Physical Activity and Functional Outcomes From Cerebral

Vascular Events in Men

Pamela M. Rist, MSc; I-Min Lee, MBBS, ScD; Carlos S. Kase, MD;
J. Michael Gaziano, MD, MPH; Tobias Kurth, MD, ScD

Background and Purpose—In studies enrolling patients with stroke, higher levels of prestroke physical activity are
associated with better functional outcomes. However, prospective studies evaluating this association are sparse. Using
a cohort of initially healthy men, we aimed to prospectively assess the association between physical activity and
functional outcomes from cerebral vascular events.
Methods—We conducted a prospective cohort study among 21 794 men enrolled in the Physician’s Health Study who
provided information on physical activity at baseline and who did not have a history of stroke or transient ischemic
attack (TIA). Baseline levels of physical activity were categorized as: vigorous exercise ⬍1, 1, 2 to 4, and ⱖ5
times/week. Possible functional outcomes included TIA and stroke with modified Rankin Scale score of 0 to 1, 2 to 3,
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or 5 to 6. Multinomial logistic regression was used to determine the association between physical activity and functional
outcomes from cerebral vascular events.
Results—After a mean of 20.2 years of follow-up, 761 TIAs, 1146 ischemic strokes, 221 hemorrhagic strokes, and 11
strokes of unknown type occurred. Compared with men who did not experience a stroke or TIA and who exercise
vigorously ⬍1 time/week, men who exercise vigorously ⱖ5 times/week had adjusted relative risk (95% CIs) of 0.67
(0.53– 0.86) for TIA, 0.84 (0.61–1.14) for stroke with modified Rankin Scale score 0 to 1, 0.85 (0.67–1.08) for modified
Rankin Scale score 2 to 3, and 1.12 (0.78 –1.60) for modified Rankin Scale score 5 to 6 after total stroke. Other levels
of physical activity did not have a significant impact on the risk of our outcomes.
Conclusions—Physical activity before TIA or stroke does not appear to influence functional outcomes after cerebral
vascular events. (Stroke. 2011;42:3352-3356.)
Key Words: epidemiology 䡲 physical activity 䡲 stroke

A s a result of the large projected morbidity burden of

stroke in the upcoming decades, identifying lifestyle
factors that may reduce stroke morbidity and mortality has
become increasingly important. One lifestyle factor that has
been linked to a reduced risk of stroke is physical activity.
Meta-analyses of the relationship between physical activity and
stroke risk have shown that occupational or leisure-time physical
activity reduces the risk of total, ischemic, and hemorrhagic
stroke.1,2 A previous study performed using data from the
Physician’s Health Study found that men who exercised vigor-
ously once a week decreased their risk of stroke by 21%
compared with men who exercised less than once per week.3
Although many studies have examined the association
between physical activity and risk of stroke, only a few
studies have explored whether physical activity is associated
with functional outcome from stroke or stroke severity. These
studies found that higher levels of prestroke physical activity
were associated with initial reduced stroke severity and better
long-term functional outcome.4 – 6 However, these studies
only enrolled patients with stroke and assessed physical
activity retrospectively. To address these limitations, we
aimed to examine the association between physical activity
and functional outcomes from stroke in a large prospective
cohort study enrolling healthy men without a history of stroke
at baseline. We hypothesized that increased levels of physical
activity will be associated with a decreased risk of poor
functional outcomes after incident cerebral vascular events.
Methods
The Physician’s Health Study was a randomized trial of the effect of
low-dose aspirin and ␤-carotene in the primary prevention of
cardiovascular disease and cancer. The design, methods, and results

