Atypical involvement of undifferentiated carcinomas of the nasopharyngeal type. Apropos of 3 cases

This study compared body sway, a measure of postural stability, between regular brisk walkers and control subjects. Furthermore, the relationship between body sway and physical activity duration in postmenopausal women was examined. Subjects were 31 healthy postmenopausal women, aged 61-71 years. They were recruited from a randomized controlled study of the influence of brisk walking on bone: 16 women had been completing 20 min d-1 brisk walking, whilst 15 controls had been completing habitual activities only. Body sway was measured using a swaymeter that measured displacement at the waist whilst subjects stood on a compliant surface, with eyes closed, for 1 min. The activity was measured using activity monitors which were worn at the waist for 3 consecutive days. Body sway (eyes closed, standing on a compliant surface) was lower in walkers than in controls: 2,958 +/- (SE) 270 versus 5,225+/-371 mm2 min-1, respectively (p < 0.05). A negative correlation was found between body sway and minutes of physical activity (r = -0.47, p < 0.01). Analysis of variance revealed that body sway differed significantly (p < 0.05) between groups of differing physical activity participation, being 4,839 +/- 499, 4,167 +/- 516, and 2,877 +/- 362 mm2 min-1, respectively, in women completing <20, 20-40, and >40 min d-1 of physical activity. Body sway was significantly lower in the most active group than in the least active (p < 0.01). These data suggest that postural stability is better in regular walkers than in control subjects. Furthermore, a dose-response relationship was observed between physical activity and postural stability in postmenopausal women. These findings provide a preliminary indication that brisk walking, a low-cost and acceptable form of physical activity for the elderly, could be incorporated into strategies for improving balance in the elderly.     

Production and characterisation of monoclonal antibodies specific for bovine interleukin-4

This study assessed physical activity patterns in a sample of urban African Americans, whose participation in physical activity has not previously been well-described. From questions administered by interviewers during health fair screenings in 19 churches in East Baltimore, information regarding participation in regular, leisure-time activity (defined as 30 minutes of activity, 5 days per week), time spent walking on the job, and distance walked to and from work was assessed from 365 adults (69% women). Regular, leisure-time activity participation was 18% for men and 16% for women. When the definition of physical activity participation was broadened to include: (1) spending over half the day walking at work; (2) walking at least 10 blocks to and from work; as well as (3) regular, leisure-time activity, 41% of men and 38% of women were active. These data suggest that, while a small percentage of African Americans participate in regular physical activity, a substantial percentage are regularly active when non-leisure-time activity is assessed. To accurately characterize overall participation, physical activity derived from a variety of sources, including transportation and work-related activity, should be assessed.     

Cost-benefit analysis of walking to prevent coronary heart disease

OBJECTIVE: To quantify the cost-benefit relationship of walking to prevent coronary heart disease. DESIGN: Cost-benefit analysis. PARTICIPANTS: Hypothetical cohorts of sedentary men and women aged 35 to 74 years. MAIN OUTCOME MEASURES: Decision-analysis simulation was used to evaluate the cost-benefit relationship of walking, varying level of benefit from exercise, frequency of exercise to achieve benefit, participation rates, and costs of exercise and injury. RESULTS: At a relative risk of 1.9 for heart disease associated with sedentary behavior, $5.6 billion would be saved annually if 10% of adults began a regular walking program. A $4.3 billion savings is predicted if the entire sedentary population began walking regularly and the cost of the time an individual spends exercising is accounted for in those who dislike exercising. According to our baseline assumptions, walking is economically beneficial for men aged 35 to 64 years and for women aged 55 to 64 years. The threshold of relative risk at which economic benefit is found for walking in this population overall is estimated at 1.7, and under a volunteer model, most adults would benefit even at a relative risk of 1.15. CONCLUSIONS: There are significant sex and age differences in the economic benefits of walking to prevent heart disease. The value assigned to the time an individual spends exercising has a significant impact on the results. Overall, a substantial savings is predicted from encouraging sedentary individuals to participate in a regular walking program.     

Reduced morbidity and the risk of premature death. Regular physical exercise is beneficial for health at all ages

Regular physical activity yields benefits to men and women of all ages. The risk of premature death is reduced, as is that of incurring or dying of ischaemic heart disease. These benefits are attainable with only moderate physical activity, such as a 30-minute daily walk, though a "dose-dependent" relationship exists between physical activity and health benefits: "Some exercise is better than none, and more is better than less". Both the World Health Organisation, and the National Institutes of Health in the USA, for example, recommend that clinicians should counsel all patients to enroll in some programme of regular physical activity tailored to suit their health status and personal life-style.     

