Low-intensity preconditioning boosts neurological outcomes

Your competent? doctor will need to EXACTLY PREDICT YOUR NEXT STROKE within four weeks so you can do this preconditioning. 

Low-intensity preconditioning boosts neurological outcomes

The team led by Prof. Lin Zhu from Guangzhou Sport University have demonstrated that 4-week low-intensity treadmill exercise before the onset of an ischemic stroke can significantly reduce brain injury and improve neurological outcomes.

This study, published in Translational Exercise Biomedicine (ISSN: 2942-6812), an official partner journal of International Federation of Sports Medicine (FIMS), offers a promising, non-pharmacological strategy for the millions of people worldwide at risk of this debilitating condition.

Ischemic stroke, caused by a blockage in blood flow to the brain, remains a leading cause of death and long-term disability worldwide. Although treatments like thrombolysis are available, narrow time windows significantly limit their therapeutic effects. This has led scientists to explore proactive, preventive measures against stroke.

The research team investigated the concept of exercise preconditioning using regular physical activity to build the brain's resilience against a future injury. The study focused on low-intensity exercise, more accessible and sustainable for at-risk populations, particularly the elderly.

Our study provides robust evidence that even low-intensity exercise can precondition the brain to be more resistant to the devastating effects of an ischemic stroke. The beauty of this approach is its practicality, it doesn't require strenuous activity, making it a viable strategy for older adults or those with physical limitations or at risk of stroke."

Lin Zhu, Study Team Leader and Professor, Shanghai Jiao Tong University

The researchers established a transient middle cerebral artery occlusion (tMCAO) mouse model, the standard for simulating human ischemic stroke. Twelve-week-old male mice were divided into three groups: healthy control group (Sham), stroke group (tMCAO), and exercise preconditioning group (Ex+tMCAO) that underwent four weeks of low-intensity treadmill running, 10 m/min for one hour a day, five days a week, before the stroke was induced.

The results were striking. At 24 hours after the stroke, the mice that had exercised showed significantly reduced infarct size. Brain tissue death was markedly lower compared to the non-exercised stroke group. In addition, the exercised mice exhibited a higher density of CD31-positive microvessels, indicating improved formation of new blood vessels in the brain, which is crucial for recovery and supplying oxygen to stressed tissues.

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Exercise preconditioning also dramatically reduced the apoptosis in neurons. At the molecular level, the exercised mice showed significantly lower expression of key pro-inflammatory cytokines and chemokines in the brain, including IL-6, CCL11, CCL2, CXCL1, and Fosl1. These factors are known to exacerbate brain damage by recruiting immune cells and triggering harmful inflammatory cascades. While the exercise group showed a trend toward improved performance on motor coordination tests, like the rotarod test, the improvements were not statistically significant at the 24-hour mark, suggesting that while tissue damage is reduced, functional recovery may take a longer period of time.

Co-corresponding author Prof. Xiaoguang Liu added, "We were excited to see the down-regulation of multiple inflammatory pathways. This confirms that exercise preconditioning not only just act through one mechanism, but also creates a broad, protective environment in the brain by simultaneously boosting repair mechanisms like angiogenesis and suppressing inflammation and apoptosis."

However, the authors acknowledge several limitations. The study was conducted only using young male mice, and female and aged models are needed to validate the results. Furthermore, though gene expression for inflammatory markers was measured, protein-level confirmation is needed to confirm the mechanistic conclusions. 

Despite these limitations, the findings have profound implications for public health. They suggest that encouraging regular, gentle physical activity, such as a brisk walk, could serve as an effective, low-cost preventive medicine against stroke.

This is especially relevant given the rising incidence of stroke in younger adults and the aging global population. Besides, this study also has certain translational significance. Building a "brain reserve" through consistent, manageable exercise could be one of the most effective ways to reduce global burden of ischemic stroke. It transforms the concept of exercise from a rehabilitative tool to a powerful preemptive exercise medicine.

