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ARTICLES: L. -H. Krarup, T. Truelsen, C. Gluud, G. Andersen, X. Zeng, J. Kõrv, A. Oskedra, G. Boysen, and The ExStroke Pilot Trial Group Prestroke physical activity is associated with severity and long-term outcome from first-ever stroke Neurology 2008; 71: 1313-1318 [Abstract] [Full text] [PDF]

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Prestroke physical activity is associated with severity and long-term outcome from first-ever stroke

Joshua Z. Willey   (14 December 2008)

Reply from the authors

Lars-Henrik Krarup, Thomas Truelsen MD PhD DMSc, Gudrun Boysen MD DMSc   (14 December 2008)

Prestroke physical activity is associated with severity and long-term outcome from first-ever stroke 14 December 2008
Joshua Z. Willey, Columbia University 710 West 169th Street, New York, NY 10032 Send Correspondence to journal: Re: Prestroke physical activity is associated with severity and long-term outcome from first-ever stroke jwilley{at}neuro.columbia.edu Joshua Z. Willey	I read the article by Krarup et al. with great interest. [1] The definition of long-term outcome was only outlined in the abstract. Krarup et al.’s previous study—-the ExStroke Pilot Trial-- provided information in the Methods on when the PASE questionnaire was obtained (within 90 days, median 10 days). [2] The authors appeared to have followed the subjects at earlier time intervals yet it would have been interesting to note when physical activity influenced the odds ratio of an increasing mRS after stroke. Table 2 and Figure 2 do not indicate how the variable mRS was treated, presumably as a binary categorical variable given the use of an OR. If so, it would have been helpful to see what the mRS cut-off points were to derive a “higher” level, and the rationale for that cut-off point. Another helpful analysis could have used the change in mRS from the time immediately after stroke and 2 years. In light of other reports indicating exercise training may also improve recovery after stroke, analyzing the pattern of physical activity after enrollment could be an interesting corollary to this study. [3] Krarup et al. have made an important contribution to the literature regarding pre-stroke level of functioning and stroke recovery. They have also confirmed the importance of physical activity not just in stroke onset prevention but in prevention of a more severe stroke and stroke recovery. References 1. Krarup L-H, Truelsen T, Gluud C, et al. Prestroke physical activity is associated with severity and long-term outcome from first-ever stroke. Neurology 2008;71:1313-1318. 2. Krarup LH, Gluud C, Truelsen T, et al. The ExSTroke Pilot Trial: rationale, design, and baseline data of a randomized multicenter trial comparing physical training versus usual care after an ischemic stroke. Contemp Clin Trials 2008;29:410-417. 3. Mead GE, Greig CA, Cunningham I, et al. Stroke: a randomized trial of exercise or relaxation. J Am Geriatr Soc 2007;55:892-899. Disclosure: The author reports no disclosures.
Reply from the authors 14 December 2008
Lars-Henrik Krarup, Dept. of Neurology, Bispebjerg University Hospital Denmark NAMB Bispebjerg Hospital, Bispebjerg Bakke, 23 DK-2400 Copenhagen NV Denmark, Thomas Truelsen MD PhD DMSc, Gudrun Boysen MD DMSc Send Correspondence to journal: Re: Reply from the authors lh.krarup{at}gmail.com Lars-Henrik Krarup, et al.	We thank Dr. Willey for his interest in our article. In the ExStroke pilot Trial, we included stroke patients within 90 days of stroke and followed them for two years. [2] The median time from stroke onset to inclusion was 10 days and the information was provided in Table 1. In the current article, we wanted to examine the association between pre-stroke physical activity and stroke severity and between pre-stroke physical activity and long-term outcome. [1] Therefore, we chose to include only the Rankin scores from the end of trial visit to best answer our scientific question. We do have data on Rankin scores from other time points and plan to publish these data in the future. The modified Rankin Scale is an ordinal scale. For the main analyses, we used ordinal logistic regression, the so called ‘shift analysis’ which, contrary to binary logistic regression, uses all possible cut-off points and gives one cumulative odds ratio as a result. This method omits the need for dichotomization and the problems that arise when ordinal scales are reduced to binary scales. Physical training may be a way to improve recovery after stroke although further studies are needed. [3] In a paper currently under review, we address the effect of repeated encouragement to be physically active as a way to generally increase physical activity. Our goal is that this will then affect stroke recovery and risk of recurrent stroke. Disclosure: The authors report no disclosures.