A nursing rehabilitation program for women with breast cancer receiving adjuvant chemotherapy

PURPOSE/OBJECTIVES: To examine the effects of a comprehensive rehabilitation program on facilitating physical and psychosocial adaptation of women with breast cancer who are receiving adjuvant chemotherapy. DESIGN: Experimental. SETTING: Breast evaluation clinics of two New England medical centers with comprehensive cancer treatment programs. SAMPLE: 14 women (mean age = 44 years) receiving adjuvant chemotherapy for breast cancer (86% stage II) following surgical treatment. METHODS: Subjects were assigned randomly to the experimental group or the usual care group. Experimental group members began a structured exercise program of walking and attended support group meetings. All subjects were tested before beginning chemotherapy, during the course of chemotherapy, and one month following chemotherapy completion. MAIN RESEARCH VARIABLES: Performance status, physical functioning, psychosocial adjustment, self-concept and body image, and 12 symptoms (e.g., fatigue, nausea, anxiety). FINDINGS: Measures of physical performance, psychosocial adjustment, and symptom intensity revealed improved adaptation in subjects who completed the walking/support group program. CONCLUSIONS: Physical and psychosocial benefits from a modest walking exercise program and a support group are possible for patients receiving adjuvant chemotherapy. IMPLICATIONS FOR NURSING PRACTICE: Although more detailed research is necessary to answer some of the questions raised by this study, implementing the walking program and forming a support group are achievable in an outpatient setting.     

Physical activity patterns associated with cardiorespiratory fitness and reduced mortality: the Aerobics Center Longitudinal Study

OBJECTIVES: This study examined cross sectionally the physical activity patterns associated with low, moderate, and high levels of cardiorespiratory fitness. METHODS: Physical activity was assessed by questionnaire in a clinic population of 13,444 men and 3972 women 20 to 87 years of age. Estimated energy expenditure (kcal.wk-1) and volume (min.wk-1) of reported activities were calculated among individuals at low, moderate, and high fitness levels (assessed by maximal exercise tests). RESULTS: Average leisure time energy expenditures of 525 to 1650 kcal.wk-1 for men and 420 to 1260 kcal.wk-1 for women were associated with moderate to high levels of fitness. These levels of energy expenditure can be achieved with a brisk walk of approximately 30 minutes on most days of the week. In fact, men in the moderate and high fitness categories walked between 130 and 138 min.wk-1, and women in these categories walked between 148 and 167 min.wk-1. CONCLUSIONS: Most individuals should be able to achieve these physical activity goals and thus attain a cardiorespiratory fitness level sufficient to result in substantial health benefits.     

Can implementation intentions and text messages promote brisk walking? A randomized trial.

Objective: To test the efficacy in promoting brisk walking of two theory-based interventions that incorporate implementation intentions and text message (Short Message Service; SMS) reminders directed at one’s walking-related plans or goals. Design: Participants (N = 149) were randomized to one of three conditions (implementation intention + SMS plan reminder, implementation intention + SMS goal reminder, control) before completing measures at baseline and follow-up 4 weeks later. At follow-up, the experimental groups were given a surprise recall task concerning their plans. All participants completed an equivalent goal recall task. Main Outcome Measures: Validated self-report measures of physical activity and measures of implementation intention and goal recall, weight, and waist-to-hip ratio. Results: Both intervention groups increased their brisk walking relative to the control group, without reducing other physical activity. The goal reminder group lost the most weight. The SMS plan reminder group recalled more of their plans than the SMS goal reminder group, but the latter were more successful in goal recall. Conclusion: Both interventions can promote brisk walking in sedentary populations. Text messages aid the recall of, and could enhance interventions that target, implementation intentions and goals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized walking trial in postmenopausal women: effects on physical activity and health 10 years later

BACKGROUND: It is important to determine if permanent lifestyle changes may result from physical activity interventions and whether health may be affected by these changes. OBJECTIVE: To conduct a 10-year follow-up of physical activity and self-reported health status in participants of a randomized clinical trial of walking intervention. METHODS: Of the original 229 volunteer postmenopausal women who participated in the original clinical trial, 196 (N = 96 intervention and 100 controls) completed the 10-year follow-up telephone interview. The interview protocol included questions on self-reported walking for exercise and purposes other than exercise, the Paffenbarger sport and exercise index, functional status, and various chronic diseases and conditions. RESULTS: The median values for both usual walking for exercise and total walking were significantly higher for walkers compared with controls (for both, P = .01), with median differences of 706 and 420 kcal/wk, respectively. After excluding women who reported heart disease during the original trial, 2 women in the walking group (2%) and 11 women in the control group (12%) reported physician-diagnosed heart disease over the last 10 years (P = .07). There were also fewer hospitalizations, surgeries, and falls among women in the walking group, although these differences were not statistically significant (P>.05). CONCLUSIONS: Although limited by self-report, this study may be the first to demonstrate long-term exercise compliance to a randomized control trial in older women and to suggest that health benefits may have ensued as a result of these increased activity levels.     