Received March 3, 2011; final revision received June 9, 2011; accepted June 21, 2011.
Bruce Ovbiagele, MD, MSc, was the Guest Editor for this paper.
From the Division of Preventive Medicine (P.M.R., I-M.L., J.M.G., T.K.) and the Division of Aging (J.M.G.), Department of Medicine, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA; the Department of Epidemiology (P.M.R., I-M.L., T.K.), Harvard School of Public Health, Boston,
MA; the Department of Neurology (C.S.K.), Boston University School of Medicine, Boston, MA; Massachusetts Veterans Epidemiology and Research
Information Center (J.M.G.), Boston Veterans Affairs Healthcare System, Boston, MA; and INSERM Unit 708-Neuroepidemiology (T.K.), Paris, France.
The online-only Data Supplement is available at http://stroke.ahajournals.org/lookup/suppl/doi:10.1161/STROKEAHA.111.619544/-/DC1.
Correspondence to Tobias Kurth, MD, ScD, INSERM U708 –Neuroepidemiology, Hôpital de la Pitié-Salpêtrière, 47 boulevard de l’Hôpital, 75651
Paris, France. E-mail tkurth@rics.bwh.harvard.edu
© 2011 American Heart Association, Inc.
Stroke is available at http://stroke.ahajournals.org DOI: 10.1161/STROKEAHA.111.619544

