Physical inactivity before stroke is associated with dependency in basic activities of daily living 3 months after stroke

Background: Physical inactivity is a leading risk factor for non-communicable
diseases, including stroke. Moreover, physical inactivity before stroke is associated
with stroke severity, which, in turn, can cause disability. However, it remains unclear
whether physical inactivity before stroke is associated with dependency in basic
activities of daily living (ADL).
Aim: The aim of this study was to evaluate whether physical inactivity before stroke
influences ADL dependency 3 months after stroke.
Methods: This longitudinal study was based on data from three Swedish registries.
Patients with acute stroke who were admitted to the Sahlgrenska University Hospital
between 9 November 2014 and 30 June 2019 were included in the study. Baseline
data were collected from the three stroke units, and self-reported questionnaires
were used to collect 3-month follow-up data. Physical inactivity before stroke was the
primary independent variable that was self-reported using the Saltin–Grimby physical
activity level scale. ADL dependency was a composite measure of three tasks: mobility,
dressing, and toilet use. A binary logistic regression analysis was used to explain
the association between physical inactivity before stroke and basic ADL 3 months
after stroke.
Results: In total, 3,472 patients were included in the study. The median age was 75
years, 49% of the patients were physically inactive before stroke, and 75% had a mild
stroke. ADL dependency at follow-up was reported to be 32%. Physically inactive
patients, compared with physically active patients, had 2.35 times higher odds for
ADL dependency 3 months after stroke (odds ratio 2.30 [95% CI 1.89 – 2.80]). The
model correctly classified 84% of the patients (the area under the receiver operating
characteristic curve was 0.84 [95% CI, 0.83 – 0.86]).
Conclusion: The findings of this study suggest that physical inactivity before stroke is
associated with dependency in basic ADL 3 months after stroke. In addition, older age,
female sex, pre-stroke living conditions, need for help, previous stroke, and admission
stroke severity are significant contributors to dependency.