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

doi:10.1161/STROKEAHA.120.032695

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

Research output: Contribution to journal › Article › peer-review

11 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 language	English
Pages (from-to)	2086-2095
Number of pages	10
Journal	Stroke
Volume	52
Issue number	6
DOIs	https://doi.org/10.1161/STROKEAHA.120.032695
State	Published - Jun 1 2021

Bibliographical note

Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.

Funding

The Atherosclerosis Risk in Communities study (ARIC) has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Department of Health and Human Services, under Contract numbers (HHSN268201700001I, HH-SN268201700002I, HHSN268201700003I, HHSN268201700005I, HH-SN268201700004I). The ARIC Study is performed as a collaborative study supported by NHLBI contracts (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HSN268201700004I). Neurocognitive data is collected by U01 2U01HL096812, 2U01HL096814, 2U01HL096899, 2U01HL096902, 2U01HL096917 from the NIH (NHLBI, National Institute of Neurological Disorders and Stroke, National Institute on Aging, and National Institute on Deafness and Other Communication Disorders), and with previous brain magnetic resonance imaging examinations funded by R01-HL70825 from the NHLBI. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Dr Lakshminarayan is funded by the National Institutes of Health and serves on the adverse events committee of Abbott Laboratories. Dr Palta is supported by grant R00AG052830 from the National Institute on Aging. Dr Mediano was supported by the Coordination for the Improvement of Higher Education Personnel during his visiting scholar fellowship (process number 88881.173102/2018-01). The other authors report no conflicts.

Funders	Funder number
National Institutes of Health (NIH)
U.S. Department of Health and Human Services	2U01HL096899, U01 2U01HL096812, 2U01HL096814, 2U01HL096902, HH-SN268201700004I, HH-SN268201700002I, HHSN268201700003I, 2U01HL096917, HHSN268201700005I, HHSN268201700001I
National Institute on Aging
National Heart, Lung, and Blood Institute (NHLBI)	U01HL096899
National Institute on Deafness and Other Communication Disorders	R01-HL70825
National Institute of Neurological Disorders and Stroke
Abbott Laboratories	R00AG052830
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior	88881.173102/2018-01

Keywords

atherosclerosis
cardiovascular disease
exercise
prognosis
public health

ASJC Scopus subject areas

Clinical Neurology
Cardiology and Cardiovascular Medicine
Advanced and Specialized Nursing

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1161/STROKEAHA.120.032695

Cite this

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title = "Prestroke Physical Activity and Adverse Health Outcomes after Stroke in the Atherosclerosis Risk in Communities Study",

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.",

keywords = "atherosclerosis, cardiovascular disease, exercise, prognosis, public health",

author = "Mediano, \{Mauro F.F.\} and Yejin Mok and Josef Coresh and Anna Kucharska-Newton and Priya Palta and Kamakshi Lakshminarayan and Rosamond, \{Wayne D.\} and Kunihiro Matsushita and Silvia Koton",

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language = "English",

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AU - Mediano, Mauro F.F.

AU - Mok, Yejin

AU - Coresh, Josef

AU - Kucharska-Newton, Anna

AU - Palta, Priya

AU - Lakshminarayan, Kamakshi

AU - Rosamond, Wayne D.

AU - Matsushita, Kunihiro

AU - Koton, Silvia

PY - 2021/6/1

Y1 - 2021/6/1

N2 - 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.

AB - 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.

KW - atherosclerosis

KW - cardiovascular disease

KW - exercise

KW - prognosis

KW - public health

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

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

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