3352
 Rist et al
have been previously described.7–9 Briefly, in 1982, 22 071 US male
physicians between the ages of 40 and 84 years were randomized to
receive aspirin, ␤-carotene, both placebo, or both active agents.
Participants were free of a history of stroke, transient ischemic attack
(TIA), myocardial infarction, and other major diseases at baseline.
All men provided written informed consent and this study has been
approved by the Institutional Review Board at Brigham and Wom-
en’s Hospital. Since the completion of the trial,7,8 follow-up is
ongoing.10 This analysis included data available as of March 2008
when morbidity and mortality follow-up was ⬎99%.
Assessment of Exposure
At baseline, all physicians filled out a questionnaire asking about
health and lifestyle characteristics, including physical activity. Spe-
cially, the men were asked, “How often do you exercise vigorously
enough to work up a sweat?” Possible responses were rarely/never,
1 to 3 times/month, 1 time/week, 2 to 4 times/week, 5 to 6
times/week, or daily.3 Previous studies have shown that this method
of assessing physical activity correlates well with physical fitness
measures.11,12 To be consistent with a prior study,3 we combined the
2 lowest categories into ⬍1 time/week and the 2 highest into ⱖ5
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times/week. Physicians with missing information on physical activ-
ity at baseline were excluded (n⫽247).
At the 36- and 108-month follow-up, the participants were asked
“Do you engage in a regular program of exercise vigorous enough to
work up a sweat?” If the participant responded affirmatively, he was
asked “How many days per week?” The possible response categories
were ⬍1, 1 to 2, 3 to 4, or 5 to 7 days/week.3
Assessment of Outcome
Participants were asked on follow-up questionnaires whether they
experienced any newly diagnosed medical conditions, including
stroke and TIA. If a participant reported a trial outcome, we asked for
permission to review his medical record. An end points committee of
physicians confirmed all outcomes. A nonfatal stroke was defined as
a focal neurological deficit with sudden or rapid onset attributable to
a cerebrovascular event that lasted ⬎24 hours. A TIA was defined
as a focal neurological deficit with sudden or rapid onset attributable
to a cerebrovascular event that lasted ⬍24 hours. Participant deaths
were usually reported by family members or postal authorities and all
available medical records, death certificates, and eyewitness ac-
counts were used to determine the cause of death. For confirmed
stroke cases, the end points committee classified strokes as ischemic,
hemorrhagic, or unknown type with high interobserver agreement.13
Using medical record information, the end points committee deter-
mined the functional outcome from confirmed strokes according to
an amended version of the 7-point modified Rankin scale (mRS;
0⫽no symptoms; 1⫽no significant disability; 2⫽slight disability;
3⫽moderate disability; 4⫽moderately severe disability; 5⫽severe
disability; 6⫽death)14,15 at hospital discharge. Our amended version
did not have the category of “4⫽moderately severe disability.” We
decided a priori to categorize the mRS score into 3 levels (0 –1, 2–3,
5– 6). If the participant experienced multiple strokes and/or TIAs,
only the first event was used in our analysis. We excluded men from
our analysis if they experienced a stroke or TIA before receiving the
baseline questionnaire (n⫽8) or if they experienced a confirmed
stroke but were missing a mRS score (n⫽22). After applying our
exclusion criteria, 21 794 men were used in our analyses.
Statistical Analysis
We used Cox proportional hazards models to calculate the hazard
ratios as a measure of the relative risk (RR) of incident TIA and total,
ischemic, and hemorrhagic stroke for each level of physical activity.
We graphically examined whether the assumption of proportional
hazards was met and found no significant violation.
We used multinomial logistic regression to evaluate the relation-
ship between levels of physical activity and functional outcomes
from cerebral vascular events. Multinomial regression is an exten-
sion of binary regression in which the outcome can have ⬎2
categories. The resulting ORs are used as a measure of the RR of
Physical Activity and Stroke Outcomes 3353
each functional outcome according to level of physical activity.
When examining the relationship between physical activity and
functional outcome after hemorrhagic stroke, TIA was not included.
We distinguished 2 multivariable models: I (confounder model)
included age (continuous), smoking status (never, past, or currently
smoking ⬍20 or ⱖ20 cigarettes daily), alcohol consumption (rarely,
monthly, weekly, or daily), and parental history of myocardial
infarction before age 60 years (yes/no). We also adjusted for
randomized treatment assignments. II (intermediate model) addition-
ally controlled for body mass index (continuous), history of hyper-
tension (yes/no), history of high cholesterol (yes/no/missing), and
history of diabetes (yes/no).
We examined whether age, randomized treatment assignment to
aspirin, smoking status, history of hypertension, or obesity modified
the association between physical activity at baseline and functional
outcomes from total stroke by including an interaction term between
physical activity and each variable in separate age-adjusted models.
In secondary analyses, we used updated physical activity infor-
mation at 36 and 108 months to determine the relationship between
physical activity and risk of our functional outcomes from stroke.
Due to differences in the response categories, we a priori decided to
dichotomize physical activity into ⬍1 time/week and ⱖ1 time/week,
consistent with a previous study.3
Participants with missing covariate information were assigned to
the mean, reference, or past user category when the number of
missing was ⬍350. More than 350 men were missing information on
history of high cholesterol so we used the missing indicator method.
All statistical analyses were performed using SAS 9.2 (Cary, NC).
All probability values are 2-tailed and P⬍0.05 was considered
statistically significant.
Results
Of the 21 974 who reported information on physical activity
at baseline, 6048 (27.8%) exercised ⬍1 time/week, 4007
(18.4%) exercised 1 time/week, 8187 (37.6%) exercised 2 to
4 times/week, and 3552 (16.3%) exercised ⱖ5 times/week.
Table 1 shows the baseline characteristics of the participants
according to their frequency of vigorous exercise. Men who
exercised the most frequently were more likely to be never
smokers and to not have a history of hypertension or high
cholesterol than the men who exercised the least frequently.
After a mean of 20.2 years of follow-up, 761 TIAs, 1146
ischemic strokes, 221 hemorrhagic strokes, and 11 strokes of
unknown type occurred. Table 2 presents the multivariable
adjusted RR of TIA, total stroke, ischemic stroke, and
hemorrhagic stroke by frequency of physical activity. Men
who exercised ⱖ5 times/week had a significantly reduced
risk of TIA compared with those men who exercised ⬍1
time/week (RR, 0.66; 95% CI, 0.52– 0.84; P⫽0.001). A
significant reduced risk of total stroke was observed for those
men who exercised 2 to 4 times/week compared with those
men who exercised ⬍1 time/week (RR, 0.86; 95% CI,
0.75– 0.98; P⫽0.02), but not for men in the other exercise
categories. No level of exercise was associated with a
significantly reduced risk of ischemic or hemorrhagic stroke.
For our functional outcomes from total stroke analysis,
compared with men who did not experience a stroke or TIA
and who exercised ⬍1 time/week, men who exercised ⱖ5
times/week had adjusted RRs (95% CIs) of 0.67 (0.53– 0.86)
for TIA, 0.84 (0.61–1.14) for stroke with mRS 0 to 1, 0.85
(0.67–1.08) for mRS 2 to 3, and 1.12 (0.78 –1.60) for mRS 5
to 6 after total stroke (Table 3). Men who exercised 2 to 4
times/week also had a reduced risk of TIA and more severe
stroke (mRS 2– 6) compared with men who exercised ⬍1
 3354 Stroke December 2011

