| Objective The correlation between cognitive function at discharge and Physical Exercise before the first onset of acute ischemic stroke has not been detailed reported in China.The purpose of this study was to investigate whether there is a causal association between physical exercise before the first onset of acute ischemic stroke and cognitive function at discharge and to explore the possible mediating effect.Methods From July 2018 to December 2020,patients with acute ischemic stroke who were hospitalized for the first time in the Department of Neurology,First Affiliated Hospital of Bengbu Medical University were selected to collect basic demographic data,pre-stroke exercises and living habits,blood test results and other related data.The modified Montreal scale(Mo CA)was used to evaluate patients’ cognitive function at discharge,and 26 points were used to classify whether cognitive function was damaged.According to the inclusion and exclusion criteria,512 patients with acute ischemic stroke were admitted to hospital for the first time,including 137 patients with exercise history before onset and 375 patients without exercise history.Analyze the differences between the two groups of research variables;Then,taking whether the cognitive function is damaged when discharged from hospital as the dependent variable,controlling the related covariate,and analyzing the related effects of exercises by logistic regression model;By using the nearest neighbor 1: 1 matching in the tendency score matching method(PSM),after matching the known confounding variables,this paper analyzes whether there is a causal relationship between exercises and cognitive function.Finally,the mediating effect model was used to analyze the possible mediating effect of blood test indicators in the effect of pre-stroke exercise history on patients’ cognitive function at discharge.Results(1)Cognitive function at discharge whether injury in age,education level,monthly income,history of drinking and diastolic blood pressure,C-reactive protein(CRP),SOD,thrombin as well as the degree of difference between the original activity was statistically significant(P <0.05).Whether to exercise before stroke,the number of years of exercise,the number of weekly exercises,the number of daily exercises,the duration of each exercise,the intensity of exercise sweat,and the changes in exercise self-sensed heart rate,the differences in the cognitive function of each group were statistically significant(P<0.05).(2)When adjusting the variables such as monthly income,educational level,age,and drinking history,logistic regression analysis showed that exercise before the first onset(OR=0.61,95%CI:0.38～0.98),exercise once a day(OR=0.55,95%CI: 0.31～0.96),exercise duration no more than 30 minutes(OR=0.33,95%CI: 0.13～0.85)and heavy sweating during exercise(OR=0.38,95%CI:0.16～0.94)protected the cognitive function at discharge.After the addition of such variables as systolic blood pressure,diastolic blood pressure,and SOD,it was found that only exercise time greater than90 minutes(OR=0.33,95% CI: 0.12～0.95)had a protective effect on the cognitive function at the time of discharge.(3)After propensity score matching,there is no significant difference in basic demographic data between whether or not to participate in exercises before stroke(P>0.05),and the matching effect is good.Analysis revealed once-daily exercise(OR=0.53,95%CI:0.30～0.95),exercise duration exceeding 90 minutes(OR=0.38,95%CI:0.15～0.99),no accelerated exercise heart rate(OR=0.52,95%CI: 0.28～0.99),and heavy sweating during exercise(OR=0.36,95%CI: 0.16～0.81)had protective effect on cognitive function at discharge.Further analysis by adding intermediate variables,it is found that only a lot of sweating during exercise(OR=0.42,95%CI: 0.17～0.99)has a protective effect.(4)SOD plays an intermediary role in the effects of exercise,exercise duration and exercise self-induced heart rate before the first stroke,it plays a part of the mediating effect in the role of exercise years,and plays a completely mediating effect in the effects of whether to exercise,the duration of exercise and exercise self-induced heart rate.Conclusion Physical exercise before the first onset of acute ischemic stroke can affect the cognitive function of patients when they are discharged from hospital.maintain a certain intensity of exercise,exercise sweating has a positive causal relationship with the cognitive function status of patients at discharge,and serum SOD plays an important mediating effect. |
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