# Safety of Physical Activity After Cervical Artery Dissection

## TL;DR

This study finds that physical activity after cervical artery dissection is generally safe, though high-intensity sports may slightly increase recurrence risk.

## Contribution

The study provides new evidence on the safety of physical activity after cervical artery dissection and identifies a potential risk with high-intensity sports.

## Key findings

- 59.2% of patients changed their physical activity levels after CeAD, with no overall link to recurrence.
- Higher-intensity sports showed a trend toward increased CeAD recurrence risk, though not statistically significant.
- Physical activity changes were not associated with cerebral ischemia or stroke recurrence.

## Abstract

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.

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.

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).

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.

We assess whether cervical artery dissection (CeAD) patients change their physical activity post‐CeAD and whether such changes or the intensity of physical activity performed relate to dissection or stroke recurrence. In this pooled registry analysis of 333 patients with 6.5 years of follow‐up, 59.2% changed activity levels, with 64.5% and 35.5% reporting decrease or increase, respectively. Neither overall change, increase, nor decrease was associated with CeAD or stroke recurrence; however, regular performance of higher‐intensity sports showed a tendency toward higher risk of CeAD recurrence.