Safety of Physical Activity After Cervical Artery Dissection

BACKGROUND: Cervical artery dissection (CeAD) is a major cause for stroke in young adults. A timely association with minor-to-moderate unimposing cervical trauma, which is often sports-related, is common in CeAD. Our goal was to assess whether physical activity puts patients at risk post-CeAD. METHODS: Pooled data from two prospective observational CeAD cohorts with in-person follow-up of at least 1-year post-CeAD were assessed. Changes in physical activity were recorded using patient-reported assessment of change in activity compared to pre-CeAD. Baecke score-derived sports index was applied to address the association between physical activity intensity and our outcomes. Outcomes were (1) recurrent dissection and (2) cerebral ischemia upon follow-up. RESULTS: A total of 648 CeAD patients were recorded. Physical activity-specific follow-up data were available in 333 (59.7%). The median follow-up duration was 6.5 (IQR 3.1, 10.9) years with 17/333 (5.1%) suffering CeAD recurrence and 22/33#3 (6.6%) experiencing cerebral ischemia. A total of 197 of 333 (59.2%) patients reported a change in physical activity post-CeAD (127 [64.5%] decrease, 70 [35.5%] increase). Neither overall change, increase, or decrease of physical activity was associated with recurrent CeAD or cerebral ischemia (p > 0.2 throughout). However, regular performance of higher-intensity sports, assessed via Baecke score-derived sports index, associated in trend to dissection recurrence (OR 3.43 [0.86, 13.64]; p = 0.080). CONCLUSIONS: CeAD patients should be reassured that regaining physical activity after CeAD is safe. However, moderation on exertion should be discussed on an individual patient basis.