Martina Reiten Bovim, Bent Indredavik, Anne Hokstad, Toby Cumming, Julie Bernhardt, Torunn Askim
Department of Neuromedicine and Movement Science, Trondheim, Norway. E-mail: martina.r.bovim@ntnu.no
DOI: 10.2340/16501977-2610

Objectives: To explore mechanisms affecting mental health in patients with stroke. The aims were to investigate the association between pre-stroke physical activity and symptoms of anxiety and depression 3 months after stroke, and to investigate how self-reported physical activity changed from before to 3 months after the stroke.
Design: Secondary analyses of a prospective observational multicentre study.
Patients: Stroke patients from 11 Norwegian stroke units.
Methods: Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale, and physical activity was assessed by self-report. Negative binomial regression was used to analyse associations.
Results: The analysed sample consisted of 205 patients; mean age was 74 years (standard deviation (SD) 11. 5); 46% were women. Higher activity levels before stroke were associated with fewer symptoms of depression in multivariable analyses with regression coefficient of 0. 84 (95% confidence interval 0. 73–0. 97), p = 0. 015. Eighty-five (41. 5%) patients reported similar activity levels before and after
stroke.
Conclusion: In this group of patients with mild symptoms of emotional distress, it seems that pre-stroke physical activity might be protective against post-stroke depression, but not anxiety. Many patients with mild-to-moderate stroke report being equally active before and after the stroke.

Depression and anxiety are more common after stroke than in the general population. In non-stroke patients, physical activity and exercise is associated with less psychological distress. This study found that pre-stroke physical activity was associated with fewer depressive symptoms 3 months after stroke. However, being physically active was not related to symptoms of anxiety. In addition, most patients reported performing approximately the same level of physical activity before and after stroke. Despite the lack of causality, these findings indicate that pre-stroke physical activity might be protective against post-stroke depression, but not against anxiety.