Functional Limitations in Stroke Survivors: Pre-Stroke Physical Activity Matters

BACKGROUND AND PURPOSE. In the chronic phase after a stroke, limitations in activities of daily living (ADL) and instrumental ADL (IADL) initially plateau before steadily increasing. However, the benefits of pre-stroke levels of physical activity on these limitations remain unclear. To clarify this relationship, this study compares the effect of physical activity on the long-term evolution of I/ADL limitations between stroke survivors and stroke-free controls. METHODS. Longitudinal data from 2,143 stroke survivors and 10,717 matched stroke-free controls aged 50 and over were drawn from the Survey of Health, Ageing and Retirement in Europe (SHARE; 2004–2020). Physical activity was assessed on the wave preceding the stroke event and number of I/ADL limitations during the post-stroke chronic phase. Each stroke survivor was matched with 5 stroke-free controls who had similar propensity scores that were computed based on key covariates. The effect of pre-stroke physical activity on I/ADL limitations in stroke survivors was compared to its effect in stroke-free controls with a similar time lag between physical activity and I/ADL assessments using linear mixed-effects models adjusted for age, sex, education level, and the number of chronic conditions. RESULTS. In stroke survivors, the beneficial effect of pre-stroke physical activity on ADL limitations after stroke is significantly stronger than its effect in stroke-free controls matched for baseline age, sex, body mass index, limitations in I/ADL, chronic conditions, and country of residence, before any of the participants had experienced a stroke. CONCLUSIONS. Physical activity is an effective preventive intervention that reduces the risk of functional dependence after stroke. In addition, pre-stroke level of physical activity is an important variable in the prognosis of functional dependence after stroke.