Glycine receptor reduction within segmental gray matter in a rat model in neuropathic pain

OBJECTIVES: To determine the prevalence rates of self-reported sleep complaints and their association with health-related factors. DESIGN: A cross-sectional study. SETTING: People living in the community. PARTICIPANTS: A total of 2398 noninstitutionalized individuals, aged 65 years and older, residing in the Veneto region, northeast Italy. MEASUREMENTS: Odds ratios for the association of sleep complaints with potential risk factors. RESULTS: The prevalence of insomnia was 36% in men and 54% in women, with increased risks for women (odds ratio (OR) = 1.69, 95% CI: 1.3-2.1), depression (OR = 1.93, 95% CI, 1.5-2.5), and regular users of sleep medications (OR = 5.58, 95% CI, 4.3-7.3). About 26% of men and 21% of women reported no sleep complaints. Night awakening, reported by about two-thirds of the participants, was the most common sleep disturbance. Women and regular users of sleep medications had significantly increased odds for insomnia and for not feeling rested upon awakening in the morning. Depressive symptomatology was more strongly associated with insomnia and night awakening than with awakening not rested, whereas physical disability was more strongly associated with awakening not rested than with the other two sleep disturbances. CONCLUSION: Our findings show that sleep complaints, highly common among older Italians, are associated with a wide range of medical conditions and with the use of sleep medications. Further longitudinal studies are needed to investigate the causes and the negative health consequences of sleep disturbances to improve both the diagnosis and treatment.     

Lipid lowering in a multidisciplinary clinic compared with primary physician management

OBJECTIVE: This study analyzed questionnaire items that address complaints about sleep from the National Vietnam Veterans Readjustment Study, a nationally representative sample of the 3.1 million men and women who served in Vietnam. This study compared the frequency of nightmares and difficulties with sleep onset and sleep maintenance in male Vietnam theater veterans with male Vietnam era veteran and male civilian comparison subjects. It focused on the role of combat exposure, nonsleep posttraumatic stress disorder (PTSD) symptoms, comorbid psychiatric and medical disorder, and substance abuse in accounting for different domains of sleep disturbance. METHOD: The authors undertook an archival analysis of the National Vietnam Veterans Readjustment Study database using correlations and linear statistical models. RESULTS: Frequent nightmares were found exclusively in subjects diagnosed with current PTSD at the time of the survey (15.0%). In the sample of veterans who served in Vietnam (N = 1,167), combat exposure was strongly correlated with frequency of nightmares, moderately correlated with sleep onset insomnia, and weakly correlated with disrupted sleep maintenance. A hierarchical multiple regression analysis showed that in Vietnam theater veterans, 57% of the variance in the frequency of nightmares was accounted for by war zone exposure and non-sleep-related PTSD symptoms. Alcohol abuse, chronic medical illnesses, panic disorder, major depression, and mania did not predict the frequency of nightmares after control for nonsleep PTSD symptoms. CONCLUSIONS: Frequent nightmares appear to be virtually specific for PTSD. The nightmare is the domain of sleep disturbance most related to exposure to war zone traumatic stress.     

Enhancing the efficacy of behavior therapy for obesity: Effects of aerobic exercise and a multicomponent maintenance program.

Tested whether the efficacy of behavior therapy for obesity might be improved by the programmatic additions of an aerobic exercise regimen during treatment and a multicomponent maintenance program following treatment. 14 male and 76 female obese 22–60 yr olds were randomly assigned to 2 treatment conditions (behavior therapy or behavior therapy plus aerobic exercise) and 2 posttreatment conditions (no further contact or a multicomponent maintenance program). The exercise regimen consisted of 80 min/week of brisk walking or stationary cycling. The maintenance program included therapist contact by telephone and mail and peer self-help group meetings. At posttreatment, Ss in the behavior therapy plus aerobic exercise condition lost significantly more weight than those who received behavior therapy only. Over an 18-mo follow-up period, maintenance program participants demonstrated significantly better weight-loss progress than Ss in the no-further-contact condition. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of lifestyle and structured interventions to increase physical activity and cardiorespiratory fitness: a randomized trial

