Clinical and neuroanatomical predictors of post-stroke fatigue.

INTRODUCTION: Post-stroke fatigue (PSF) has been described as early exhaustion with tiredness that develops during physical or mental activity and generally does not improve with rest. There are inconsistent findings on the relationship between the characteristics of the ischemic brain lesion and PSF. However, some studies suggest that specific neuroanatomical and neuroplastic changes could explain post-stroke fatigue. The aim was to evaluate the severity of PSF in relation to the location and the size of the ischemic lesion in acute stroke patients to establish possible predictors of PSF. PATIENTS AND METHODS: We performed a prospective observational study to establish potential early predictors of long-term PSF, which was assessed using the Fatigue Assessment Scale six months after ischemic stroke. After segmenting brain infarcts on Diffusion-Weighted Imaging (DWI) images, we studied the association with PSF using Voxel-Based Lesion-Symptom Mapping (VLSM). RESULTS: Out of 104 patients, 61 (59 %) reported PSF. Female sex and history of diabetes mellitus were associated with a greater risk of developing PSF. The association of PSF with female sex was confirmed in a replication cohort of 50 patients. The ischemic lesion volume was not associated with PSF, and VBLSM analysis did not identify any specific brain area significantly associated with PSF. CONCLUSIONS: PSF is frequent in stroke patients, especially women, even after six months. The absence of neuroanatomical correlates of PSF suggests that it is a multifactorial process with biological, psychological, and social risk factors that require further study.

Viabilidad y eficacia de una estrategia multidimensional para fomentar la actividad física en pacientes con ictus agudo / Feasibility and efficacy of a multidimensional strategy to promote physical activity in acute stroke patients

Objetivo: Describir la viabilidad, la seguridad y la eficacia de un enfoque multidimensional para fomentar la actividad física precoz después de un ictus isquémico. Materiales y métodos: Estudio de casos y controles que compara los resultados en los pacientes ingresados en la unidad de ictus antes y después de establecer un protocolo de fomento de la actividad física mediante la incorporación de un ejercicio aeróbico usando un cicloergómetro, y la facilitación de información verbal y escrita sobre los beneficios de la actividad física. La medida principal del estudio fue la actividad física realizada a los 3 meses usando el International Physical Activity Questionnaire. Resultados: Incluimos 93 pacientes (60 controles y 33 en el grupo activo). La actividad física previa al ictus era baja. Las 126 sesiones de cicloergómetro se toleraron bien. A los 3 meses del ictus, la actividad física fue mayor (693 vs. 462 MET-min/semana; p=0,039) y el tiempo de sedestación, menor (2.100 vs. 2.520min; p=0,009) en el grupo activo. Conclusiones: A pesar de un conocimiento apropiado de los beneficios del ejercicio sobre la salud, la actividad física es baja después del ictus. Un enfoque multidisciplinar, combinando ejercicio precoz e información individualizada, puede incrementarla

Objective: To describe the feasibility, safety, and efficacy of a multidimensional approach to promote physical activity soon after ischaemic stroke. Materials and methods: Case-control study comparing the outcomes in consecutive patients admitted to a stroke unit before and after implementing a physical activity promotion protocol by performing aerobic exercise using a cycle ergometer, and informing them on the benefits of physical activity. The primary outcome measurement was physical activity at 3 months using the International Physical Activity Questionnaire. Results: A total of 93 patients were included (60 controls and 33 in the active group). Pre-stroke activity was low. A total of 126 cycle ergometer sessions were well tolerated. At 3 months, post-stroke physical activity was greater (693 vs. 462 MET-min/week; P=.039) and sedentary time shorter (2,100 vs. 2,520min; P=.009) in the active group. Conclusions: Despite proper knowledge of the health benefits of exercise, physical activity is low after stroke. A multidisciplinary approach combining early exercise and individualised information on its benefits may increase physical activity after stroke