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Physical activity (PA) is a modifiable factor that may influence these conditions. This study aimed to examine the association between pre-stroke PA and symptoms of depression and anxiety in post-stroke patients at 3 and 12 months after discharge. The analysis was based on 821 patients from the SCHANA study, recruited between 2018 and 2022 at the University Hospital Augsburg. PA was assessed using the International Physical Activity Questionnaire (IPAQ) and categorized into low, moderate, and high activity level groups. Depression and anxiety were evaluated using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder scale (GAD-7), respectively. Multivariable linear regression models were applied. Moderate PA before stroke was associated with fewer depressive symptoms at 3 months post-stroke compared to low PA (\u03b2 = -1.01, p\u2009=\u20090.007), but not after 12 months. High PA showed no significant association at either time point. Additionally, no significant association was observed for anxiety outcomes. A strong correlation was identified between symptoms of depression and anxiety at 3 months follow-up (r\u2009=\u20090.75, p\u2009&lt;\u20090.001). Engaging in PA before stroke may contribute to better mental well-being during the subacute phase of stroke recovery. The association between depression and anxiety highlights the potential of lifestyle interventions to impact mental health outcomes post-stroke. Physicians should pay close attention to both inactive and highly active patients, as poor mental health can negatively affect recovery process.\u00a0<\/jats:p>","DOI":"10.1038\/s41598-026-51679-5","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T11:05:20Z","timestamp":1779793520000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Moderate pre-stroke physical activity has a protective effect on symptoms of depression in the post-acute phase after stroke"],"prefix":"10.1038","volume":"16","author":[{"given":"Moritz","family":"Hahner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Meisinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inge","family":"Kirchberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Ertl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Naumann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakob","family":"Linseisen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timo","family":"Schmitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"51679_CR1","unstructured":"World Health Organization. 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