Association Between Physical Activity and Cryptogenic Ischemic Stroke in Young Adults: A Case–Control Study

Abstract

Background: Data on the association between physical activity (PA) and cryptogenic ischaemic stroke (CIS) in young adults are scarce. We investigated the relationship between PA levels and early-onset CIS, stratified by the presence of a high-risk patent foramen ovale (PFO). Methods: Patients aged 18–49 years with first-ever CIS and sex- and age-matched stroke-free controls were recruited from 19 European centres. PA was assessed using the short International Physical Activity Questionnaire and expressed as Metabolic Equivalents, categorized into percentiles (bottom 10%, 10%–25%, 25%–75% [reference], 75%–90%, top 10%). Associations between PA and CIS were analyzed using conditional logistic regression adjusted for age, education level, traditional risk factors, and non-traditional risk factors. Results: Altogether, 533 patients (median age 41 [interquartile range 34–46]; 47.3% women) and 533 controls were included. Scoring in the top 10% of PA was independently associated with CIS: adjusted odds ratio 2.07; 95% confidence interval 1.22-3.51. Comparing patients without high-risk PFO to all controls, the top 10% PA category (1.78; 1.07-2.94) and the bottom 10% category (1.76; 1.06-2.92) were associated with CIS. No independent association was observed in patients with high-risk PFO. Conclusions: PA in the top 10% was associated with an increased risk of early-onset CIS in the overall study population. Among patients without a high-risk PFO, both the bottom 10% and top 10% of PA were consistently associated with elevated CIS risk. These findings highlight the need to better understand the mechanisms through which both low and high activity levels may predispose to stroke.