Table 1. Baseline Characteristics According to Level of Physical Activity in the Physician’s

Health Study (Nⴝ21 794)
Frequency of Vigorous Exercise

⬍1 Time/Wk 1 Time/Wk 2– 4 Times/Wk ⱖ5 Times/Wk

Characteristic (N⫽6048) (N⫽4007) (N⫽8187) (N⫽3552)
Mean age, y 54.6 53.2 53.3 54.0
Mean body mass index, kg/m2 25.2 25.0 24.7 24.1
Cigarette use, %
Never 47.1 49.4 50.6 50.8
Past 38.5 36.8 40.1 42.0
Current ⬍20 cigarettes/d 4.2 4.4 3.6 3.3
Current ⱖ20 cigarettes/d 10.0 9.1 5.5 3.7
Alcohol consumption, %
Rarely 17.1 13.2 13.0 16.4
Monthly 13.8 11.5 9.5 9.7
Weekly 44.5 50.3 51.7 47.8
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Daily 24.0 24.4 25.2 25.5

History of diabetes, % 4.5 2.6 2.3 2.6
Mean blood pressure, mm Hg
Systolic 127.2 127.0 125.6 124.5
Diastolic 79.5 79.4 78.6 77.5
History of hypertension, %* 26.4 25.0 22.0 21.0
History of high cholesterol, %† 11.0 10.5 10.6 9.5
Parental history of myocardial 9.0 9.2 9.1 9.6
infarction at ⬍60 y, %
Random assignment to aspirin group, % 49.5 49.9 50.7 49.2
Numbers may not add to 100% because of rounding or missing data.
*History of hypertension was defined as self-reported systolic blood pressure ⱖ140 mm Hg, diastolic blood
pressure ⱖ90 mm Hg, or treatment for hypertension.
†History of high cholesterol was defined as blood cholesterol ⱖ240 mg/100 mL or cholesterol medication use.

time/week and who did not experience a stroke or TIA,
although this reduction in risk was not statistically significant.
Adjusting for potential intermediates did not impact our
results (data not shown). Results when examining only
ischemic stroke outcomes were similar to those seen for total
stroke outcomes (Table 3). When examining hemorrhagic
stroke, there was some suggestion that exercising 2 to 4
times/week reduces one’s risk of any of our functional
outcomes from stroke (Table 3).
We found no evidence of effect modification by age,
history of hypertension, smoking status, randomized aspi-
rin assignment, or obesity on the association between
physical activity and functional outcome from total stroke
(all Pinteraction ⬎0.16).
When we dichotomized physical activity (⬍1 time/week
versus ⱖ1 time/week) to perform analyses updated over time,
results were essentially unchanged (Supplemental Tables;
http://stroke.ahajournals.org).

Table 2. Multivariable-Adjusted Relative Risk of Total Stroke, TIA, and Ischemic or Hemorrhagic Stroke According to Level of
Physical Activity (Nⴝ21 794)*
TIA Total Stroke Ischemic Stroke Hemorrhagic Stroke

Frequency of Relative Risk Relative Risk Relative Risk Relative Risk

Vigorous Exercise No. (95% CI)† No. (95% CI)† No. (95% CI)† No. (95% CI)†
⬍1 time/wk 239 1.00 429 1.00 350 1.00 73 1.00
1 time/wk 150 0.99 (0.81–1.22) 249 0.94 (0.81–1.10) 207 0.96 (0.81–1.14) 41 0.90 (0.61–1.31)
2–4 times/wk 276 0.86 (0.72–1.02) 475 0.86 (0.75–0.98) 404 0.89 (0.77–1.03) 69 0.72 (0.52–1.01)
ⱖ5 times/wk 96 0.66 (0.52–0.84) 225 0.88 (0.75–1.03) 185 0.89 (0.74–1.06) 38 0.88 (0.59–1.30)
TIA indicates ischemic attack; CI, confidence interval.
*Men who exercised ⬍1 time/wk and who did not experience a stroke or TIA, served as the reference category.
†Values have also been adjusted for age, smoking status, alcohol consumption, parental history of myocardial infarction before age 60 y, and randomized treatment
assignments.
 Rist et al Physical Activity and Stroke Outcomes 3355

