title: Physical activity and ischemic stroke risk. The atherosclerosis risk in communities study.
abstract: OBJECTIVE
  The relationship between physical activity and stroke is inconclusive according to the 1996 US Surgeon General's Report on Physical Activity and Health. Therefore, this study examined the relationship between physical activity and ischemic stroke risk among 14 575 Atherosclerosis Risk in Communities Study participants aged 45 to 64 years free of self-reported stroke and coronary heart disease at baseline.
  
  
  METHODS
  Eligible potential stroke hospitalizations were identified from ongoing hospital surveillance and from hospitalizations reported by the cohort study participants. All strokes were validated by hospitalization records. Physical activity was measured as sport, leisure (nonsport), and work with the use of the Baecke questionnaire. Multivariable Poisson and Cox proportional hazards models were used to determine the association of differing levels of physical activity with ischemic stroke incidence.
  
  
  RESULTS
  During an average of 7.2 years of follow-up, 189 incident ischemic strokes occurred. Ischemic stroke incidence rates were highest in the lowest quartile of sport, leisure, and work scores. The hazard rate ratios with 95% CIs for ischemic stroke for the highest quartile compared with the lowest quartile of activity adjusted for age, sex, race-center, education, and smoking, were sport 0.83 (0.52, 1.32), leisure 0.89 (0.57, 1.37), and work 0.69 (0.47, 1.00). Further adjustment for factors that likely were intermediate variables (hypertension, diabetes, fibrinogen, and body mass index) between physical activity and stroke attenuated the associations.
  
  
  CONCLUSIONS
  Our findings suggest that physical activity was weakly associated with a reduced risk of ischemic stroke among middle-aged adults. The association may be due to links between physical activity and other risk factors or due to chance.
authors.affiliation: Department of Epidemiology School of Public Health, University of North Carolina-Chapel Hill, USA. kelly__evenson@unc.edu
authors.forename: K R
authors.initials: KR
authors.lastname: Evenson
authors.forename: W D
authors.initials: WD
authors.lastname: Rosamond
authors.forename: J
authors.initials: J
authors.lastname: Cai
authors.forename: J F
authors.initials: JF
authors.lastname: Toole
authors.forename: R G
authors.initials: RG
authors.lastname: Hutchinson
authors.forename: E
authors.initials: E
authors.lastname: Shahar
authors.forename: A R
authors.initials: AR
authors.lastname: Folsom
mesh_terms: D002545:Brain Ischemia / Q000150:complications* / Q000453:epidemiology; D002544:Cerebral Infarction / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D005082:Physical Exertion; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology