{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:18:53Z","timestamp":1792685933559,"version":"4.5.0"},"reference-count":37,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Associations of domain-specific physical activity with stroke incidence and poststroke outcomes have not been extensively studied using long-term, population-based data.<\/jats:p><\/jats:sec>Objective<\/jats:title>To investigate associations of leisure time, work time, transport, and household physical activity with stroke incidence and death or dependency in activities of daily living (ADL) 3 months after stroke.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>The prospective, population-based Interplay Between Genetic Susceptibility and External Factors (INTERGENE) cohort study was conducted among a random sample of individuals from an urban-rural area covering western Sweden; 3614 individuals aged 24 to 77 years were examined in 2001 to 2004, and 1394 individuals were reexamined in 2014 to 2016. The median (range) follow-up was 20.0 years (56 days to 21.9 years). Data were analyzed from September through October 2023.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Physical activity levels were self-reported for leisure time, work time, transportation, and household domains. The mean number of steps taken over a 6-day period was collected in a subgroup of participants using a sealed pedometer.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Follow-up for stroke incidence and mortality rates continued until December 31, 2022. The composite outcome of death or ADL dependency was assessed at 3 months after stroke.<\/jats:p><\/jats:sec>Results<\/jats:title>Among 3614 individuals (mean [SD] age, 51.4 [13.1] years; 1910 female [52.9%]); 269 individuals (7.4%) developed stroke, of whom 120 individuals (44.6%) were dead or ADL dependent at 3 months. Intermediate (adjusted hazard ratio [aHR], 0.54; 95% CI, 0.38-0.77) and high (aHR, 0.47; 95% CI, 0.31-0.73) levels of leisure time physical activity were associated with a reduced incidence of stroke compared with low levels, as was an intermediate level of physical activity in transportation (aHR, 0.69; 95% CI, 0.52-0.93). High levels of leisure time physical activity were also associated with a reduced risk of poststroke death or ADL dependency (adjusted odds ratio, 0.34; 95% CI, 0.16-0.71) compared with low levels. Work time and household physical activity were not associated with stroke incidence or stroke outcomes. In exploratory subgroup analyses, there were interactions between physical activity and smoking (current smoking or smoking in the past year associated with stroke risk only in participants with low or intermediate physical activity: aHR, 2.33; 95% CI, 1.72-3.15) and family history of stroke (first-degree relative with a history of stroke associated with stroke risk only in participants with low or intermediate physical activity: aHR, 1.73; 95% CI, 1.27-2.38).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this study, leisure time and transport-related physical activities were associated with a reduced risk of stroke. A high level of leisure time physical activity was also associated with a lower risk of death or ADL dependency 3 months after stroke.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.13453","type":"journal-article","created":{"date-parts":[[2024,5,29]],"date-time":"2024-05-29T15:01:24Z","timestamp":1716994884000},"page":"e2413453","source":"Crossref","is-referenced-by-count":14,"title":["Domain-Specific Physical Activity and Stroke in Sweden"],"prefix":"10.1001","volume":"7","author":[{"given":"Adam","family":"Viktorisson","sequence":"first","affiliation":[{"name":"Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"},{"name":"Department of Rehabilitation Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie","family":"Palstam","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"},{"name":"Department of Rehabilitation Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden"},{"name":"School of Health and Welfare, Dalarna University, Falun, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredrik","family":"Nyberg","sequence":"additional","affiliation":[{"name":"School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Berg","sequence":"additional","affiliation":[{"name":"Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Lissner","sequence":"additional","affiliation":[{"name":"School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina S.","family":"Sunnerhagen","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"},{"name":"Department of Rehabilitation Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,5,29]]},"reference":[{"issue":"10","key":"zoi240463r1","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1016\/S1474-4422(21)00252-0","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease study 2019.","volume":"20","author":"GBD 2019 Stroke Collaborators","year":"2021","journal-title":"Lancet Neurol"},{"issue":"6","key":"zoi240463r2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.15385","article-title":"Association of accelerometer-measured sedentary time and physical activity with risk of stroke among US adults.","volume":"5","author":"Hooker","year":"2022","journal-title":"JAMA Netw Open"},{"key":"zoi240463r3","doi-asserted-by":"publisher","first-page":"i3857","DOI":"10.1136\/bmj.i3857","article-title":"Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease study 