Source:

Shanghai Jiao Tong University

Journal reference:

Chen, P., et al. (2026). Low-intensity treadmill exercise preconditioning alleviates post-ischemic stroke injury in mice by inhibiting ischemia-induced inflammation and apoptosis. Translational Exercise Biomedicine. DOI: 10.1515/teb-2025-0029. https://www.degruyterbrill.com/document/doi/10.1515/teb-2025-0029/html.

Measuring Left Atrial Mechanical Function Can Improve Stroke Prediction

I see nothing here that is useful. Predicting stroke does nothing if you don't have protocols that will prevent it from happening. DO YOU PEOPLE EVER THINK AT ALL?

Measuring Left Atrial Mechanical Function Can Improve Stroke Prediction

A cohort study of more than 4,500 persons without a history of atrial fibrillation (AF) or stroke has found that measuring left atrial mechanical function can improve stroke prediction.

“In people without prior atrial fibrillation or stroke, when added to CHA2DS2-VASc variables, left atrial reservoir strain improves

stroke prediction and yields a predicted net benefit, as shown by decision curve analysis,” wrote Ankit Maheshwari, MD, Heart and Vascular Institute, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, and colleagues.

The study, published in Annals of Internal Medicine, included 4,917 participants without a history of stroke or AF from the Atherosclerosis Risk in Communities (ARIC) study. The researchers evaluated the association of echocardiographic left atrial function (reservoir, conduit, and contractile strain) and left atrial size (left atrial volume index) with ischaemic stroke. Ischemic stroke events (2011-2019) were adjudicated by physicians. Left atrial strain was measured using speckle-tracking echocardiography.

Over 5 years, the cumulative incidences of ischaemic stroke in the lowest quintiles of left atrial reservoir, conduit, and contractile strain were 2.99%, 3.18%, and 2.15%, respectively, and that of severe left atrial enlargement was 1.99%.

“On the basis of the Akaike information criterion, left atrial reservoir strain plus CHA2DS2-VASc variables was the best predictive model,” the authors wrote. “With the addition of left atrial reservoir strain to CHA2DS2-VASc variables, 11.6% of the 112 participants with stroke after 5 years were reclassified to higher risk categories and 1.8% to lower risk categories. Among the 4805 participants who did not develop stroke, 12.2% were reclassified to lower and 12.7% to higher risk categories.”

In an accompanying editorial, Darae Ko, MD, and Emelia J. Benjamin, MD, Boston Medical Center, Boston, Massachusetts, applaud the study authors for bringing attention to the possible role of atrial cardiopathy in mediating cardioembolic stroke in the absence of AF. They also said the findings of the study are important in the real-world setting.

Reference: https://www.acpjournals.org/doi/10.7326/M22-1638

SOURCE: American College of Physicians

A Score of Low-Grade Inflammation for Predicting Stroke Recurrence in Patients with Ischemic Stroke

So you described a problem, offered no solution. Useless.

A Score of Low-Grade Inflammation for Predicting Stroke Recurrence in Patients with Ischemic Stroke

      

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Authors Wu M, Zhang X, Chen J, Zha M, Yuan K, Huang K, Xie Y, Xue J, Liu X

Received 7 July 2021

Accepted for publication 28 August 2021

Published 14 September 2021 Volume 2021:14 Pages 4605—4614

DOI https://doi.org/10.2147/JIR.S328383

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Ning Quan

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Min Wu,^1,* Xiaohao Zhang,^2,* Jingjing Chen,^3,* Mingming Zha,⁴ Kang Yuan,⁵ Kangmo Huang,² Yi Xie,² Jianzhong Xue,⁶ Xinfeng Liu<sup>1,2,7