Table 3. Multivariable-Adjusted ORs of Functional Outcomes After Cerebral Vascular Events According to Level of Physical
Activity (Nⴝ21 794)*
No TIA/stroke TIA mRS 0 –1 mRS 2–3 mRS 5– 6

No. Percent No. Percent RR (95% CI)† No. Percent RR (95% CI)† No. Percent RR (95% CI)† No. Percent RR (95% CI)†
Total stroke (n⫽761) (n⫽429) (n⫽708) (n⫽241)
⬍1 time/wk 5380 27.4 239 31.4 1.00 127 29.6 1.00 225 31.8 1.00 77 32.0 1.00
1 time/wk 3608 18.4 150 19.7 1.04 (0.84–1.28) 78 18.2 1.04 (0.78–1.38) 135 19.1 1.01 (0.81–1.26) 36 14.9 0.83 (0.56–1.24)
2–4 times/wk 7436 37.8 276 36.3 0.91 (0.76–1.09) 162 37.8 1.03 (0.82–1.31) 236 33.3 0.85 (0.70–1.03) 77 32.0 0.84 (0.61–1.16)
ⱖ5 times/wk 3231 16.4 96 12.6 0.67 (0.53–0.86) 62 14.5 0.84 (0.61–1.14) 112 15.8 0.85 (0.67–1.08) 51 21.2 1.12 (0.78–1.60)
Ischemic stroke (n⫽761) (n⫽396) (n⫽634) (n⫽116)
⬍1 time/wk 5380 27.4 239 31.4 1.00 115 29.0 1.00 200 31.6 1.00 35 30.2 1.00
1 time/wk 3608 18.4 150 19.7 1.04 (0.84–1.28) 69 17.4 1.02 (0.75–1.38) 121 19.1 1.03 (0.81–1.30) 17 14.7 0.88 (0.49–1.57)
2–4 times/wk 7436 37.8 276 36.3 0.91 (0.76–1.09) 152 38.4 1.07 (0.84–1.37) 213 33.6 0.87 (0.71–1.06) 39 33.6 0.96 (0.60–1.52)
ⱖ5 times/wk 3231 16.4 96 12.6 0.67 (0.53–0.86) 60 15.2 0.89 (0.65–1.22) 100 15.8 0.86 (0.67–1.10) 25 21.6 1.22 (0.73–2.06)
Hemorrhagic stroke (n⫽30) (n⫽73) (n⫽118)
⬍1 time/wk 5380 27.4 NA NA NA 10 33.3 1.00 24 32.9 1.00 39 33.1 1.00
1 time/wk 3608 18.4 NA NA NA 9 30.0 1.40 (0.57–3.47) 14 19.2 0.92 (0.47–1.79) 18 15.3 0.81 (0.46–1.41)
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2–4 times/wk 7436 37.8 NA NA NA 9 30.0 0.72 (0.29–1.78) 23 31.5 0.74 (0.42–1.32) 37 31.4 0.78 (0.50–1.23)
ⱖ5 times/wk 3231 16.4 NA NA NA 2 6.7 0.37 (0.08–1.70) 12 16.4 0.85 (0.42–1.70) 24 20.3 1.03 (0.62–1.73)
TIA indicates ischemic attack; mRS, modified Rankin Scale; RR, relative risk; CI, confidence interval; OR, odds ratio; NA, not applicable.
*Men who exercised ⬍1 time/wk and who did not experience a stroke or TIA, served as the reference category.
†Values have also been adjusted for age, smoking status, alcohol consumption, parental history of myocardial infarction before age 60 y, and randomized treatment
assignments.

