Abstract
PURPOSE OF ARTICLE: The role of immediate precipitating activities in aneurysmal subarachnoid hemorrhage (aSAH) remains unclear, lcontributing to uncertainty regarding activity restriction. This systematic review and meta-analysis examined the relative strain of activities preceding spontaneous aSAH using metabolic equivalents of task (METs).
MATERIALS AND METHODS: A systematic search identified studies reporting activities preceding aSAH (categorised as nonstrenuous, MET 1-4, and strenuous, MET ≥5). Associations between activity category and aSAH occurrence were assessed using chi-squared testing, with Fisher's combined method evaluating overall association. Odds of aSAH were evaluated using sleep or rest (MET 1) as the reference.
RESULTS: Six studies (3,285 aSAH cases) were included. aSAH mostly preceded nonstrenuous activities (43.2%) compared with strenuous activities (23.5%). Heavy strain activities (MET 6-8) , preceded 8.9% of cases ,while Valsalva maneuversaccounted for 7.9%. Fisher's combined method showed aSAH occurred less frequently after strenuous activities (p <0.001). Compared with sleep or rest, odds of aSAH were comparable or lower across all other activity categories.
CONCLUSION: Routine nonstrenuous activities most often preceded aSAH, suggesting high physical exertion may not be a dominant immediate trigger of aneurysm rupture. Other factors, including circadian blood pressure fluctuations and impaired autoregulation, may contribute to rupture risk.