39)
Did not want to participate (n =26)
Patients included
and eligible
n=411
Excluded, n=21
No stroke diagnosis (n=16)
Early discharge from hospital (n=1)
Withdrew (n=1)
Lost to follow-up (n=3)
Inclusion, n=390
Patients with complete data
on pre-stroke PA, and PA
and HADS at 3 months
follow-up
n=205
Reasons for not completing
questionnaires n=185
Unknown (n=5)
Cognitive impairment (n=93)
Lost to follow up (n=13)
Incomplete schemes (n=34)
Dead ( n =39)
Did not wish to reply (n=1)
Table II. Baseline data of patients responding and not responding
to questionnaires
Women b , n (%)
Age c , mean (SD),
Patients in
analyses
n  = 205 Patients not
responding
n  = 185 p-value
95 (46.3)
74.0 (11.5) 106 (57.3)
79.9 (10.1) 0.031
< 0.001
median (25–75 th percentile) 75.1 (67.4–82.9) 81.5 (76.2–86.8)
Infarction b , n (%)
Haemorrhage b , n (%)
NIHSS d , mean (SD),
181 (88.3) 153 (82.7) 0.12
24 (11.7)
4.0 (3.6) 32 (17.3)
12.3 (8.7) 0.12
< 0.001
median (25–75 th percentile) 3.0 (1.5–6.0)
Premorbid mRS d , n (%)
mRS 0–2
mRS 3–5
mRS at 3 months d , n (%)
mRS 0–2
mRS 3–5
168 (82.0)
37 (18.0) 115 (62.2)
70 (37.8)
113 (55.1)
92 (44.9) 25 (13.5)
121 (65.4)
44 (21.5) a 60 (32.4)
< 0.001
Atrial fibrillation
44 (21.5) a
Previous stroke/TIA
Dementia 5 (2.4) a
Heart attack 35 (17.1)
a
140 (68.3) a
Hypertension
b
2
10.0 (5.0–19.0)
< 0.001
Comorbidity b , n (%)
0.006
34 (18.4) 0.57
24 (13.0) < 0.001
28 (15.1) 0.73
107 (57.8) 0.084
c
d
n  = 194; Pearson χ test; independent sample t-test; Mann–Whitney U test.
SD: standard deviation; NIHSS: National Institutes of Health Stroke Scale;
mRS: modified Rankin Scale; TIA: transient ischaemic attack.
a
Fig. 1. Flow chart of participants in the study. PA: physical activity;
HADS: Hospital Anxiety and Depression Scale.
RESULTS
757
A total of 547 patients were screened for inclusion, and 390
patients were included in the LEAST study. The flow of patients
is illustrated in Fig. 1.
Baseline information of patients with complete vs not com-
plete dataset is listed in Table II. Patients responding to the ques-
tionnaires, and hence included in the analyses, were significantly
younger, with less severe strokes and higher functional level
both pre- and post-stroke, compared with those not responding.
Among the 205 respondents, the median score on the HADS-
anxiety was 1 (interquartile range (IQR) = 4) and median score
on HADS-depression was 3 (IQR = 4) 3 months after stroke.
Thirty-four patients (16.6%) scored above the cut-off for
depression, and 23 patients (11.2%) scored above the cut-off
for anxiety.
Variance inflation factor (VIF) was below 1.6 for pairwise
correlation between all variables in the regression model, in-
dicating no severe collinearity between any of the covariates.
As shown in Table III, pre-stroke PA was not associated with
symptoms of anxiety 3 months after stroke, but it was associated
with symptoms of depression. In multivariable regression, pre-
stroke PA was associated with fewer symptoms of depression
when adjusted for age, sex, premorbid mRS and NIHSS at
inclusion. This association indicates that for each unit increase
in premorbid PA, the score on HADS-depression is reduced by
a factor of 0.84, 95% CI 0.73–0.97, p = 0.015.
Fig. 2 illustrates the number of patients reporting different ac-
tivity levels before and after stroke. Eighty-five patients (41.5%)
reported the same activity level premorbid and 3 months after
stroke. Sixty-eight patients (33.2%) reported a lower activity
level 3 months after stroke than before the stroke, while 52
patients (25.4%) reported a higher activity level 3 months after
stroke. There were no significant differences in the activity
levels reported pre- and post-stroke, p = 0.325. Among the 34
patients scoring above cut-off for depression post-stroke, 3%
reported no PA before the stroke. Very light PA was reported
in 47%, light PA in 35%, moderate PA in 12% and hard PA in
Table III. Regression analysis for the association between physical activity before stroke and symptom of anxiety and depression
after stroke
Anxiety symptoms
Univariable analysis
Age, years
Sex
Premorbid mRS
NIHSS at inclusion
PA before the stroke
Multivariable analysis
Age, years
Sex
Premorbid mRS
NIHSS at inclusion
PA before the stroke
Depression symptoms
Regression
coefficient 95% CI p-value Regression
coefficient 95% CI p-value
1.0
1.35
1.32
1.04
0.92 0.98–1.01
0.95–1.90
1.12–1.56
0.99–1.09
0.77–1.09 0.77
0.091
0.001
0.12
0.31 1.01
1.29
1.44
1.052
0.75 1.00–1.02
0.97–1.72
1.27–1.63
1.01–1.09
0.65–0.86 0.055
0.077
< 0.001
0.011
< 0.001
0.99
1.26
1.35
1.02
1.01 0.97–1.00
0.89–1.77
1.12–1.63
0.97–1.07
0.84–1.22 0.10
0.19
0.002
0.43
0.90 1.00
1.06
1.31
1.03
0.84 0.99–1.01
0.81–1.39
1.14–1.51
0.99–1.06
0.73–0.97 0.96
0.67
< 0.001
0.17
0.015
PA: physical activity; 95% CI: 95% confidence interval; NIHSS: National Institutes of Health Stroke Scale; mRS: modified Rankin Scale.
J Rehabil Med 51, 2019