Lifestyle Risk Behaviors Among Stroke Survivors With and Without Diabetes

Associations of sedentary behaviors with mental health outcomes in a cohort of patients with minor ischemic stroke

OBJECTIVE

The relationship between sedentary behaviors and functional outcomes of acute ischemic stroke (AIS) has been previously reported. However, it remains unclear whether sedentary behaviors are associated with mental health outcomes in AIS patients. Therefore, the objective of this study was to investigate the mental health outcomes in patients with minor AIS one year after stroke onset.

METHODS

This cross-sectional study recruited 1230 patients with minor AIS (NIHSS ≤ 5) from three hospitals in China. One year after discharge, patients were interviewed using face-to-face questionnaires, including the PHQ-9, GAD-7, and ISI, to assess symptoms of depression, anxiety, and insomnia, respectively. Participants were categorized into the long sedentary time group and the short sedentary time group based on the median sedentary time of all participants. The associations between leisure sedentary time and mental health outcomes were investigated.

RESULTS

Participants with a long leisure sedentary time had higher PHQ-9, GAD-7, and ISI scores than those with a short sedentary time. Longer sedentary time was associated with an increased risk of experiencing symptoms of major depression (RR, 95% CI: 1.79, 1.47 to 2.18), anxiety (RR, 95% CI: 3.28, 2.08 to 5.18), and insomnia (RR, 95% CI: 2.58, 2.03 to 3.28) one year after a minor AIS.

CONCLUSION

Excessive sedentary time is associated with long-term mental health conditions after stroke. Therefore, reducing the sedentary time might be helpful for preventing poststroke depression, anxiety, and insomnia.

Excessive Sedentary Time Is Associated with Cognitive Decline in Older Patients with Minor Ischemic Stroke

BACKGROUND

Cognitive impairment is commonly seen after acute ischemic stroke (AIS). Sedentary behaviors increase the risk of dementia among community dwelling population.

OBJECTIVE

This study aims to investigate the association of sedentary behaviors with poststroke cognitive impairment among older adults with minor AIS.

METHODS

This cohort study recruited 594 older subjects with minor AIS from three hospitals in China during February 1, 2016, and December 31, 2018. Participants were followed up for two years and the sedentary time per day was self-reported at the end of follow-up. Cognitive functions were assessed by Mini-Mental State Examination (MMSE). Participants were categorized into the high and low sedentary time group according to the median sedentary time of the participants.

RESULTS

At two years of follow-up, the long sedentary time group had significantly lower MMSE scores than the short sedentary time group [median, (IQR): 21 (18 to 25) versus 22 (18 to 25), p = 0.368]. The long sedentary time group had a higher speed of cognitive decline than the short sedentary time group. Excessive sedentary time was associated with a higher risk of longitudinal cognitive decline (OR: 2.267, 95% CI: 1.594 to 3.225), adjusting for age, sex, education, body mass index, APOE genotype, comorbidities, symptoms of depression, anxiety, and insomnia, baseline MMSE scores and National Institute of Health Stroke Scale scores, cognitive therapy, and TOAST ischemic stroke subtypes.

CONCLUSIONS

This study identified a possible link between sedentary behaviors and longitudinal cognitive decline among older patients with minor AIS, suggesting that reducing sedentary time might be helpful for preventing poststroke dementia.

Predictors of Adherence to Lifestyle Recommendations in Stroke Secondary Prevention

The risk of recurrent vascular events is high following ischaemic stroke or transient ischaemic attack (TIA). Unmanaged modifiable risk factors present opportunities for enhanced secondary prevention. This cross-sectional study (n = 142 individuals post-ischaemic stroke/TIA; mean age 63 years, 70% male) describes adherence rates with risk-reducing behaviours and logistical regression models of behaviour adherence. Predictor variables used in the models com-prised age, sex, stroke/TIA status, aetiology (TOAST), modified Rankin Scale, cardiovascular fit-ness (VO_2peak) measured as peak oxygen uptake during incremental exercise (L/min) and Hospital Anxiety and Depression Score (HADS). Of the study participants, 84% abstained from smoking; 54% consumed ≥ 5 portions of fruit and vegetables/day; 31% engaged in 30 min moderate-to-vigorous physical activity (MVPA) at least 3 times/week and 18% were adherent to all three behaviours. VO_2peak was the only variable predictive of adherence to all three health behaviours (aOR 12.1; p = 0.01) and to MVPA participation (aOR 7.5; p = 0.01). Increased age (aOR 1.1; p = 0.03) and lower HADS scores (aOR 0.9; p = 0.02) were predictive of smoking abstinence. Men were less likely to consume fruit and vegetables (aOR 0.36; p = 0.04). Targeted secondary prevention interventions after stroke should address cardiovascular fitness training for MVPA and combined health behaviours; management of psychological distress in persistent smokers and consider environmental and social factors in dietary interventions, notably in men.