ABSTRACT NUMBER: ESOC2026A2151 PRE-STROKE PHYSICAL ACTIVITY IS ASSOCIATED WITH STROKE PHENOTYPE, SEVERITY, AND EARLY FUNCTIONAL OUTCOMES ACROSS ISCHEMIC STROKE, INTRACEREBRAL HEMORRHAGE, TRANSIENT ISCHEMIC ATTACKS, AND STROKE MIMICS

Abstract Background and aims Pre-stroke physical activity (PA) enhances vascular health and functional reserve. However, its impact on the acute stroke phenotype, severity, and early outcomes across ischemic stroke, transient ischemic attack (TIA), and stroke mimics remains insufficiently understood. Methods We conducted a prospective cohort study at AIIMS from May 2025 to January 2026 on patients with suspected acute stroke. Pre-stroke physical activity (PA) and BMI were recorded at admission. Stroke types included AIS, ICH, TIA, or mimics. Outcomes measured were NIHSS, mRS, and BI at baseline, current, and discharge. Associations between PA, stroke type, severity, treatment, and outcomes were analyzed using non-parametric and multivariable regression. Results Out of 400 patients, baseline data was available for 384 (96%). Diagnoses included AIS (189), ICH (123), TIA (30), and mimics (42). In AIS, moderate-high PA linked to lower NIHSS scores (median 7 vs 12, p=0.004), lower mRS (2 vs 4, p=0.002), and higher BI (7 vs 4, p=0.003). 69% of active AIS patients had favorable mRS (0–2) versus 31% inactive. TIA patients with higher PA had milder deficits. Stroke mimics with lower PA showed more disability. Higher PA correlated with fewer ICHs (12% vs 31%, p=0.02). BMI alone wasn't linked to outcomes, but PA-BMI interaction influenced stroke severity. Conclusions Pre-stroke physical activity is consistently linked to milder presentation and improved early functional outcomes across ischemic stroke, TIA, and stroke mimics, regardless of BMI. These results underscore physical activity as a key, modifiable factor that enhances cerebrovascular resilience, influencing acute stroke phenotype and recovery. Conflict of interest Manabesh Nath: nothing to disclose, Awadh Kishor Pandit: nothing to disclose, Rajesh Kumar Singh: nothing to disclose, Pradeep Kumar: nothing to disclose, Deepti Vibha: nothing to disclose