Prestroke Physical Activity and Adverse Health Outcomes after Stroke in the Atherosclerosis Risk in Communities Study

Mauro F.F. Mediano, Yejin Mok, Josef Coresh, Anna Kucharska-Newton, Priya Palta, Kamakshi Lakshminarayan, Wayne D. Rosamond, Kunihiro Matsushita, Silvia Koton*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Background and Purpose: The association of physical activity (PA) before stroke (prestroke PA) with long-term prognosis after stroke is still unclear. We examined the association of prestroke PA with adverse health outcomes in the ARIC study (Atherosclerosis Risk in Communities). Methods: We included 881 participants with incident stroke occurring between 1993 and 1995 (visit 3) and December 31, 2016. Follow-up continued until December 31, 2017 to allow for at least 1-year after incident stroke. Prestroke PA was assessed using a modified version of the Baecke questionnaire in 1987 to 1989 (visit 1) and 1993 to 1995 (visit 3), evaluating PA domains (work, leisure, and sports) and total PA. We used Cox proportional hazards models to quantify the association between tertiles of accumulated prestroke PA levels over the 6-year period between visits 1 and 3 and mortality, risk of cardiovascular disease, and recurrent stroke after incident stroke. Results: During a median follow-up of 3.1 years after incident stroke, 676 (77%) participants had adverse outcomes. Highest prestroke total PA was associated with decreased risks of all-cause mortality (hazard ratio, 0.78 [95% CI, 0.63-0.97]) compared with lowest tertile. In the analysis by domain-specific PA, highest levels of work PA were associated with lower risk for all-cause (hazard ratio, 0.77 [95% CI, 0.62-0.96]) and cardiovascular mortality (hazard ratio, 0.45 [95% CI, 0.29-0.70]), and highest levels of leisure PA were associated with lower all-cause mortality (hazard ratio, 0.72 [95% CI, 0.58-0.89]) compared with lowest tertile of PA. No significant associations for sports PA were observed. Conclusions: Higher levels of total prestroke PA as well as work and leisure PA were associated with lower risk of mortality after incident stroke. Public health strategies to increase lifetime PA should be encouraged to decrease long-term mortality after stroke.

Original languageEnglish
Pages (from-to)2086-2095
Number of pages10
JournalStroke
Volume52
Issue number6
DOIs
StatePublished - 1 Jun 2021

Funding

FundersFunder number
National Institutes of Health
U.S. Department of Health and Human Services2U01HL096899, U01 2U01HL096812, 2U01HL096814, 2U01HL096902, HH-SN268201700004I, HH-SN268201700002I, HHSN268201700003I, 2U01HL096917, HHSN268201700005I, HHSN268201700001I
National Institute on Aging
National Heart, Lung, and Blood InstituteU01HL096899
National Institute on Deafness and Other Communication DisordersR01-HL70825
National Institute of Neurological Disorders and Stroke
Abbott LaboratoriesR00AG052830
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior88881.173102/2018-01

    Keywords

    • atherosclerosis
    • cardiovascular disease
    • exercise
    • prognosis
    • public health

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