Discussion of physical activity were more likely to present with a less

Our updated analysis on the risk of stroke and TIA in the
Physician’s Health Study showed a decreased risk of TIA and
total, ischemic, and hemorrhagic stroke for men who exercise
vigorously at least twice per week. The results of the
evaluation of the association between physical activity and
TIA or functional outcome from stroke suggested decreased
risk of TIA and milder strokes (mRS 0 –3) among those who
exercise ⱖ5 times/week, although this decrease was only
statistically significant for TIA.
Although we did observe a protective association of
physical activity on the risk of stroke, the magnitude of our
results is attenuated compared with those observed in an
earlier study using data from the Physician’s Health Study.3
Despite the lack of effect modification by age in our study,
physical activity may exert a stronger protective effect at
younger ages.
A few studies have examined the association among
prestroke physical activity, stroke severity, and functional
outcomes after stroke and found that higher levels of physical
activity were associated with better functional outcomes. One
study in patients with ischemic stroke found that moderate
physical activity and leisure-time physical activity were
associated with increased odds of having National Institutes
of Health Stroke Scale score of 0 to 5 at admission, mRS
score of 0 to 1 at Day 8, and Barthel Index score of 95 to 100
at Day 8.4 Another study found that moderate or heavy levels
of prestroke physical activity were associated with less severe
stroke as measured by the Oxford Handicap Scale and the
Barthel Index at enrollment. Three months after stroke,
moderate and heavy physical activity showed some associa-
tion with better functional outcomes but not all of these
associations were significant.6 The ExStroke Pilot Trial found
that patients with ischemic stroke who were in the top quartile
severe stroke as measured by the Scandinavian Stroke Scale
and to have decreased odds of having a higher mRS score 2
years after stroke.5
In contrast, our results do not show a strong association
between higher levels of physical activity and better func-
tional outcomes after stroke. One possible explanation for
these discrepancies may be the different populations studied
and study designs. Previous studies enrolled only patients
with stroke and retrospectively assessed physical activity
through self-report. This implies that the most severely
affected patients (those who died or who could not commu-
nicate) are excluded from these studies. As a result, these
studies are exploring the association between physical activ-
ity and stroke severity in stroke survivors only. In contrast,
our study is exploring whether physical activity influences
functional outcome from stroke in an initially healthy
population.
Although we did not have information on prestroke dis-
ability levels, men were most likely able-bodied at baseline
because they had to be free of many major disabling diseases
at baseline to be enrolled in the cohort. Additionally, an
advantage to using the mRS as our measure of functional
outcome from stroke is that it takes into account prestroke
disability.15 Although there are limitations to using the
mRS,16 it is widely accepted for use in clinical trials,17,18 has
strong test–retest reliability, interrater reliability, and valid-
ity,16 and does not seem to demonstrate a “ceiling effect” like
the Barthel Index.19 Finally, it can be assessed retrospectively
from medical records, which allows us to obtain the same
measure of functional outcome for all participants.
Strengths of this study include its prospective design, the
large number of participants and outcome events, the avail-
ability of information on stroke subtypes, and the high
interobserver agreement for stroke subtype classification.
 3356 Stroke December 2011
Several limitations should be considered when interpreting
our results. Although we have updated information on phys-
ical activity during follow-up, we only could dichotomize
activity levels, which may lead to some misclassification.
Additionally, we did not have information on the types and
intensities of physical activity. Because this is an observa-
tional study, residual confounding may be present. Finally,
although the homogeneity of the cohort improves our internal
validity, it may limit the generalizability of our results to
other male populations or women.
In conclusion, results of this large prospective study in men
suggest that physical activity may help to reduce the risk of
incident stroke, but there is little evidence that prestroke
physical activity influences functional outcomes after stroke.
Future research is warranted to explore whether specific types
of physical activity or other lifestyle factors influence func-
tional outcomes from stroke.
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Sources of Funding
The Physician’s Health Study is supported by grants CA-34944,
CA-40360, and CA-097193 from the National Cancer Institute and
grants HL-26490 and HL-34595 from the National Heart, Lung, and
Blood Institute, Bethesda, MD. P.M.R. is funded by a training grant
from the National Institute of Aging (AG-00158).
Disclosures
None.
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 Physical Activity and Functional Outcomes From Cerebral Vascular Events in Men
Pamela M. Rist, I-Min Lee, Carlos S. Kase, J. Michael Gaziano and Tobias Kurth

