title: Risk of Recurrent Stroke and Death After First Stroke in Long-Distance Ski Race Participants.
abstract: BACKGROUND
  Physical activity is of benefit for primary prevention of cardiovascular diseases, but it appears to increase the risk for atrial fibrillation. We aimed to study a cohort of patients following a first stroke in individuals with previous high physical activity, compare them to the general population with respect to recurrent stroke and death, and relate these to atrial fibrillation.
  
  
  RESULTS
  From the participants of the Vasaloppet, the world's largest ski-race, and matched individuals from the general population (n=708,604), we identified 5964 patients hospitalized with a first-time stroke between 1994 and 2010. Individuals with severe diseases were excluded. One half percent of skiers and 1% of nonskiers were hospitalized due to stroke. The incidence rate was 8.3 per 100 person-years among skiers and 11.1 among nonskiers. The hazard ratio (HR) for recurrent stroke or death between the 2 groups was 0.76 (95% CI 0.67 to 0.86). The result was consistent in subgroups. The HR for death was 0.66 (95% CI 0.56 to 0.78) and for recurrent stroke 0.82 (95% CI 0.70 to 0.96). After adjustment for smoking and socioeconomic factors, the HR for death was consistent at 0.70 (95% CI 0.56 to 0.87) while the HR for recurrent stroke was not statistically significant. Outcomes for skiers with atrial fibrillation tended to show a lower risk than for nonskiers.
  
  
  CONCLUSIONS
  This large cohort study supports the hypothesis that patients with a stroke and with prior regular physical activity have a lower risk of death, while their risk for recurrent stroke is similar to that of nonskiers. The skiers had a higher incidence of atrial fibrillation, but still no increased risk of recurring stroke.
authors.affiliation: Department of Medical Sciences, Uppsala University, Uppsala, Sweden (U., S., J., S.J.) Department of Internal Medicine, Mora Hospital, Mora, Sweden (U.).
authors.forename: Ulf
authors.initials: U
authors.lastname: Hållmarker
authors.affiliation: Department of Medical Sciences, Uppsala University, Uppsala, Sweden (U., S., J., S.J.) Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (S., K.M., J.L., S.J.).
authors.forename: Signild
authors.initials: S
authors.lastname: Åsberg
authors.affiliation: Department of Surgical Sciences, Uppsala University, Uppsala, Sweden (K.M.) Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (S., K.M., J.L., S.J.).
authors.forename: Karl
authors.initials: K
authors.lastname: Michaëlsson
authors.affiliation: Department of Medical Sciences, Uppsala University, Uppsala, Sweden (U., S., J., S.J.) School of Health and Social Studies, Dalarna University, Falun, Sweden (J.).
authors.forename: Johan
authors.initials: J
authors.lastname: Ärnlöv
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden (D.H., J.L.).
authors.forename: Dan
authors.initials: D
authors.lastname: Hellberg
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden (D.H., J.L.) Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (S., K.M., J.L., S.J.).
authors.forename: Johan
authors.initials: J
authors.lastname: Lindbäck
authors.affiliation: Department of Public Health and Medicine, Umeå University, Umeå, Sweden (P.W.).
authors.forename: Per
authors.initials: P
authors.lastname: Wester
authors.affiliation: Department of Medical Sciences, Uppsala University, Uppsala, Sweden (U., S., J., S.J.) Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (S., K.M., J.L., S.J.).
authors.forename: Stefan
authors.initials: S
authors.lastname: James
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D002423:Cause of Death; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010807:Physical Endurance; D065840:Protective Factors; D012008:Recurrence; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012865:Skiing; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
keywords: Sweden; Vasaloppet; atrial fibrillation; cerebrovascular disease; cross‐country skiing; epidemiology; lifestyle; physical activity; prevention; recurrent stroke; sports medicine