Mild exercise reduces cerebral vasospasm after aneurysm subarachnoid hemorrhage: A retrospective clinical study and correlation with laboratory investigation

Abstract

Background: Aneurysmal subarachnoid hemorrhage (SAH) is a leading cause of death and disability and is often complicated by cerebral vasospasm (CV). Conventional management to prevent CV includes bedrest; however, inactivity places the patient at risk for nonneurological complications. We investigated the effect of mild exercise after SAH in clinical and laboratory settings.Methods: Clinical: Data from 80 patients with SAH were analyzed retrospectively. After aneurysms were secured, physical therapy was initiated as tolerated. CV and complications were compared by the timing of active physical therapy. Laboratory: 18 Rodents were divided into three groups: (1) control, (2) SAH without exercise, and (3) SAH plus mild exercise. On day 5, brain-stems were removed and analyzed for the injury marker inducible nitric oxide synthase (iNOS).Results: Clinical: Mild exercise before day 4 signifi cantly lowered the incidence of symptomatic CV compared with the nonexercised group. There was no difference in the incidence of additional complications based upon exercise. Laboratory: Staining for iNOS was signifi cantly higher in the SAH group than the control group, but there was no difference between exercised and nonexercised SAH groups, confi rming that exercise did not promote neuronal injury.Conclusion: Early mobilization signifi cantly reduced clinical CV. The relationship should be studied further in a prospective trial with defi ned exercise regimens.