Post-stroke White Matter Hyperintensities and Physical Activity: A CANVAS Study Exploratory Analysis

• Published in: Medicine and science in sports and exercise 2022-04
• Main Authors: Hung, Stanley Hughwa, Khlif, Mohamed Salah, Kramer, Sharon, Werden, Emilio, Bird, Laura J., Campbell, Bruce C.V., Brodtmann, Amy
• Format: Article
• Language: English
• ISSN: 0195-9131; 1530-0315
• DOI: 10.1249/MSS.0000000000002946

White matter hyperintensities (WMHs) are associated with post-stroke cognitive decline and mortality. Physical activity (PA) may decrease WMH risk by reducing vascular risk factors and promoting cerebral perfusion. However, the association between post-stroke PA and WMH progression remains unclear. We examined the association between PA and WMH volume 12-months post-stroke, and between PA and change in WMH volume between 3-months and 12-months post-stroke. We included ischemic stroke survivors from the Cognition And Neocortical Volume After Stroke (CANVAS) cohort with available brain MRI and objective PA data. Total, periventricular, and deep WMH volumes (mL) were estimated with manually-edited, automated segmentations (Wisconsin White Matter Hyperintensities Segmentation toolbox). Moderate-to-vigorous intensity PA (MVPA) was estimated using the SenseWear® Armband. Participants with MVPA ≥30 minutes/day were classified as "Meeting PA Guidelines". We used quantile regression to estimate the associations between PA (MVPA and meeting PA guidelines) with WMH volume at 12-months and change in WMH volume between 3-months and 12-months post-stroke. 100 participants were included (median National Institutes of Health Stroke Scale 2, IQR: 1 - 4). MVPA was not associated with WMH volume. In univariable analysis, meeting PA guidelines was associated with lower total, periventricular, and deep WMH volumes by 3.0 mL (95%CI: 0.5 - 9.7), 2.8 mL (95%CI: 0.5 - 7.1), and 0.9 mL (95%CI: 0.1 - 3.0), respectively. However, in multivariable analysis, meeting PA guidelines was not associated with WMH volume, and older age was associated with greater WMH volume at 12-months. PA was not associated with change in WMH volume. Meeting PA guidelines was associated with lower WMH volume at 12-months in univariable analysis, but not in multivariable analysis. Age consistently predicted greater WMH volume.