Cerebral small vessel disease burden in acute ischemic stroke and the role of physical activity: cross-sectional study

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Abstract Background Cerebral small vessel disease (cSVD) is a major cause of stroke and cognitive decline. While classical cardiovascular risk factors are well-established contributors to overall cSVD burden, the effect of physical activity (PA) is not fully understood. This study aims to investigate the association between PA and cSVD burden in patients with acute ischemic stroke (AIS). Methods This is a post hoc analysis using pooled data from patients enrolled in two randomized stroke trials. cSVD burden was quantified as presence of microbleeds, lacunes, white matter hyperintensities and atrophy on acute admission magnetic resonance imaging (MRI) with a higher score corresponding to a higher overall cSVD burden (range 0-4). Pre-stroke PA was assessed by questionnaire on admission and grouped by quartiles (low quartile is low PA level). Ordinal logistic regression analyses were used to evaluate the association of PA and cSVD burden. Results A total of 762 patients with AIS were included. The median (IQR) age was 71 (62, 79) and 279 (37 %) were females. The proportion of patients with a cSVD score of 0 were 26 %, 38 %, 43 % and 57 %, respectively, through lowest to highest PA quartile. In the multivariable analysis the odds ratios for a higher cSVD score were lower in fourth PA quartile 0.63 (confidence intervals: 0.43 to 0.93), third 0.86 (0.57 to 1.29) and second 0.56 (0.36 to 0.87) quartile compared to the first quartile. Conclusion Among patients with AIS, a higher PA level was independently associated with a lower cSVD burden. This indicates a protective effect of PA on cSVD burden beyond modification of vascular risk factors.

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