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

Serio, L ORCID: 0009-0008-2568-3721, Askarinejad, A ORCID: 0000-0003-2803-079X, Wang, C, Ahmadzadeh, K, Gu, T, Proietti, R ORCID: 0000-0003-4113-7030, Ferri, C, Buckley, BJR ORCID: 0000-0002-1479-8872 and Lip, GYH (2026) Exercise-based cardiac rehabilitation after stroke and the risk of incident dementia: an observational study from a global federated network. European Stroke Journal, 11 (10). ISSN 2396-9873

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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.

Item Type:	Article
Uncontrolled Keywords:	cardiovascular risk; cognitive decline; dementia; exercise-based cardiac rehabilitation; stroke; Humans; Male; Dementia; Aged; Female; Stroke Rehabilitation; Middle Aged; Stroke; Cardiac Rehabilitation; Incidence; Ischemic Attack, Transient; Exercise Therapy; Risk Factors; 4203 Health Services and Systems; 32 Biomedical and Clinical Sciences; 3202 Clinical Sciences; 42 Health Sciences; Neurosciences; Stroke; Aging; Cardiovascular; Brain Disorders; Acquired Cognitive Impairment; Physical Activity; Dementia; Neurodegenerative; Behavioral and Social Science; Rehabilitation; Cerebrovascular; 7.1 Individual care needs; 6.7 Physical; 3 Good Health and Well Being; Humans; Male; Dementia; Aged; Female; Stroke Rehabilitation; Middle Aged; Stroke; Cardiac Rehabilitation; Incidence; Ischemic Attack, Transient; Exercise Therapy; Risk Factors; 3201 Cardiovascular medicine and haematology; 4202 Epidemiology; 4206 Public health
Subjects:	R Medicine > RC Internal medicine > RC1200 Sports Medicine
Divisions:	Sport and Exercise Sciences
Publisher:	Oxford University Press
Date of acceptance:	30 September 2026
Date of first compliant Open Access:	30 October 2026
Date Deposited:	30 Oct 2026 14:05
Last Modified:	30 Oct 2026 14:05
DOI or ID number:	10.1093/esj/aakag127
URI:	https://researchonline.ljmu.ac.uk/id/eprint/29778

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