Stroke afflicts ≈1 in 6 people in their lifetime, 1 causing 6.2 million deaths worldwide.2 To improve stroke prevention, knowledge of key risk factors, especially those that are modifiable such as physical activity, is essential. In middle-aged men 3 and women, 4 it has been shown that higher levels of physical activity are associated with reduced risk of future ischemic stroke (IS). Specifically, in 2 meta-analyses on 16 original studies of middle-aged men and women undertaking more intensive versus lower levels of physical activity, the overall risk reduction was 19% to 27%. 5,6 However, in these and most other such studies, physical activity is assessed by self-report in questionnaires and interviews in large numbers of subjects, yet it has been shown that self-report leaves the true degree of physical activity vulnerable to bias.
7Aerobic or cardiovascular fitness (henceforth fitness), however, can be measured objectively. Although measurement requires relatively time-consuming ergometric tests, and so has generated fewer observations and studies, it has been shown to be a more accurate predictor of cardiovascular risk Background and Purpose-Low cardiovascular fitness (fitness) in mid-and late life is a risk factor for stroke. However, the respective effects on long-term stroke risk of fitness and muscle strength in early adulthood are unknown. Therefore, we analyzed these in a large cohort of young men. There were stronger associations for fatal stroke. All 3 stroke types displayed similar associations. Associations between fitness and stroke remained when adjusted for muscle strength, whereas associations between muscle strength and stroke weakened/disappeared when adjusted for fitness. Conclusions-At the age of 18 years, low fitness and to a lesser degree low muscle strength were independently associated with an increased future stroke risk.