Journal of Rehabilitation Medicine 51-9 | Page 22

J Rehabil Med 2019; 51: 646–651 ORIGINAL REPORT A PHYSICAL ACTIVITY INTERVENTION TO PREVENT COGNITIVE DECLINE AFTER STROKE: SECONDARY RESULTS FROM THE LIFE AFTER STROKE STUDY, AN 18-MONTH RANDOMIZED CONTROLLED TRIAL Hege IHLE-HANSEN, MD, PhD 1,2 , Birgitta LANGHAMMER, PhD 3,4 , Stian LYDERSEN, PhD 5 , Mari GUNNES, MSc 6 , Bent INDREDAVIK, MD, PhD 6,7 and Torunn ASKIM, PhD 6,7 ; on behalf of the LAST Collaboration group From the 1 Department of Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Bærum, 2 Department of Medicine, Oslo University Hospital, Ullevål, Oslo, 3 Department of Physiotherapy, Oslo Metropolitan University, Oslo, 4 Sunnaas Rehabilitation Hospital, HF, Nesoddtangen, 5 Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, NTNU, Norwegian University of Science and Technology, 6 Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, and 7 Department of Medicine, Stroke Unit, Trondheim University Hospital, Trondheim, Norway Objective: To examine the effects of individualized regular coaching and exercise on post-stroke cogni- tive and emotional function. Methods: The Life After STroke (LAST) study investi- gated the differences between intervention and ca- re-as-usual between 3 and 21 months post-stroke. Outcome measures were the Trail Making Test (TMT) A and B, Mini Mental State Examination (MMSE), Hospital Anxiety and Depression Scale (HADS), and adherence to the intervention. Results: Of the 362 patients included in the study, 177 were assigned to the intervention. The mean age was 71.7 years (SD 11.3) and 39.5% were female. The adjusted mean difference between groups for TMT A was 8.54 (95% CI 0.7 to 6.3), p  = 0.032, for TMT B 8.6 (95% CI –16.5 to 33.6), p  = 0.50, for MMSE –0.1 (95% CI –0.8 to 0. 6), p  = 0.77, for HADS A –0.2 (95% CI –0.9 to 0.5), p  = 0.56 and for HADS D –0.1 (95% CI –0.7 to 0.5), p  = 0.76). A higher level of adherence to the in- tervention was significantly associated with increased MMSE (B  = 0.030 (95% CI 0.005–0.055), p  = 0.020). Conclusion: No clinically relevant effects on cognitive or emotional function were found of individualized regular coaching for physical activity and exercise. However, increased adherence to the intervention was associated with improved cognitive function. Key words: stroke; intervention; physical activity; cognition. Accepted Jul 17, 2019; Epub ahead of print Aug 20, 2019 J Rehabil Med 2019; 51: 646–651 Correspondence address: Hege Ihle-Hansen, Department of Medicine, Oslo University Hospital, Postboks 4950 Nydalen, NO-0424 Oslo, Nor- way. E-mail: [email protected] P hysical activity and exercise is recommended to stroke survivors for prevention of stroke recur- rence (1) and to improve functional outcome (2). Best practice recommendations include promotion of phy- sical activity and advice to engage in regular exercise of moderate-to-high intensity levels on most days of the week (1). However, the levels of intensity in post- stroke physical activity are often light-to-moderate (3). LAY ABSTRACT Physical activity may help to keep the brain healthier and preserve cognitive ability and mood years after a stroke. In The Life After STroke (LAST) study, stroke survivors were allocated into 2 groups. A training group was encouraged to perform physical activity for 30 min daily, and 45–60 min of moderate-to-intense physical exercise every week. A control group was followed by their general practitioner as usual. This study aimed to measure the effect on cognitive and emotional function in both groups after 18 months. Of the 362 participants, almost half were in the training group. The mean age was 72 years and 40% were female. There were no dif- ferences between the groups regarding effect on cogni- tive or emotional function. In conclusion, this study did not show an effect of the physical training programme on cognition or mood after stroke. Interventions based on risk assessment and risk factor management post-stroke are increasingly common, with stroke recurrence or physical function as outcome (4, 5). Prevention of cognitive decline in high-risk persons is shown to be possible when physical, cognitive, vas- cular and nutritional interventions are given regularly (6). A recently published meta-analysis of randomized controlled trials (RCTs) showed a positive effect of physical activity on cognitive performance post-stroke (7), especially on attention and processing speed and through programmes combining aerobic interventions and stretching. However, the included studies involved young patients, small sample sizes, and interventions lasting from 4 to 24 weeks. So far, multifactorial inter- ventions aiming to prevent post-stroke cognitive decline have not been shown to be effective, possibly due to heterogeneity, short follow-ups, and low intensity (8). The Life After STroke (LAST) study assessed the ef- fect on motor function of individualized regular coach- ing on physical activity and exercise for 18 months post-stroke (9). Despite neutral results on primary outcome, the aim of the current study was to investigate whether the intervention could improve cognitive or This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm doi: 10.2340/16501977-2588 Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977