Higher pre-TIA physical activity 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, suggesting pre-TIA PA may reflect broader health and vascular risk rather than a strong independent association with recurrence.
Key Findings
Results
In crude analyses, moderate/vigorous physical activity prior to TIA was associated with lower hazards of ischaemic stroke compared with sedentary individuals.
Crude HR for ischaemic stroke was 0.36 (95% CI 0.16 to 0.78) for moderate/vigorous PA versus sedentary individuals.
Crude HR for total stroke was 0.39 (95% CI 0.20 to 0.79) for moderate/vigorous PA versus sedentary individuals.
These associations were statistically significant in unadjusted models.
The cohort included 1610 adults with a registered TIA between November 2014 and December 2019.
Results
The associations between moderate/vigorous pre-TIA physical activity and stroke outcomes were attenuated after adjustment for age and sex and were no longer statistically significant.
After adjustment for age and sex, HR for ischaemic stroke was 0.48 (95% CI 0.22 to 1.08).
After adjustment for age and sex, HR for total stroke was 0.53 (95% CI 0.26 to 1.09).
Both confidence intervals crossed 1.0 after age and sex adjustment, indicating loss of statistical significance.
Further adjustment for clinical, socioeconomic, and treatment-related factors did not materially alter the estimates.
Results
The majority of TIA patients in this cohort reported light physical activity as their predominant activity level prior to TIA.
50.4% of participants reported light physical activity.
The cohort was 51.7% female with a mean age of 72.5 years.
The study was conducted at stroke units in Gothenburg, Sweden, using a local stroke register linked to national healthcare and demographic registers.
Participants were registered with TIA between November 2014 and December 2019.
Methods
Pre-TIA physical activity was examined as a predictor of three distinct cerebrovascular outcomes: ischaemic stroke, total stroke, and a composite of stroke or TIA.
Primary outcome was ischaemic stroke (ICD-10 codes I63 and I64).
Secondary outcome of total stroke included codes I61, I63, and I64.
A composite secondary outcome included stroke or TIA (I61, I63, I64, and G45.9).
Time-to-event analyses were performed using Cox proportional hazards models with progressive adjustment.
Discussion
The authors concluded that pre-TIA physical activity may reflect broader health and vascular risk profile rather than demonstrate a strong independent association with cerebrovascular recurrence.
Attenuation of associations after age adjustment suggested confounding by age-related health status.
The authors noted that imprecise estimates for moderate/vigorous PA remain compatible with a potentially lower stroke hazard.
The authors called for further investigation given the wide confidence intervals.
The study design was a register-based cohort study, which limits causal inference.
What This Means
This research examined whether the amount of physical activity a person did before having a transient ischaemic attack (TIA, or 'mini-stroke') was linked to their risk of having a subsequent stroke. The study followed 1,610 adults in Gothenburg, Sweden, who had a TIA between 2014 and 2019, using health register data. When researchers looked at the raw data without accounting for other factors, people who were moderately or vigorously active before their TIA had about 60-64% lower risk of subsequent stroke compared to sedentary individuals — a seemingly striking difference.
However, when the researchers adjusted for age and sex, this apparent protective effect shrank considerably and was no longer statistically significant. Adding further adjustments for clinical conditions, socioeconomic factors, and treatments did not change the picture much. This suggests that much of the apparent benefit of physical activity was actually explained by the fact that more active people tend to be younger and have fewer health problems overall — in other words, physical activity before a TIA may be a marker of general health rather than an independent protector against future stroke.
This research suggests that while staying active is generally associated with better cardiovascular health, the relationship between pre-TIA physical activity and stroke recurrence is more complex than it might first appear. The study's estimates were imprecise enough that a real protective effect cannot be ruled out, and the authors call for larger studies to clarify whether physical activity truly reduces the risk of stroke after a TIA independently of age and other health factors.
Beņislavska E, Mavridis A, Reinholdsson M, Sunnerhagen K. (2026). Physical activity prior to transient ischaemic attack and risk of subsequent cerebrovascular events: a Swedish register-based study.. BMJ open. https://doi.org/10.1136/bmjopen-2026-124056