Jeff K. Vallance, Lynn Corcoran
Abstract
The presence of a patent foramen ovale (PFO) in the heart is a risk factor for stroke due to the potential for paradoxical embolism. Given the implication of the heart in PFO-associated stroke and transcatheter closure, there may be unique factors that prevent patients from returning to physical activity
Introduction
Approximately 30% of ischemic strokes are classified as cryptogenic, indicating no identifiable cause despite comprehensive diagnostic evaluation [1]. Among patients with cryptogenic stroke, a patent foramen ovale (PFO) is detected in roughly 40%–50%, a prevalence rate that is substantially higher than observed in the general population (~25%) [2,3]. A PFO is a flap-like communication between the right and left atria that can permit right-to-left shunting, allowing venous thrombi to bypass the pulmonary circulation and enter the cerebral arterial system and cause a stroke.
Materials and methods
Qualitative inquiry is used to address novel research questions often related to participants’ lived experiences. An in-depth understanding of these experiences is gained through revealing meaning, exploring context, and interpreting patterns in the data which often consists of interview transcripts [11,12]. Data was collected via 1:1 interviews with participants and analyzed using Braun and Clarke’s reflexive thematic analysis (RTA) [13].
Results
The demographic and clinical characteristics of the study sample are presented in Table 2. The mean age of the sample was 47.7 ± 8.2 years and the mean age at the time of stroke was 44.7 ± 8.2 years. Average months since stroke was 38.5 ± 36.7 months and average months since transcatheter closure was 30.2 ± 34.3 months. Overall, 65% of participants were from the USA and 79% had at least a university/college degree. All participants were diagnosed with a PFO
Discussion
This paper is the first published research study investigating physical activity and exercise in the PFO-associated stroke context. Previous physical activity research with non PFO-associated stroke survivors has suggested stroke survivors are able to return to prestroke physical activity patterns with a “…business as usual attitude toward physical activity” (p. 195) [23]. The results of our study suggested PFO-associated stroke survivors have a variety of unique psychosocial (e.g., fear of having another stroke due to continued shunting) and physical (e.g., Afib, oxygen desaturation).
Conclusion
PFO-associ ated stroke and transcatheter closure are associated with unique challenges associated with physical activity. Our data suggest PFO-associated stroke can significantly impair activity levels, and participants reported several barriers to re-engaging in physical activity. Our study included individuals engaged in varying levels of activity ranging from individuals who were mostly sedentary to those who were considered elite/competitive athletes (e.g., endurance rowers, competitive marathon runners, cyclists, distance swimmers).
Citation: Vallance JK, Corcoran L (2026) Patient perceptions of physical activity after patent foramen ovale (PFO)-associated stroke and transcatheter closure: A qualitative study. PLoS One 21(8): e0354118. https://doi.org/10.1371/journal.pone.0354118
Editor: Chong Liu, The University of Aukland, NEW ZEALAND
Received: December 16, 2025; Accepted: July 4, 2026; Published: August 5, 2026
Copyright: © 2026 Vallance, Corcoran. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: Data cannot be shared publicly. Participants were assured their transcripts and data are confidential. Data are available from the Athabasca University Institutional Data Access / Ethics Committee (gleicht@athabascau.ca) for researchers who meet the criteria for access to confidential data.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
