title: Physical inactivity is a strong risk factor for stroke in the oldest old: Findings from a multi-ethnic population (the Northern Manhattan Study).
abstract: Background The fastest growing segment of the population is those age ≥80 who have the highest stroke incidence. Risk factor management is complicated by polypharmacy-related adverse events. Aims To characterize the impact of physical inactivity for stroke by age in a multi-ethnic prospective cohort study (NOMAS, n = 3298). Methods Leisure time physical activity was assessed by a validated questionnaire and our primary exposure was physical inactivity (PI). Participants were followed annually for incident stroke. We fit Cox-proportional hazard models to calculate hazard ratios and 95% confidence intervals (HR 95% CI) for the association of PI and other risk factors with risk of stroke including two-way interaction terms between the primary exposures and age (<80 vs. ≥80). Results The mean age was 69 ± 10.3 years and 562 (17%) were ≥80 at enrolment. PI was common in the cohort (40.8%). Over a median of 14 years, we found 391 strokes. We found a significant interaction of age ≥80 on the risk of stroke with PI ( p = 0.03). In stratified models, PI versus any activity (adjusted HR 1.60, 95%CI 1.05-2.42) was associated with an increased risk of stroke among those ≥80. Conclusion Physical inactivity is a treatable risk factor for stroke among those older than age 80. Improving activity may reduce the risk of stroke in this segment of the population.
authors.affiliation: 1 Department of Neurology, Columbia University, New York, NY, USA.
authors.forename: Joshua Z
authors.initials: JZ
authors.lastname: Willey
authors.affiliation: 1 Department of Neurology, Columbia University, New York, NY, USA.
authors.forename: Yeseon P
authors.initials: YP
authors.lastname: Moon
authors.affiliation: 2 Department of Neurology, University of Miami, Miami, FL, USA.
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.affiliation: 3 Department of Epidemiology, Columbia University, New York, NY, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Greenlee
authors.affiliation: 4 Department of Medicine, Columbia University, New York, NY, USA.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Diaz
authors.affiliation: 2 Department of Neurology, University of Miami, Miami, FL, USA.
authors.forename: Clinton B
authors.initials: CB
authors.lastname: Wright
authors.affiliation: 1 Department of Neurology, Columbia University, New York, NY, USA.|3 Department of Epidemiology, Columbia University, New York, NY, USA.
authors.forename: Mitchell Sv
authors.initials: MS
authors.lastname: Elkind
authors.affiliation: 5 Department of Biostatistics, Columbia University, New York, NY, USA.
authors.forename: Yuen K
authors.initials: YK
authors.lastname: Cheung
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D015444:Exercise; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007899:Leisure Activities; D009519:New York City; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior; D057185:Sedentary Behavior; D057566:Self Report; D020521:Stroke / Q000453:epidemiology* / Q000517:prevention & control
keywords: Stroke; aging; epidemiology; exercise; mortality; physical inactivity