Stroke. 2011;42:3352-3356; originally published online September 22, 2011;

Downloaded from http://stroke.ahajournals.org/ by guest on October 12, 2017

doi: 10.1161/STROKEAHA.111.619544
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Online Table. Multivariable-adjusted odds ratios of functional outcomes after cerebral vascular events according to baseline
level of physical activity (N=21,794).*
No TIA or TIA MRS 0-1 MRS 2-3 MRS 5-6
stroke
N % N % RR N % RR N % RR N % RR
(95% CI)† (95% CI)† (95% CI)† (95% CI)†
Total Stroke (n=761) (n=429) (n=708) (n=241)
<1 time/wk 5380 27.4 239 31.4 1.00 127 29.6 1.00 225 31.8 1.00 77 32.0 1.00

1 time/wk 14275 72.6 522 68.6 0.88 302 70.4 0.99 483 68.2 0.89 164 68.1 0.91
(0.75, 1.04) (0.80, 1.22) (0.76, 1.05) (0.69, 1.20)

Ischemic Stroke (n=761) (n=396) (n=634) (n=116)

<1 time/wk 5380 27.4 239 31.4 1.00 115 29.0 1.00 200 31.6 1.00 35 30.2 1.00
1 time/wk 14275 72.6 522 68.6 0.88 281 71.0 1.01 434 68.5 0.91 81 69.8 1.01
(0.75, 1.04) (0.81, 1.27) (0.76, 1.08) (0.67, 1.50)

Hemorrhagic Stroke (n=30) (n=73) (n=118)

<1 time/wk 5380 27.4 NA NA NA 10 33.3 1.00 24 32.9 1.00 39 33.1 1.00
1 time/wk 14275 72.6 NA NA NA 20 66.7 0.83 49 67.1 0.81 79 67.0 0.85
(0.38, 1.78) (0.50, 1.33) (0.58, 1.25)
* CI denotes confidence interval. Men who exercised less than one time per week served as the reference category.
† Values have also been adjusted for age, smoking status, alcohol consumption, parental history of myocardial infarction before age
60, and randomized treatment assignment to aspirin and/or beta-carotene.
 Online Table. Multivariable-adjusted odds ratios of functional outcomes after cerebral vascular events according to 36 month
level of physical activity (N=20,997).*
No TIA or TIA MRS 0-1 MRS 2-3 MRS 5-6
stroke
N % N % RR N % RR N % RR N % RR
(95% CI)† (95% CI)† (95% CI)† (95% CI)†
Total Stroke (n=674) (n=365) (n=657) (n=219)
<1 time/wk 8149 42.7 329 48.8 1.00 172 47.1 1.00 303 46.1 1.00 112 51.1 1.00

1 time/wk 10933 57.3 345 51.2 0.86 193 52.9 0.95 354 53.9 1.00 107 48.9 0.83
(0.73, 1.00) (0.77, 1.17) (0.85, 1.17) (0.64, 1.09)
Ischemic Stroke
Ischemic Stroke (n=674) (n=339) (n=590) (n=108)
<1 time/wk 8149 42.7 329 48.8 1.00 160 47.2 1.00 271 45.9 1.00 53 49.1 1.00
1 time/wk 10933 57.3 345 51.2 0.86 179 52.8 0.95 319 54.1 1.02 55 50.9 0.94
(0.73, 1.00) (0.76, 1.18) (0.86, 1.20) (0.64, 1.38)
Hemorrhagic Stroke
Hemorrhagic Stroke (n=25) (n=66) (n=107)
<1 time/wk 8149 42.7 NA NA NA 11 44.0 1.00 31 47.0 1.00 57 53.3 1.00
1 time/wk 10933 57.3 NA NA NA 14 56.0 1.04 35 53.0 0.91 50 46.7 0.75
(0.47, 2.32) (0.56, 1.49) (0.51, 1.10)

