This meta-analysis aimed to assess the association of pre-stroke physical activity with post-stroke outcomes.

While physical activity offers numerous health benefits, most studies focus on individual post-stroke outcomes. This review provides updated evidence on the effects of pre-stroke physical activity across multiple outcomes.

A systematic search of PubMed, EMBASE, SCOPUS, and Web of Science was performed up to September 2024, using terms like “pre-stroke,” “physical activity,” and “outcomes.” Two independent reviewers extracted data and evaluated the study quality. The primary outcomes determined were mean NIHSS scores on admission and the odds of a good functional outcome (mRS 0–2) at 3 months. Effect sizes were reported with 95% confidence intervals (MD or OR) and I² statistics.

After screening 2,936 studies, 8 cohort studies were included in the meta-analysis. For the NIHSS score on admission, there were 4 studies with 6,532 stroke patients (5547 ischemic, 488 hemorrhagic, 497 others), 689 in the pre-stroke physical activity group and 5,843 in the physically inactive group showing a mean difference of -0.65 (95% CI: -1.16 to -0.16; I² = 38.3%) between the two groups, which was quite significant.

For mRS outcome at 3 months post stroke, there were four studies with 40,657 stroke cases (33,395 ischemic, 6979 hemorrhagic, 283 others). Among them, 19,908 were in the physical activity group and 20,749 in the physically inactive group. The mRS outcomes did not differ significantly between the two groups (OR = 5.05, 95% CI: 0.71 to 35.68; I² = 93.5%).

Qualitative analysis showed moderate activity (2–3 hours/week) was more beneficial than light activity (4-hour weekly walks) in enhancing cognition and quality of life 3 months post-stroke.

Pre-stroke physical activity is significantly associated with lower NIHSS scores, indicating reduced stroke severity. However, no significant difference in mRS-outcome was found, underscoring the need for further research on post-stroke recovery.