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Review
. 2022 Jul;53(7):2404-2410.
doi: 10.1161/STROKEAHA.121.037343. Epub 2022 May 4.

Impact of Exercise on Cerebrovascular Physiology and Risk of Stroke

Justin A Edward  1 , William K Cornwell 3rd  1   2
Affiliations
Review

Impact of Exercise on Cerebrovascular Physiology and Risk of Stroke

Justin A Edward et al. Stroke. 2022 Jul.

Abstract

Ischemic heart disease and stroke are the number 1 and number 2 causes of death worldwide, respectively. A lifelong commitment to exercise reduces the risk of these adverse events and is also associated with several cardiometabolic improvements, including reductions in blood pressure, cholesterol, and inflammatory markers, as well as improved glucose control. Routine exercise also reduces the risk of developing comorbidities that increase the risk of cardiovascular or cerebrovascular disease. While the benefits of a lifelong commitment to exercise are well documented, there is a complex interaction between exercise and stroke risk, such that the risk of ischemic or hemorrhagic stroke may increase acutely during or immediately following exercise. In this article, we discuss the physiological responses to different types of exercise, as well as the determinants of resting and exertional cerebrovascular perfusion, and explore the complex interaction between atrial fibrillation, exercise, and stroke risk. Finally, we highlight the increased risk of stroke during different types of exercise, as well as factors that may alleviate this risk.

Keywords: atrial fibrillation; blood glucose; blood pressure; cause of death; exercise; hemorrhagic stroke; ischemic stroke.

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Figures

Figure 1
Figure 1
The classification of different sports/exercises is based on the relative contribution of static v. dynamic exercise intensity. Reprinted from Levine et al with permission. Copyright ©2015, the American Heart Association, Inc. and the American College of Cardiology Foundation. Reprinted from Mitchell et al with permission. Copyright ©2005, the American College of Cardiology Foundation.
Figure 2
Figure 2
Changes in cardiac output (CO), cerebral blood flow (CBF), and partial pressure of arterial carbon dioxide (PaCO2) in response to progressive increase in exercise intensity. Vertical dashed line indicates ventilatory threshold.
Figure 3
Figure 3
Hemodynamic response to exercise in a 59yo healthy male during cardiopulmonary exercise test during stationary upright cycle ergometery, demonstrating initial increase in middle cerebral arterial velocity during exercise, followed by leveling off and eventual reduction in velocity during exercise above ventilatory threshold. Blood presure obtained from radial arterial catheterization. Middle cerebral arterial velocity obtained from transcranial Doppler during exercise. Gas exchange parameters obtained by breath-by-breath indirect calorimetry. Unpublished data from senior author (clinicaltrials.gov # NCT03232736).
See this image and copyright information in PMC

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