Pre-stroke physical activity matters for functional limitations: A longitudinal case-control study of 12,860 participants

Objective. In the chronic phase after a stroke, limitations in activities of daily living (ADLs) and instrumental ADL (IADLs) initially plateau before steadily increasing. The benefits of pre-stroke physical activity on these limitations remain unclear. To clarify this relationship, we examined the effect of physical activity on the long-term evolution of functional limitations in a cohort of stroke survivors and compared it to a cohort of matched stroke-free adults. Methods. Longitudinal data from 2,143 stroke survivors and 10,717 stroke-free adults aged 50 years and older were drawn from a prospective cohort study based on the Survey of Health, Ageing and Retirement in Europe (2004–2022; 8 data collection waves). Physical activity was assessed in the pre-stroke wave. Functional limitations were assessed in the post-stroke waves. Each stroke survivor was matched with 5 stroke-free adults who had similar propensity scores computed on the basis of key covariates, including baseline age, sex, body mass index, limitations in ADL and IADL, chronic conditions and country of residence, before any of the participants from either cohort had experienced a stroke. Results. Results showed an interaction between stroke status and physical activity on ADL limitations (b = −0.076; 95% CI = −0.142 to −0.011), with the effect of physical activity being stronger in stroke survivors (b = −0.345, 95% CI = −0.438 to −0.252) than in stroke-free adults (b = −0.269, 95% CI = −0.269 to −0.241). Conclusion. The beneficial effect of pre-stroke physical activity on ADL limitations after stroke is stronger than its effect in matched stroke-free adults followed for a similar number of years. Impact. Physical activity, an intervention within the physical therapist’s scope of practice, is effective in reducing the risk of functional dependence after stroke. Moreover, pre-stroke levels of physical activity can inform the prognosis of functional dependence in stroke survivors.


Pre-Stroke Physical Activity Matters for Functional Limitations: A Longitudinal Case-Control Study of 12,860 Participants
Zack van Allen, Dan Orsholits, Matthieu P. Boisgontier Table S1.Stroke survivors with at least slight dependency in activities of daily living (ADLs) at 1-year follow-up.
Table S2.Stroke survivors with at least moderate dependency in activities of daily living (ADLs) at 1-year follow-up.
Table S3.Stroke survivors with severe or total dependency in activities of daily living (ADLs) at 1-year follow-up.
Table S4.Stroke survivors who are moderately active in instrumental activities of daily living (IADLs) at 1-year follow-up.
Table S5.Stroke survivors who are inactive in instrumental activities of daily living (IADLs) at 1-year follow-up.
Table S6.Activities of daily living (ADLs) and instrumental activities of daily living (IADLs) counts for stroke survivors and stroke-free adults.Counts reflect the number of I/ADL limitations reported.
Table S7.Frequency of moderate and vigorous physical activity in stroke survivors and strokefree adults at baseline.
Table S8.Counts of physically active and inactive participants in stroke survivors and strokefree adults.
Table S9.Results of the sensitivity analyses testing the interaction between stroke-related status and physical activity ("hardly ever or never" vs. "at least once a month") on limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

Figure S1.
Result of the sensitivity analysis showing the effect of physical activity ("Hardly ever or never" vs. "At least once a month") on limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) in stroke survivors and matched stroke-free adults over time.Notes.In the main analyses, participants who answered "more than once a week" to at least one of the questions were classified as physically active, whereas the other participants were classified as physically inactive.In the sensitivity analyses, participants who answered "hardly ever or never" to one of the two questions related to the level of physical activity were classified as physically inactive, whereas the other participants were classified as physically active.
Table S9.Results of the sensitivity analyses testing the interaction between stroke-related status and physical activity (hardly ever or never vs. at least once a month) on limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

Exposures
Figure S1.Result of the sensitivity analysis showing the effect of physical activity (PA; "Hardly ever or never" vs. "At least once a month") on limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) in stroke survivors and matched stroke-free adults over time.

Table S1 .
Stroke survivors with at least slight dependency in activities of daily living (ADLs) at 1-year follow-up

Table S2 .
Stroke survivors with at least moderate dependency in activities of daily living (ADLs) at 1-year followup

Table S3 .
Stroke survivors with severe or total dependency in activities of daily living (ADLs) at 1-year follow-up

Table S4 .
Stroke survivors who are moderately active in instrumental activities of daily living (IADLs) at 1-year follow-up.

Table S5 .
Stroke survivors who are inactive in instrumental activities of daily living (IADLs) at 1-year follow-up.

Table S6 .
Activities of daily living (ADLs) and instrumental activities of daily living (IADLs) counts for stroke survivors and stroke-free adults.Counts reflect the number of I/ADL limitations reported.

Table S7 .
Frequency of moderate and vigorous physical activity in stroke survivors and stroke-free adults at baseline.The question for assessing moderate physical activity was "How often do you engage in activities that require a low or moderate level of energy such as gardening, cleaning the car, or doing a walk?".The question for assessing vigorous physical activity was "How often do you engage in vigorous physical activity, such as sports, heavy housework, or a job that involves physical labor?

Table S8 .
Counts of physically active and inactive participants in stroke survivors and stroke-free adults.