ESC Congress 2026 Abstract · Oct 26, 2026

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

By Serio L, Askarinejad A, Weng C et al.

Background: Dementia is a common and disabling complication after stroke. Exercise-based cardiac rehabilitation (EXCR) improves vascular risk factors, physical fitness, and systemic inflammation factors that may be relevant to post-stroke cognitive decline. Purpose: To investigate the association between initiation of EXCR after stroke and the subsequent risk of developing incident dementia. Methods: We used TriNetX, a global federated electronic health record (EHR) network, to conduct a retrospective observational cohort study of adults with ischemic and/or hemorrhagic stroke and baseline NIHSS ≤16. Patients were grouped according to initiation of EXCR between 1 day and 6 months after the index stroke and were propensity score–matched. The primary outcome was incident composite dementia (Alzheimer’s disease, vascular dementia, or unspecified dementia). Secondary outcomes included dementia subtypes, all-cause mortality, stroke recurrence, rehospitalization, and acute myocardial infarction (AMI), evaluated using time-to-event analyses over 5 years (primary analysis) and 3 years (sensitivity analysis). To mitigate potential reverse causation, we also conducted a 1-year lagged analysis excluding events occurring within the first year after the index date; the association with incident dementia remained statistically significant. Results: The study included 20,200 stroke patients who underwent EXCR (mean age 67.0 ± 13.5 years; 54.9% male) and 1,706,668 stroke patients who did not undergo EXCR (mean age 66.5 ± 15.3 years; 48.4% male). After propensity score matching (PSM), EXCR was associated with a lower 5-year risk of incident dementia (HR 0.68; 95% CI 0.64–0.72) and lower all-cause mortality (HR 0.52; 95% CI 0.50–0.54). EXCR was also associated with reduced stroke recurrence (HR 0.51; 95% CI 0.46–0.56) and fewer rehospitalizations (HR 0.75; 95% CI 0.73–0.77). In a 1-year lagged analysis excluding events occurring within the first year after the index date, the association with incident dementia remained significant (HR 0.85; 95% CI 0.79–0.92). Results from the 3-year follow-up analysis were consistent with the primary findings. Conclusions: EXCR after stroke was associated with a lower 5-year risk of incident dementia and with lower mortality and recurrent stroke. Results were consistent at 3 years. Prospective studies are warranted to confirm these findings and clarify mechanisms.Forest plot of outcome at five yearsFor image description, please refer to the figure legend and surrounding text.Forest plot of outcome at three yearsFor image description, please refer to the figure legend and surrounding text.

doi.org/10.1093/eurheartj/ehag785.2692Open accessPopulations