Division of Cardiology, Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hwaseong, Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea.
Sci Rep. 2023 Oct 4;13(1):16715. doi: 10.1038/s41598-023-44031-8.
Stroke survivors are at an increased risk of falls and fractures. Physical activity is inversely associated with the fracture risk in the general population. However, the association between incident fracture risk and changes in habitual physical activity before and after an index stroke remains unclear. This study attempted to explore the association between incident fracture risk and changes in physical activity after stroke. Using the claims database of the National Health Insurance Program in Korea, participants with their first ischemic stroke between 2010 and 2016 were enrolled in the study. The participants were divided into four groups according to changes in physical activity habits evaluated using two consecutive self-reported questionnaires before and after stroke, if available: persistent non-exercisers, exercise dropouts, new exercisers, and persistent exercisers. The primary outcome was a composite of vertebral, hip, and other fractures. We performed multivariable Cox proportional hazard regression analysis and provided adjusted hazard ratios and 95% confidence intervals for each outcome. Among 202,234 participants included from 1,005,879 datasets, 16,621 (8.22%) experienced any type of fracture as the primary outcome. After multivariable adjustment, exercise dropouts (n = 37,106), new exercisers (n = 36,821), and persistent exercisers (n = 74,647) had a significantly reduced risk of any type of fracture (aHR 0.932, 95% CI 0.893-0.973; aHR 0.938, 95% CI 0.900-0.978; aHR 0.815, 95% CI 0.780-0.852, respectively) compared to the persistent non-exercisers (n = 53,660). Furthermore, regardless of pre-stroke exercise status, those who exercised ≥ 1000 metabolic equivalents of tasks post-stroke had a significantly reduced risk of fractures. Initiating or continuing moderate-to-vigorous regular physical activity after acute ischemic stroke was associated with a significantly lower risk of incident fractures, including hip, vertebral, and other types.
中风幸存者发生跌倒和骨折的风险增加。体力活动与普通人群的骨折风险呈负相关。然而，在指数性中风前后习惯性体力活动变化与新发骨折风险之间的关系尚不清楚。本研究试图探讨中风后体力活动变化与新发骨折风险之间的关系。使用韩国国家健康保险计划的理赔数据库，纳入了 2010 年至 2016 年间首次发生缺血性中风的患者。如果有连续两次中风前后自我报告问卷评估的体力活动习惯变化，参与者被分为以下四组：持续不运动者、运动减少者、新运动者和持续运动者。主要结局是椎体、髋部和其他部位骨折的综合结果。我们进行了多变量 Cox 比例风险回归分析，并为每个结局提供了调整后的危险比和 95%置信区间。在纳入的 202234 名参与者中，有 16621 名（8.22%）发生了任何类型的骨折作为主要结局。经过多变量调整后，运动减少者（n=37106）、新运动者（n=36821）和持续运动者（n=74647）发生任何类型骨折的风险显著降低（aHR 0.932，95%CI 0.893-0.973；aHR 0.938，95%CI 0.900-0.978；aHR 0.815，95%CI 0.780-0.852），而持续不运动者（n=53660）则无显著差异。此外，无论中风前是否运动，中风后进行≥1000 代谢当量任务的运动量与骨折风险显著降低相关。急性缺血性中风后开始或继续进行适度至剧烈的有规律体力活动与新发骨折风险显著降低相关，包括髋部、椎体和其他类型的骨折。