* CI denotes confidence interval. Men who exercised less than one time per week served as the reference category.
† Values have also been adjusted for age, smoking status, alcohol consumption, parental history of myocardial infarction before age
60, and randomized treatment assignment to aspirin and/or beta-carotene.
 Online Table. Multivariable-adjusted odds ratios of functional outcomes after cerebral vascular events according to 108
month level of physical activity (N=19735). *
No TIA or TIA MRS 0-1 MRS 2-3 MRS 5-6
stroke
N % N % RR N % RR N % RR N % RR
(95% CI)† (95% CI)† (95% CI)† (95% CI)†
Total Stroke (n=542) (n=239) (n=524) (n=165)
<1 time/wk 7510 41.1 252 46.5 1.00 96 40.2 1.00 219 41.8 1.00 80 48.5 1.00
1 time/wk 10755 58.9 290 53.5 0.90 143 59.8 1.17 305 58.2 1.14 85 51.5 0.92
(0.75, 1.07) (0.90, 1.53) (0.95, 1.36) (0.67, 1.26)

Ischemic Stroke (n=542) (n=227) (n=473) (n=78)

N % N % RR N % RR N % RR N % RR
(95% CI) (95% CI) † (95% CI) (95% CI)
<1 time/wk 7510 41.1 252 46.5 1.00 91 40.1 1.00 203 42.9 1.00 36 46.2 1.00
1 time/wk 10755 58.9 290 53.5 0.90 136 59.9 1.19 270 57.1 1.09 42 53.9 1.02
(0.76, 1.07) (0.90, 1.56) (0.91, 1.32) (0.64, 1.60)
* CI denotes confidence interval. Men who exercised less than one time per week served as the reference category.
† Values have also been adjusted for age, smoking status, alcohol consumption, parental history of myocardial infarction before age
60, and randomized treatment assignment to aspirin and/or beta-carotene.
Due to the limited number of hemorrhagic stroke cases, we could not perform an analysis at 108 months.
Online Table. Multivariable-adjusted odds ratios of functional outcomes after stroke and stroke subtypes according to level of
physical activity at baseline, 36 months and 108 months (N=11,497).*
No TIA or TIA MRS 0-1 MRS 2-3 MRS 5-6
stroke
Total Stroke
(n=294) (n=138) (n=320) (n=86
N % N % RR N % RR N % RR N % RR
(95% CI) (95% CI) † (95% CI) (95% CI)
Always 2919 27.4 101 34.4 1.00 36 26.1 1.00 101 31.6 1.00 28 32.6 1.00
<1 time/wk
Always 7740 72.6 193 65.6 0.82 102 73.9 1.27 219 68.4 1.02 58 67.4 1.00
1 time/wk (0.64, 1.06) (0.86, 1.88) (0.79, 1.30) (0.63, 1.59)
Ischemic Stroke
(n=294) (n=130) (n=292) (n=45)
N % N % RR N % RR N % RR N % RR
(95% CI) (95% CI) † (95% CI) (95% CI)
Always 2919 27.4 101 34.4 1.00 33 25.4 1.00 94 32.2 1.00 14 31.1 1.00
<1 time/wk
Always 7740 72.6 193 65.6 0.82 97 74.6 1.33 198 67.8 0.99 31 68.9 1.09
1 time/wk (0.64, 1.05) (0.89, 2.00) (0.76, 1.28) (0.57, 2.08)
* CI denotes confidence interval. Men who exercised less than one time per week served as the reference category.
† Values have also been adjusted for age, smoking status, alcohol consumption, parental history of myocardial infarction before age
60, and randomized treatment assignment to aspirin and/or beta-carotene.
Due to the limited number of hemorrhagic stroke cases, we could not perform this analysis for hemorrhagic stroke.