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

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          Abstract

          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.

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          Most cited references77

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          Fitting Linear Mixed-Effects Models Usinglme4

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            Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

            Summary Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12·2 million (95% UI 11·0–13·6) incident cases of stroke, 101 million (93·2–111) prevalent cases of stroke, 143 million (133–153) DALYs due to stroke, and 6·55 million (6·00–7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8–12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1–6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0–73·0), prevalent strokes increased by 85·0% (83·0–88·0), deaths from stroke increased by 43·0% (31·0–55·0), and DALYs due to stroke increased by 32·0% (22·0–42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0–18·0), mortality decreased by 36·0% (31·0–42·0), prevalence decreased by 6·0% (5·0–7·0), and DALYs decreased by 36·0% (31·0–42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0–24·0) and incidence rates increased by 15·0% (12·0–18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5–3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5–3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57–8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97–3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01–1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7–90·8] DALYs or 55·5% [48·2–62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3–48·6] DALYs or 24·3% [15·7–33·2]), high fasting plasma glucose (28·9 million [19·8–41·5] DALYs or 20·2% [13·8–29·1]), ambient particulate matter pollution (28·7 million [23·4–33·4] DALYs or 20·1% [16·6–23·0]), and smoking (25·3 million [22·6–28·2] DALYs or 17·6% [16·4–19·0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries. Funding Bill & Melinda Gates Foundation.
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              Validity of the international physical activity questionnaire short form (IPAQ-SF): A systematic review

              Background The International Physical Activity Questionnaire - Short Form (IPAQ-SF) has been recommended as a cost-effective method to assess physical activity. Several studies validating the IPAQ-SF have been conducted with differing results, but no systematic review of these studies has been reported. Methods The keywords "IPAQ", "validation", and "validity" were searched in PubMed and Scopus. Studies published in English that validated the IPAQ-SF against an objective physical activity measuring device, doubly labeled water, or an objective fitness measure were included. Results Twenty-three validation studies were included in this review. There was a great deal of variability in the methods used across studies, but the results were largely similar. Correlations between the total physical activity level measured by the IPAQ-SF and objective standards ranged from 0.09 to 0.39; none reached the minimal acceptable standard in the literature (0.50 for objective activity measuring devices, 0.40 for fitness measures). Correlations between sections of the IPAQ-SF for vigorous activity or moderate activity level/walking and an objective standard showed even greater variability (-0.18 to 0.76), yet several reached the minimal acceptable standard. Only six studies provided comparisons between physical activity levels derived from the IPAQ-SF and those obtained from objective criterion. In most studies the IPAQ-SF overestimated physical activity level by 36 to 173 percent; one study underestimated by 28 percent. Conclusions The correlation between the IPAQ-SF and objective measures of activity or fitness in the large majority of studies was lower than the acceptable standard. Furthermore, the IPAQ-SF typically overestimated physical activity as measured by objective criterion by an average of 84 percent. Hence, the evidence to support the use of the IPAQ-SF as an indicator of relative or absolute physical activity is weak.
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                Author and article information

                Journal
                medRxiv
                MEDRXIV
                medRxiv
                Cold Spring Harbor Laboratory
                18 September 2023
                : 2023.09.14.23295576
                Affiliations
                [1 ] School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Canada
                [2 ] Perley Health Centre of Excellence in Frailty-Informed Care, Ottawa, Canada
                [3 ] Bruyère Research Institute, Ottawa, Canada
                Author notes
                [* ] Author for correspondence: Matthieu P. Boisgontier, matthieu.boisgontier@ 123456uottawa.ca
                Article
                10.1101/2023.09.14.23295576
                10516084
                37745591
                78b7dd57-8d9c-4e53-af5a-cdfaaa46f8ac

                This work is licensed under a Creative Commons Attribution 4.0 International License, which allows reusers to distribute, remix, adapt, and build upon the material in any medium or format, so long as attribution is given to the creator. The license allows for commercial use.

                History
                Funding
                Funded by: European Commission
                Award ID: QLK6-CT-2001-00360
                Award ID: RII-CT-2006-062193
                Award ID: CIT5-CT-2005-028857
                Award ID: CIT4-CT-2006-028812
                Award ID: no.211909
                Award ID: no.227822
                Award ID: no.261982
                Funded by: German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the U.S. National Institute on Aging
                Award ID: U01_AG09740-13S2
                Award ID: P01_AG005842
                Award ID: P01_AG08291
                Award ID: P30_AG12815
                Award ID: R21_AG025169
                Award ID: Y1-AG-4553-01
                Award ID: IAG_BSR06-11
                Award ID: OGHA_04-064
                Award ID: HHSN271201300071C
                Categories
                Article

                cohort studies,comorbidity,disability,exercise,functional status,health behavior,longitudinal studies,prognosis,prospective studies,stroke survivors

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