PT  - JOURNAL ARTICLE
AU  - Adam Viktorisson
AU  - Dongni Buvarp
AU  - Anna Danielsson
AU  - Thomas Skoglund
AU  - Katharina S Sunnerhagen
TI  - Prestroke physical activity is associated with admission haematoma volume and the clinical outcome of intracerebral haemorrhage
AID  - 10.1136/svn-2023-002316
DP  - 2023 Dec 01
TA  - Stroke and Vascular Neurology
PG  - 511--520
VI  - 8
IP  - 6
4099  - http://svn.bmj.com/content/8/6/511.short
4100  - http://svn.bmj.com/content/8/6/511.full
SO  - Stroke Vasc Neurol2023 Dec 01; 8
AB  - Background Prestroke physical activity (PA) has been linked to improved outcomes after intracerebral haemorrhage (ICH), but its association with ICH volume is unknown. We aimed to investigate associations of prestroke PA with location-specific haematoma volume and the clinical outcome of ICH.Methods All patients with primary ICH, admitted to three hospitals between 2014 and 2019, were included. Patients performing light PA ≥4 hour/week the year before stroke were considered physically active. Haematoma volumes were assessed from admission brain imaging. Adjusted associations were estimated using multivariate linear and logistic regression models. Haematoma volume was explored as mediator to the relationship between prestroke PA and mild stroke severity (0–4 points on the National Institutes of Health Stroke Scale), a good 1-week functional status (0–3 points on the modified Rankin Scale) and 90-day survival. Average direct effects (ADE) and average causal mediation effects (ACME) were computed.Results Of 686 primary ICH cases, 349 were deep, 240 lobar and 97 infratentorial. Prestroke PA predicted smaller haematoma volumes in deep ICH (β=−0.36, SE=0.09, p<0.001) and lobar ICH (β=−0.23, SE=0.09, p=0.016). Prestroke PA was also associated with mild stroke severity (OR 2.53, 95% CI 1.59 to 4.01), a good 1-week functional status (OR 2.12, 95% CI 1.37 to 3.30) and 90-day survival (OR 3.48, 95% CI 2.06 to 5.91). Haematoma volume partly mediated the relationships between PA and stroke severity (ADE 0.08, p=0.004; ACME 0.10, p<0.001), 1-week functional status (ADE 0.07, p=0.03; ACME 0.10, p<0.001) and 90-day survival (ADE 0.14, p<0.001; ACME 0.05, p<0.001).Conclusions Light PA ≥4 hour/week prior to ICH was associated with smaller haematoma volumes in deep and lobar locations. Physically active patients with ICH had a higher likelihood of mild stroke, a good 1-week functional status and 90-day survival, in part mediated by smaller haematoma volumes on admission.Data are available upon reasonable request. Data cannot be made publicly available because of Swedish regulations. Researchers may apply to access anonymised data from Professor Katharina Stibrant Sunnerhagen after obtaining necessary approvals.