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Peer-reviewedCC BYEuropean stroke journal

Exercise-based cardiac rehabilitation after stroke and the risk of incident dementia: an observational study from a global federated network.

  • Leandra Serio1,2,3
  • Amir Askarinejad1
  • Chen Wang1
  • Koohyar Ahmadzadeh1
  • Tianshu Gu1,4
  • Riccardo Proietti1
  • Claudio Ferri2,3
  • Ben Buckley1,5
  • Gregory Y H Lip1,6,7
7 affiliations
  1. 1Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom.
  2. 2Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
  3. 3Internal Medicine and Nephrology Division, ASL1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy.
  4. 4Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China.
  5. 5Cardiovascular Health Sciences, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom.
  6. 6Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
  7. 7Department of Clinical Medicine, Medical University of Bialystok, Bialystok, Poland.
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Abstract

Introduction

Dementia is a common and disabling complication after stroke. Exercise-based cardiac rehabilitation (EXCR) may influence vascular and inflammatory mechanisms relevant to cognitive decline. We investigated the association between EXCR initiation after stroke and incident dementia.Patients and methods

Using TriNetX, we identified adults with ischaemic stroke or TIA. Patients with recorded ICD-10-CM codes indicating an NIHSS score ≥ 16 were excluded from the primary analysis. Patients initiating EXCR within 6 months were compared with those without documented post-index EXCR. Propensity score matching balanced demographics, comorbidities, medication use and available stroke-severity measures. Outcomes were assessed at 3 and 5 years.Results

The unmatched cohorts included 4226 patients initiating EXCR (mean age, 64.7 years; 60.8% male) and 1,889,796 without EXCR (mean age, 66.3 years; 48.2% male). After matching, 4138 patients remained in each cohort. At 5 years, EXCR was associated with lower hazards of incident dementia (HR, 0.70; 95% CI, 0.59-0.82), all-cause mortality (HR, 0.50; 95% CI, 0.45-0.55) and recurrent stroke (HR, 0.75; 95% CI, 0.61-0.91), but a higher hazard of rehospitalisation (HR, 1.21; 95% CI, 1.06-1.38); no significant association was observed for acute myocardial infarction. The association with incident dementia remained consistent across sensitivity analyses.Discussion

The observed association with lower dementia risk suggests that the potential benefits of post-stroke EXCR may extend beyond cardiovascular and functional outcomes.Conclusions

EXCR initiation after ischaemic stroke or TIA was associated with a lower hazard of incident dementia. This association remained consistent across the 3-year, 30-day landmark, 1-year lagged and all-stroke-severity sensitivity analyses.

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Cite

BibTeXRIS
BibTeX
@article{serio2026exercisebased,
  title = {{Exercise-based cardiac rehabilitation after stroke and the risk of incident dementia: an observational study from a global federated network.}},
  author = {Leandra Serio and Amir Askarinejad and Chen Wang and Koohyar Ahmadzadeh and Tianshu Gu and Riccardo Proietti and Claudio Ferri and Ben Buckley and Gregory Y H Lip},
  journal = {European stroke journal},
  year = {2026},
  month = oct,
  doi = {10.1093/esj/aakag127},
  url = {https://europepmc.org/article/MED/42911872},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Exercise-based cardiac rehabilitation after stroke and the risk of incident dementia: an observational study from a global federated network.
AU  - Leandra Serio
AU  - Amir Askarinejad
AU  - Chen Wang
AU  - Koohyar Ahmadzadeh
AU  - Tianshu Gu
AU  - Riccardo Proietti
AU  - Claudio Ferri
AU  - Ben Buckley
AU  - Gregory Y H Lip
PY  - 2026
DA  - 2026/10/01
JO  - European stroke journal
DO  - 10.1093/esj/aakag127
UR  - https://europepmc.org/article/MED/42911872
AB  - Introduction  Dementia is a common and disabling complication after stroke. Exercise-based cardiac rehabilitation (EXCR) may influence vascular and inflammatory mechanisms relevant to cognitive decline. We investigated the association between EXCR initiation after stroke and incident dementia.Patients and methods  Using TriNetX, we identified adults with ischaemic stroke or TIA. Patients with recorded ICD-10-CM codes indicating an NIHSS score ≥ 16 were excluded from the primary analysis. Patients initiating EXCR within 6 months were compared with those without documented post-index EXCR. Propensity score matching balanced demographics, comorbidities, medication use and available stroke-severity measures. Outcomes were assessed at 3 and 5 years.Results  The unmatched cohorts included 4226 patients initiating EXCR (mean age, 64.7 years; 60.8% male) and 1,889,796 without EXCR (mean age, 66.3 years; 48.2% male). After matching, 4138 patients remained in each cohort. At 5 years, EXCR was associated with lower hazards of incident dementia (HR, 0.70; 95% CI, 0.59-0.82), all-cause mortality (HR, 0.50; 95% CI, 0.45-0.55) and recurrent stroke (HR, 0.75; 95% CI, 0.61-0.91), but a higher hazard of rehospitalisation (HR, 1.21; 95% CI, 1.06-1.38); no significant association was observed for acute myocardial infarction. The association with incident dementia remained consistent across sensitivity analyses.Discussion  The observed association with lower dementia risk suggests that the potential benefits of post-stroke EXCR may extend beyond cardiovascular and functional outcomes.Conclusions  EXCR initiation after ischaemic stroke or TIA was associated with a lower hazard of incident dementia. This association remained consistent across the 3-year, 30-day landmark, 1-year lagged and all-stroke-severity sensitivity analyses.
SN  - 2396-9873
SN  - 2396-9881
ER  -