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Association Between Physical Activity and Cryptogenic Ischemic Stroke in Young Adults: A Case-Control Study.
Shakar Kutal1, Nilufer Yesilot2, Tomi Sarkanen3
1Department of Neurology, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland.
European Journal of Neurology
|May 28, 2026
Summary
High physical activity (PA) is linked to increased risk of cryptogenic ischemic stroke (CIS) in young adults. Both very low and very high PA levels may elevate CIS risk, particularly in those without high-risk patent foramen ovale (PFO).
Area of Science:
- Neurology
- Cardiology
- Public Health
Background:
- Limited data exists on the link between physical activity (PA) and cryptogenic ischemic stroke (CIS) in young adults.
- Investigating PA's role in early-onset CIS, considering patent foramen ovale (PFO) status, is crucial.
Purpose of the Study:
- To examine the association between physical activity levels and cryptogenic ischemic stroke (CIS) in young adults.
- To stratify this relationship based on the presence of a high-risk patent foramen ovale (PFO).
Main Methods:
- A case-control study involving 533 patients aged 18-49 with first-ever CIS and 533 matched controls from 19 European centers.
- Physical activity (PA) assessed using the short International Physical Activity Questionnaire (IPAQ) and categorized into percentiles.
- Conditional logistic regression analysis adjusted for various risk factors was employed.
Main Results:
- The top 10% of physical activity (PA) was independently associated with an increased risk of CIS (OR 2.07).
- In patients without high-risk PFO, both the bottom 10% (OR 1.76) and top 10% (OR 1.78) of PA were linked to elevated CIS risk.
- No significant association between PA levels and CIS was found in patients with high-risk PFO.
Conclusions:
- Highest levels of physical activity (top 10%) are associated with a greater risk of early-onset CIS in the general young adult population.
- Both extremes of physical activity (bottom and top 10%) are associated with increased CIS risk among individuals without high-risk PFO.
- Further research is needed to elucidate the mechanisms linking both low and high physical activity to stroke risk.
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