Tailored Physical Activity Patterns Reduce Post-Stroke Cognitive Impairment Risk and Improve Long-Term Cognitive Trajectories: Evidence from a Decade-Long CHARLS Cohort.
prospective_cohort · Level II
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- Record sourced from PubMed, PMID 41825706.
- Also identified by DOI 10.1016/j.apmr.2026.03.004.
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Abstract
To examine the associations of specific physical activity (PA) patterns-intensity, frequency, and duration-with the risk of post-stroke cognitive impairment (PSCI) and long-term cognitive trajectories in Chinese stroke survivors. Observational cohort study (cross-sectional and longitudinal analyses) using CHARLS data. Community-based nationwide survey in China (China Health and Retirement Longitudinal Study [CHARLS], 2011-2020). Cross-sectional: 1502 stroke survivors (2011-2020). Longitudinal: 170 stroke survivors with PSCI at baseline (MMSE-defined) and 10-year cognitive follow-up. Not applicable. PSCI status (education-adjusted Mini-Mental State Examination [MMSE] criteria) and cognitive trajectory group over 10 years. In the cross-sectional analysis, vigorous physical activity (VPA) performed three days per week for 2-4 hours (OR=0.51, 95% CI 0.27-0.95; p=0.034), and moderate physical activity (MPA) six days per week for 10-30 minutes (OR=0.32, 95% CI 0.18-0.57; p<0.001), were significantly associated with lower PSCI risk. VPA showed greater benefits in participants with hypertension, liver disease, or kidney disease, whereas MPA was more protective in older adults and those without dyslipidemia. The longitudinal analysis identified four distinct cognitive trajectories ("high-stable," "low-declining," "moderate high-stable," and "moderate low-declining"). MPA significantly improved cognitive function over time in PSCI patients (p=0.022). Our results strongly support regular moderate physical activity for reducing PSCI risk and preserving long-term cognitive function. The role of vigorous activity appears promising but requires further confirmation. Thus, moderate-intensity exercise is recommended as the cornerstone of cognitive protection after stroke, with the benefits of vigorous exercise to be more firmly established in future studies.