Is physical activity a trigger factor for subarachnoid hemorrhage?

Area of Science:

• Neurology
• Public Health
• Sports Medicine

Background:

• Subarachnoid hemorrhage (SAH) carries a high mortality rate (43%) and causes significant disability.
• Current guidelines lack recommendations regarding physical activity for individuals with unruptured intracranial aneurysms (ICAs).
• Some medical teams advise against all sports for patients with ICAs as a precautionary measure.

Purpose of the Study:

• To evaluate the impact of physical activity as a risk factor for SAH.
• To review existing literature on the association between physical exertion and SAH onset.
• To provide evidence-based insights for clinical recommendations concerning physical activity in patients with ICAs.

Main Methods:

• A systematic literature review was conducted from 2000 to 2020, adhering to PRISMA guidelines.
• Included prospective and retrospective studies with over 50 patients where physical activity was linked to SAH onset.
• The primary endpoint was the prevalence of SAH occurring post-physical activity; comparative prevalences for other activities were calculated.

Main Results:

• Physical activity was associated with SAH onset in only 3% of cases, significantly lower than rest (30%), defecation (7.3%), or sexual activity (4.5%).
• Factors associated with SAH during physical activity included age under 60, male gender (M/F ratio 1.38), and smoking (67.1%).

Conclusions:

• Physical activity is an infrequent trigger for SAH.
• The findings contradict the notion that physical activity should be avoided by patients with unruptured ICAs.
• There is currently no scientific evidence to support an association between physical activity and aneurysmal SAH.