Trajectories of Engagement in Leisure-time Physical Activity and Risk of Incident Ischemic Stroke: The Atherosclerosis Risk in Communities Study

Document Type

Conference Proceeding

Publication Date


Publication Title

Circulation: American Heart Association Meeting




Introduction: Engagement in leisure-time physical activity (PA) levels recommended by the American Heart Association (AHA) is inversely associated with ischemic stroke risk. PA level can fluctuate over time but the association between PA fluctuations and ischemic stroke risk is unknown. The extent that ischemic stroke risk could be attenuated by increasing PA among those who are inactive could inform stroke prevention.

Hypothesis: We hypothesize that participants who remained active or increased their PA levels will have lower ischemic stroke risk relative to those who were persistently inactive.

Methods: We included 12,611participants of the Atherosclerosis Risk in Communities (ARIC) cohort study ages 45-64 at visit 1 (1987-1989) who did not have a history of stroke at visit 3 (1993-1995). Leisure-time PA was assessed using the modified Baecke questionnaire at visits 1 and 3 and categorized according to the AHA guidelines for PA (ideal, intermediate, or poor). All adjudicated definite and probable incident ischemic strokes between visit 3 and end of year 2013 were included. Cox-proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for ischemic stroke by cross-categories of PA at visits 1 and 3 using those with poor PA at both visits as the referent group. We adjusted for age, sex, race/center, smoking status, and alcohol intake at visit 3.

Results: During a median of 18.6 years of follow-up, 777 incident ischemic stroke events occurred. Compared with those with poor PA at visits 1 and 3, participants with ideal PA at both visits had the lowest ischemic stroke risk (HR=0.64, 0.51, 0.80). Those whose PA increased from poor to ideal also had significantly lower ischemic stroke risk (HR = 0.70, 0.53, 0.94).

Conclusion: Sustained ideal PA was associated with the lowest ischemic stroke risk. Increasing PA between visit 1 and visit 3 was also associated with significantly lower ischemic stroke risk. Increasing PA may be an important component of stroke prevention.


© 2019 by American Heart Association, Inc.