Supplementary Material for: Association between Physical Activity and Risk of Stroke Subtypes: The Atherosclerosis Risk in Communities Study

<b><i>Background:</i></b> The relationship between stroke subtypes and physical activity is unclear. <b><i>Methods:</i></b> Using data from 13,069 men and women aged 45–64 years who participated in the Atherosclerosis Risk in Communities Study, physical activity was assessed by self-report using the Baecke questionnaire at baseline (1987–1989). The American Heart Association’s ideal cardiovascular health guidelines served as a basis for the calculation of three physical activity categories: poor, intermediate, and ideal. Stroke and its subtypes were ascertained from physician review of medical records. Multivariable adjusted hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox regression models. <b><i>Results:</i></b> During a median follow-up of 18.8 years, a total of 648 incident ischemic strokes occurred. Significant inverse associations were found between physical activity categories and total, total ischemic, and nonlacunar stroke in adjusted models (age, sex, race-center, education, cigarette-years). Compared with poor physical activity, the adjusted HR (95% CI) for ideal physical activity were 0.78 (0.62–0.97) for total, 0.76 (0.59–0.96) for total ischemic, 0.85 (0.51–1.40) for lacunar, 0.77 (0.47–1.27) for cardioembolic, and 0.71 (0.51–0.99) for nonlacunar stroke. Additional adjustments for waist-to-hip ratio, systolic blood pressure, antihypertensive medication, diabetes, left ventricular hypertrophy and laboratory parameters attenuated the HR. Further sex- and race-specific analyses revealed that the association was predominantly observed among males and among African-Americans. <b><i>Conclusion:</i></b> These data suggest a tendency toward a reduced risk of total, total ischemic, and nonlacunar stroke with higher levels of physical activity.

**背景**：卒中（stroke）亚型与体力活动之间的关联尚不明确。
**方法**：本研究纳入参与社区动脉粥样硬化风险研究（Atherosclerosis Risk in Communities Study）的13069名45~64岁男女受试者，于基线阶段（1987-1989年）采用巴克问卷（Baecke questionnaire）通过自我报告形式评估受试者的体力活动水平。以美国心脏协会（American Heart Association, AHA）理想心血管健康指南为分类依据，将体力活动划分为不佳、中等及理想三个等级。通过医师审阅病历的方式确认卒中及其亚型。采用Cox回归模型计算多变量校正后的风险比（hazard ratio, HR）及95%置信区间（confidence interval, CI）。
**结果**：中位随访18.8年期间，共发生648例首发缺血性卒中（ischemic stroke）。在校正年龄、性别、种族-中心、教育水平及吸烟年数的模型中，体力活动等级与总卒中、总缺血性卒中及非腔隙性卒中（nonlacunar stroke）呈显著负相关。以体力活动不佳组为参照，理想体力活动组的校正HR（95%CI）分别为：总卒中0.78（0.62~0.97）、总缺血性卒中0.76（0.59~0.96）、腔隙性卒中（lacunar stroke）0.85（0.51~1.40）、心源性卒中（cardioembolic stroke）0.77（0.47~1.27）以及非腔隙性卒中0.71（0.51~0.99）。进一步校正腰臀比（waist-to-hip ratio）、收缩压、降压药物使用情况、糖尿病、左心室肥厚（left ventricular hypertrophy）及实验室检测指标后，上述HR值有所减弱。按性别与种族开展亚组分析后发现，该关联主要见于男性及非裔美国人群体。
**结论**：本研究数据表明，体力活动水平越高，总卒中、总缺血性卒中及非腔隙性卒中的发病风险呈降低趋势。