2013.","volume":"354","author":"Kyu","year":"2016","journal-title":"BMJ"},{"issue":"9735","key":"zoi240463r4","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/S0140-6736(10)60834-3","article-title":"Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study.","volume":"376","author":"O\u2019Donnell","year":"2010","journal-title":"Lancet"},{"issue":"10113","key":"zoi240463r5","doi-asserted-by":"publisher","first-page":"2643","DOI":"10.1016\/S0140-6736(17)31634-3","article-title":"The effect of physical activity on mortality and cardiovascular disease in 130?000 people from 17 high-income, middle-income, and low-income countries: the PURE study.","volume":"390","author":"Lear","year":"2017","journal-title":"Lancet"},{"issue":"4","key":"zoi240463r6","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1212\/WNL.0000000000003534","article-title":"Relationship between risk factor control and vascular events in the SAMMPRIS trial.","volume":"88","author":"Turan","year":"2017","journal-title":"Neurology"},{"issue":"3","key":"zoi240463r7","doi-asserted-by":"publisher","first-page":"312","DOI":"10.5853\/jos.2020.03006","article-title":"Mechanisms of preconditioning exercise-induced neurovascular protection in stroke.","volume":"23","author":"Hafez","year":"2021","journal-title":"J Stroke"},{"key":"zoi240463r8","doi-asserted-by":"publisher","DOI":"10.2340\/jrm.v53.51","article-title":"Pre-stroke physical activity in relation to post-stroke outcomes\u2014linked to the International Classification of Functioning, Disability and Health (ICF): a scoping review.","volume":"54","author":"Viktorisson","year":"2022","journal-title":"J Rehabil Med"},{"issue":"10","key":"zoi240463r9","doi-asserted-by":"publisher","first-page":"2475","DOI":"10.1161\/01.STR.0000091843.02517.9D","article-title":"Physical activity and stroke risk: a meta-analysis.","volume":"34","author":"Lee","year":"2003","journal-title":"Stroke"},{"issue":"2","key":"zoi240463r10","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1161\/01.STR.29.2.380","article-title":"Leisure-time physical activity and ischemic stroke risk: the Northern Manhattan Stroke Study.","volume":"29","author":"Sacco","year":"1998","journal-title":"Stroke"},{"issue":"9","key":"zoi240463r11","doi-asserted-by":"publisher","first-page":"1994","DOI":"10.1161\/01.STR.0000177868.89946.0c","article-title":"Leisure time, occupational, and commuting physical activity and the risk of stroke.","volume":"36","author":"Hu","year":"2005","journal-title":"Stroke"},{"issue":"9","key":"zoi240463r12","doi-asserted-by":"publisher","first-page":"2346","DOI":"10.1161\/STROKEAHA.117.017465","article-title":"Trajectories in leisure-time physical activity and risk of stroke in women in the California Teachers Study.","volume":"48","author":"Willey","year":"2017","journal-title":"Stroke"},{"issue":"4","key":"zoi240463r13","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1093\/ije\/dyh168","article-title":"Physical activity and stroke: a meta-analysis of observational data.","volume":"33","author":"Wendel-Vos","year":"2004","journal-title":"Int J Epidemiol"},{"issue":"3","key":"zoi240463r14","doi-asserted-by":"publisher","first-page":"267","DOI":"10.5271\/sjweh.3787","article-title":"Occupational and leisure-time physical activity differentially predict 6-year incidence of stroke and transient ischemic attack in women.","volume":"45","author":"Hall","year":"2019","journal-title":"Scand J Work Environ Health"},{"issue":"3","key":"zoi240463r15","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1136\/bjsm.37.3.197","article-title":"Limits to the measurement of habitual physical activity by questionnaires.","volume":"37","author":"Shephard","year":"2003","journal-title":"Br J Sports Med"},{"issue":"6","key":"zoi240463r16","doi-asserted-by":"publisher","first-page":"1742","DOI":"10.1093\/ije\/dyw332","article-title":"Cohort profile: the INTERGENE study.","volume":"46","author":"Mehlig","year":"2017","journal-title":"Int J Epidemiol"},{"issue":"6","key":"zoi240463r17","doi-asserted-by":"publisher","first-page":"1104","DOI":"10.1161\/01.CIR.38.6.1104","article-title":"Physiological analysis of middle-aged and old former athletes: comparison with still active athletes of the same ages.","volume":"38","author":"Saltin","year":"1968","journal-title":"Circulation"},{"key":"zoi240463r18","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1111\/sms.2015.25.issue-S4","article-title":"The \u201cSaltin-Grimby Physical Activity Level Scale\u201d and its application to health research.","volume":"25","author":"Grimby","year":"2015","journal-title":"Scand J Med Sci Sports"},{"issue":"5","key":"zoi240463r19","doi-asserted-by":"publisher","first-page":"682","DOI":"10.1038\/sj.ijo.0801597","article-title":"Validity and reproducibility of self-reported total physical activity\u2013differences by relative weight.","volume":"25","author":"Norman","year":"2001","journal-title":"Int J Obes Relat Metab Disord"},{"issue":"1-2","key":"zoi240463r20","first-page":"113","article-title":"How accurate are Omron X-HJ-304-E and Yamax SW-700\/701 pedometers at different speeds and various inclinations?","volume":"55","author":"Wallmann-Sperlich","year":"2015","journal-title":"J Sports Med Phys Fitness"},{"key":"zoi240463r21","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1159\/000068203","article-title":"Riks-stroke\u2014a Swedish national quality register for stroke care.","volume":"15","author":"Asplund","year":"2003","journal-title":"Cerebrovasc