Pamela M Rist1, Benjamin D Capistrant2, Elizabeth Rose Mayeda2, Sze Y Liu2, M Maria Glymour2. 1. From the Division of Preventive Medicine (P.M.R), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology (P.M.R.) and Social and Behavioral Sciences (M.M.G.), Harvard T. H. Chan School of Public Health, Boston; Harvard Center for Population and Development Studies (S.Y.L.), Harvard University, Cambridge, MA; Division of Epidemiology and Community Health (B.D.C), University of Minnesota, Minneapolis; and Department of Epidemiology and Biostatistics (E.R.M., M.M.G), University of California, San Francisco. prist@mail.harvard.edu. 2. From the Division of Preventive Medicine (P.M.R), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology (P.M.R.) and Social and Behavioral Sciences (M.M.G.), Harvard T. H. Chan School of Public Health, Boston; Harvard Center for Population and Development Studies (S.Y.L.), Harvard University, Cambridge, MA; Division of Epidemiology and Community Health (B.D.C), University of Minnesota, Minneapolis; and Department of Epidemiology and Biostatistics (E.R.M., M.M.G), University of California, San Francisco.
Abstract
OBJECTIVE: To determine whether physical activity and body mass index (BMI) predict instrumental or basic activities of daily living (I/ADL) trajectories before or after stroke compared to individuals who remained stroke-free. METHODS: Using a prospective cohort, the Health and Retirement Study, we followed adults without a history of stroke in 1998 (n = 18,117) for up to 14 years. We estimated linear regression models of I/ADL trajectories comparing individuals who remained stroke-free throughout follow-up (n = 16,264), those who survived stroke (n = 1,374), and those who died after stroke and before the next interview wave (n = 479). We evaluated whether I/ADL trajectories differed by physical activity or BMI at baseline (before stroke), adjusting for demographic and socioeconomic covariates. RESULTS: Compared to those who were physically active, stroke survivors who were physically inactive at baseline had a lower probability of independence in ADLs and IADLs 3 years after stroke (risk difference = -0.18 and -0.16 for ADLs and IADLs, respectively). However, a similar difference in the probability of independence was also present 3 years before stroke, and we observed no evidence that physical activity slowed the rate of decline in independence before or after stroke. Unlike the results for physical activity, we did not observe a consistent pattern for the probability of independence in ADLs or IADLs comparing obese stroke survivors to normal-weight or to overweight stroke survivors 3 years before stroke or 3 years after stroke. CONCLUSIONS: Physical inactivity predicts a higher risk of being dependent both before and after stroke.
OBJECTIVE: To determine whether physical activity and body mass index (BMI) predict instrumental or basic activities of daily living (I/ADL) trajectories before or after stroke compared to individuals who remained stroke-free. METHODS: Using a prospective cohort, the Health and Retirement Study, we followed adults without a history of stroke in 1998 (n = 18,117) for up to 14 years. We estimated linear regression models of I/ADL trajectories comparing individuals who remained stroke-free throughout follow-up (n = 16,264), those who survived stroke (n = 1,374), and those who died after stroke and before the next interview wave (n = 479). We evaluated whether I/ADL trajectories differed by physical activity or BMI at baseline (before stroke), adjusting for demographic and socioeconomic covariates. RESULTS: Compared to those who were physically active, stroke survivors who were physically inactive at baseline had a lower probability of independence in ADLs and IADLs 3 years after stroke (risk difference = -0.18 and -0.16 for ADLs and IADLs, respectively). However, a similar difference in the probability of independence was also present 3 years before stroke, and we observed no evidence that physical activity slowed the rate of decline in independence before or after stroke. Unlike the results for physical activity, we did not observe a consistent pattern for the probability of independence in ADLs or IADLs comparing obese stroke survivors to normal-weight or to overweight stroke survivors 3 years before stroke or 3 years after stroke. CONCLUSIONS: Physical inactivity predicts a higher risk of being dependent both before and after stroke.
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