Trajectories in Leisure-Time Physical Activity and Risk of Stroke in Women in the California Teachers Study

Background and purpose

Whether changes in leisure-time physical activity (LTPA) over time are associated with lower risk of stroke is not well established.

We examined the association between changes in self-reported LTPA 10 years apart, with risk of incident stroke in the CTS (California Teachers Study).

We hypothesized that the risk of stroke would be lowest among those who remained active.


Sixty-one thousand two hundred and fifty-six CTS participants reported LTPA at 2 intensity levels (moderate and strenuous activity) at 2 time points (baseline 1995-96; 10-year follow-up 2005-2006).

LTPA at each intensity level was categorized based on American Heart Association (AHA) recommendations (moderate, >150 minutes/week; strenuous, >75 minutes/week).

Changes in LTPA were summarized as follows: (1) not meeting recommendations at both time points; (2) meeting recommendations only at follow-up; (3) meeting recommendations only at baseline; and (4) meeting recommendations at both time points. Incident strokes were identified through California state hospitalization records.

Using multivariable Cox models, we examined the associations between changes in LTPA with incident stroke.


Nine hundred and eighty-seven women were diagnosed with stroke who completed both questionnaires.

Meeting AHA recommendations at both the time points was associated with a lower risk of all stroke (adjusted hazard ratio, 0.84; 95% confidence interval, 0.72-0.98).

The protective effects for stroke were driven by meeting AHA recommendations for moderate activity and largely observed for ischemic strokes (adjusted hazard ratio, 0.70; 95% confidence interval, 0.55-0.88).


Meeting AHA recommendations for moderate activity had a protective effect for reducing ischemic stroke risk.

Participants who met AHA recommendations at baseline but not at follow-up, however, were not afforded reduced stroke risk.