1</sup>Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, 210002, People’s Republic of China; ²Department of Neurology, Jinling Hospital, Affiliated Medical School of Nanjing University, Nanjing, 210002, People’s Republic of China; ³Department of Neurology, Changhai Hospital, Navy Medical University, Shanghai, 200433, People’s Republic of China; ⁴Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, 210002, People’s Republic of China; ⁵Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, 210000, People’s Republic of China; ⁶Department of Neurology, Changshu No.2 People’s Hospital, Changshu, People’s Republic of China; ⁷Stroke Center & Department of Neurology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Xinfeng Liu
Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, No. 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu Province, 210002, People’s Republic of China
Tel +86 138 13835114
Email xfliu2@vip.163.com
Jianzhong Xue
Department of Neurology, Changshu No.2 People’s Hospital, No. 18 Taishan Road, Changshu, Jiangsu Province, People’s Republic of China
Tel +86 13506247572
Email xjz2021@sina.com

Background and Purpose: The impact of low-grade inflammation (LGI) on stroke recurrence has not been well studied yet. We aimed to evaluate the association between LGI and stroke recurrence in patients with ischemic stroke.
Methods: Patients with first-ever ischemic stroke diagnosed within 72 hours of symptoms onset were consecutively recruited from the Nanjing Stroke Registry Program. C-reactive protein (CRP) level, white blood cell (WBC) count, platelet (PLT) count, and neutrophil-to-lymphocyte ratio (NLR) were conceived as low-grade inflammation biomarkers and combined into a standardized LGI score. The association of LGI score with the risk of stroke recurrence was analyzed with multivariate Cox regression models. Analyses accounting for the competing risk of stroke recurrence and death were also performed.
Results: Of the 1214 patients studied (median age, 61 years; male, 71.6%), 177 (14.6%) patients experienced a recurrent stroke with a median follow-up of 23.0 (interquartile ranges, 14.5– 34.0) months. Patients with stroke recurrence had a higher LGI score (median, 3 versus − 2; P < 0.001) than those without recurrence. The univariate analysis indicated that patients with LGI scores in the fourth quartile were more likely to have a stroke recurrence (hazard ratios [HR], 4.312; 95% confidence interval [CI], 2.675– 6.952; P < 0.001). After adjusting for potential confounders, the association remained significant in the multivariate Cox regression model (HR, 4.080; 95% CI, 2.420– 6.879; P < 0.001). Competing risks model and sensitivity analysis further confirmed this conclusion.
Conclusion: This study showed that an elevated LGI score was associated with a higher risk of stroke recurrence, independent of other vascular risk factors.

Keywords: low-grade inflammation, stroke recurrence, ischemic stroke, predictor

Introduction

In most countries, the incidence of ischemic stroke is increasing with the age of the general population.^1,2 A recurrent stroke occurs more frequently during the first years after stroke, with estimated frequency ranging between 7.1% and 26.0%, depending on the population studied and the length of follow-up.^3–5 Furthermore, stroke recurrence is more fatal and disabling than the first-ever stroke.⁶ Thus, early identification and management of the high risk of recurrent stroke patients are of great significance.

Low-grade inflammation (LGI) has been reported to be associated with several chronic conditions including cardiovascular disease, cancer, and neurodegenerative disease.^7–9 Due to the sensitivity to lifestyle modifications, LGI also emerged as an important target for disease prevention.¹⁰ Several biomarkers, both circulating (ie, C-reactive protein [CRP]) and cellular (ie, platelet [PLT] and white blood cell [WBC] count) have been recognized as indicators of LGI.^11,12 The CAPRIE study (Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events) demonstrated that increased leukocyte count was related to recurrent ischemic stroke.¹³ However, several large-scale epidemiological studies on CRP level and recurrent vascular events yielded inconsistent results, some showing significant positive associations between CRP and stroke recurrence,¹⁴ whereas others indicated no association.¹⁵ Recently, the neutrophil-to-lymphocyte ratio (NLR) was also shown to be a reliable marker of cellular inflammation.¹⁶ Considering that these LGI markers do not occur separately in a patient, a comprehensive approach that takes into account the possible synergistic effects might better illustrate the LGI status. Meanwhile, the association of LGI status with recurrent stroke has not been fully investigated.

Thus, the study aimed to use a predefined composite LGI score based on the 4 abovementioned individual LGI markers and to investigate its relationship with stroke recurrence in a cohort of patients who initially presented with first-ever ischemic stroke.