BMJ Open. 2026 Sep 21;16(9):e124056. doi: 10.1136/bmjopen-2026-124056.
ABSTRACT
OBJECTIVES: To examine the association between pre-transient ischaemic attack (TIA) physical activity (PA) and subsequent cerebrovascular events.
DESIGN: Register-based cohort study SETTING: Stroke units in Gothenburg, Sweden, using a local stroke register linked to national healthcare and demographic registers.
PARTICIPANTS: 1610 adults (51.7% female, mean age 72.5 years) with a registered TIA between November 2014 and December 2019.
PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was ischaemic stroke (International Classification of Diseases, 10th Revision I63 and I64). Secondary outcomes were total stroke (I61, I63 and I64) and a composite of stroke or TIA (I61, I63, I64 and G45.9). Time-to-event analyses were performed using Cox proportional hazards models with progressive adjustment for demographic, clinical and treatment-related factors.
RESULTS: Most participants reported light PA (50.4%). In crude analyses, moderate/vigorous PA was associated with lower hazards of ischaemic stroke (HR 0.36, 95% CI 0.16 to 0.78) and total stroke (HR 0.39, 95% CI 0.20 to 0.79) compared with sedentary individuals. These associations were attenuated after adjustment for age and sex and were no longer statistically significant (HR 0.48, 95% CI 0.22 to 1.08 for ischaemic stroke; HR 0.53, 95% CI 0.26 to 1.09 for total stroke). Further adjustment for clinical, socioeconomic and treatment-related factors did not materially alter the estimates.
CONCLUSIONS: Higher pre-TIA PA was associated with substantially lower crude hazards of subsequent ischaemic and total stroke, but these associations were attenuated after accounting for age and remained similar with further adjustment. Pre-TIA PA may therefore reflect broader health and vascular risk rather than show a strong independent association with recurrence. However, imprecise estimates for moderate/vigorous PA remain compatible with a potentially lower stroke hazard and warrant further investigation.
PMID:42767726 | DOI:10.1136/bmjopen-2026-124056