Dis"},{"issue":"20","key":"zoi240463r22","doi-asserted-by":"publisher","first-page":"3896","DOI":"10.1002\/sim.v38.20","article-title":"Estimation of the adjusted cause-specific cumulative probability using flexible regression models for the cause-specific hazards.","volume":"38","author":"Kipourou","year":"2019","journal-title":"Stat Med"},{"issue":"3","key":"zoi240463r23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v045.i03","article-title":"Mice: multivariate imputation by chained equations in R.","volume":"45","author":"van Buuren","year":"2011","journal-title":"J Stat Softw"},{"issue":"20","key":"zoi240463r24","doi-asserted-by":"publisher","first-page":"1320","DOI":"10.1136\/bjsports-2017-098540","article-title":"Do highly physically active workers die early: a systematic review with meta-analysis of data from 193 696 participants.","volume":"52","author":"Coenen","year":"2018","journal-title":"Br J Sports Med"},{"issue":"3","key":"zoi240463r25","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1136\/bjsports-2017-097965","article-title":"The physical activity paradox: six reasons why occupational physical activity (OPA) does not confer the cardiovascular health benefits that leisure time physical activity does.","volume":"52","author":"Holtermann","year":"2018","journal-title":"Br J Sports Med"},{"issue":"3","key":"zoi240463r26","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1002\/acn3.v9.3","article-title":"Physical activity level and stroke risk in US population: a matched case-control study of 102,578 individuals.","volume":"9","author":"Ghozy","year":"2022","journal-title":"Ann Clin Transl Neurol"},{"issue":"6","key":"zoi240463r27","doi-asserted-by":"publisher","first-page":"2086","DOI":"10.1161\/STROKEAHA.120.032695","article-title":"Prestroke physical activity and adverse health outcomes after stroke in the atherosclerosis risk in communities study.","volume":"52","author":"Mediano","year":"2021","journal-title":"Stroke"},{"issue":"12","key":"zoi240463r28","doi-asserted-by":"publisher","first-page":"1525","DOI":"10.1111\/ene.2017.24.issue-12","article-title":"Pre-stroke physical activity is associated with fewer post-stroke complications, lower mortality and a better long-term outcome.","volume":"24","author":"Wen","year":"2017","journal-title":"Eur J Neurol"},{"issue":"8","key":"zoi240463r29","doi-asserted-by":"publisher","first-page":"3203","DOI":"10.1007\/s10072-020-04903-7","article-title":"Regular physical activity postpones age of occurrence of first-ever stroke and improves long-term outcomes.","volume":"42","author":"Morovatdar","year":"2021","journal-title":"Neurol Sci"},{"issue":"9","key":"zoi240463r30","first-page":"716","article-title":"A seven-year follow-up analysis on prognosis factors of stroke patients.","volume":"26","author":"Li","year":"2005","journal-title":"Zhonghua Liu Xing Bing Xue Za Zhi"},{"issue":"19","key":"zoi240463r31","doi-asserted-by":"publisher","first-page":"e2137","DOI":"10.1212\/WNL.0000000000201097","article-title":"Associations of prestroke physical activity with stroke severity and mortality after intracerebral hemorrhage compared with ischemic stroke.","volume":"99","author":"Viktorisson","year":"2022","journal-title":"Neurology"},{"issue":"18","key":"zoi240463r32","doi-asserted-by":"publisher","first-page":"1718","DOI":"10.1212\/WNL.0000000000003888","article-title":"Physical activity, but not body mass index, predicts less disability before and after stroke.","volume":"88","author":"Rist","year":"2017","journal-title":"Neurology"},{"issue":"12","key":"zoi240463r33","doi-asserted-by":"publisher","first-page":"2251","DOI":"10.1249\/MSS.0b013e3181e32e9a","article-title":"Comparing physical activity measures in a diverse group of midlife and older adults.","volume":"42","author":"Banda","year":"2010","journal-title":"Med Sci Sports Exerc"},{"issue":"12","key":"zoi240463r34","doi-asserted-by":"publisher","first-page":"1725","DOI":"10.1161\/CIRCRESAHA.123.322121","article-title":"Physical activity over the lifecourse and cardiovascular disease.","volume":"132","author":"Perry","year":"2023","journal-title":"Circ Res"},{"key":"zoi240463r35","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1093\/ageing\/27.suppl_3.17","article-title":"Stability and change in levels of habitual physical activity in later life.","volume":"27","author":"Armstrong","year":"1998","journal-title":"Age Ageing"},{"key":"zoi240463r36","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1186\/1471-2458-11-450","article-title":"External review and validation of the Swedish national inpatient register.","volume":"11","author":"Ludvigsson","year":"2011","journal-title":"BMC Public Health"},{"issue":"9","key":"zoi240463r37","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1007\/s10654-017-0316-1","article-title":"The Swedish cause of death register.","volume":"32","author":"Brooke","year":"2017","journal-title":"Eur J Epidemiol"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2819140\/viktorisson_2024_oi_240463_1715884802.53555.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,29]],"date-time":"2024-05-29T15:01:28Z","timestamp":1716994888000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2819140"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,29]]},"references-count":37,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.13453","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,29]]}}}