CONTEXT: Even though the strong association between physical inactivity and ill health is well documented, 60% of the population is inadequately active or completely inactive. Traditional methods of prescribing exercise have not proven effective for increasing and maintaining a program of regular physical activity. OBJECTIVE: To compare the 24-month intervention effects of a lifestyle physical activity program with traditional structured exercise on improving physical activity, cardiorespiratory fitness, and cardiovascular disease risk factors. DESIGN: Randomized clinical trial conducted from August 1, 1993, through July 31, 1997. PARTICIPANTS: Sedentary men (n = 116) and women (n = 119) with self-reported physical activity of less than 36 and 34 kcal/kg per day, respectively. INTERVENTIONS: Six months of intensive and 18 months of maintenance intervention on either a lifestyle physical activity or a traditional structured exercise program. MAIN OUTCOME MEASURES: Primary outcomes were physical activity assessed by the 7-Day Physical Activity Recall and peak oxygen consumption (VO2peak) by a maximal exercise treadmill test. Secondary outcomes were plasma lipid and lipoprotein cholesterol concentrations, blood pressure, and body composition. All measures were obtained at baseline and at 6 and 24 months. RESULTS: Both the lifestyle and structured activity groups had significant and comparable improvements in physical activity and cardiorespiratory fitness from baseline to 24 months. Adjusted mean changes (95% confidence intervals [CIs]) were 0.84 (95% CI, 0.42-1.25 kcal/kg per day; P<.001) and 0.69 (95% CI, 0.25-1.12 kcal/kg day; P = .002) for activity, and 0.77 (95% CI, 0.18-1.36 mL/kg per minute; P = .01) and 1.34 (95% CI, 0.72-1.96 mL/kg per minute; P<.001) for VO2peak for the lifestyle and structured activity groups, respectively. There were significant and comparable reductions in systolic blood pressure (-3.63 [95% CI, -5.54 to -1.72 mm Hg; P<.001] and -3.26 [95% CI, -5.26 to -1.25 mm Hg; P = .002]) and diastolic blood pressure (-5.38 [95% CI, -6.90 to -3.86 mm Hg; P<.001] and -5.14 [95% CI, -6.73 to -3.54 mm Hg; P<.001) for the lifestyle and structured activity groups, respectively. Neither group significantly changed their weight (-0.05 [95% CI, -1.05 to 0.96 kg; P = .93] and 0.69 [95% CI, -0.37 to 1.74 kg; P = .20]), but each group significantly reduced their percentage of body fat (-2.39% [95% CI, -2.92% to -1.85%; P<.001] and -1.85% [95% CI, -2.41 % to -1.28%; P<.001]) in the lifestyle and structured activity groups, respectively. CONCLUSIONS: In previously sedentary healthy adults, a lifestyle physical activity intervention is as effective as a structured exercise program in improving physical activity, cardiorespiratory fitness, and blood pressure.     

Older adults with chronic disease: Benefits of group-mediated counseling in the promotion of physically active lifestyles.

In this 12-month trial standard exercise training was compared with a group-mediated cognitive behavioral (GMCB) intervention with respect to effects on long-term adherence and change in physical function of older adults who were either at risk for or had cardiovascular disease. Participants (147 older men and women) were randomized to the 2 treatments. Outcomes included self-reported physical activity, fitness, and self-efficacy. The GMCB treatment produced greater improvements on all outcomes than did standard exercise therapy. Regardless of treatment assignment, men had more favorable change on the study outcomes than did women. Analysis of a self-regulatory process measure in the GMCB group revealed that change in barriers efficacy was related to change in physical activity and fitness. Results suggest that teaching older adults to integrate physical activity into their lives via GMCB leads to better long-term outcomes than standardized exercise therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Habitual physical activity in a population residing in the city of Barcelona

OBJECTIVES: To describe the sociodemographic distribution of habitual physical activity and to analyse its relationship with self-perceived health status and occupational status, among the population older that 16 years of age in the city of Barcelona, Spain. METHODS: A sample of 1,885 adult men and 2,196 women answered the Health Interview Survey of Barcelona in 1992. Those whose habitual activity required high physical exertion or walking were considered as active. Bivariate and multivariate analyses adjusting logistic regression models were used to study the relationship between habitual physical activity and the rest of variables, for each occupational situation. RESULTS: Fifty six percent of adults reported being physically active. Physical activity was lower among workers than non workers, although workers reported more physical exertion (14.5% in men and 8.0% in women). Physical activity was associated with occupation and educational level among male workers, but only with occupation among female workers. In the non working population, physical activity was lower among those who perceived their health status as fair or poor, compared with those that described it as good or very good, (ORa in men was 0.2, 95% confidence interval = 0.1-0.5; ORa in women was 0.5, 95% confidence interval = 0.3-0.8). CONCLUSIONS: More than half of the Barcelona population were physically active in an habitual manner. Among workers, this activity was mainly determined by the occupation. Non-workers with a poor self-perceived health status did less physical activity.     

Using sleep dysfunction to explore the nature of resilience in adult survivors of childhood abuse or trauma

OBJECTIVE: In early studies, resilience to trauma was equated with psychological well-being. This study explores the possibility that such resilience is better described as social-behavioral competency and that, in turn, such competency can conceal emotional pain. METHOD: A university sample of 97 participants, 79 women and 18 men, completed measures of childhood abuse and trauma, resilient characteristics, and sleep dysfunction. The measures of sleep problems could be divided into those tapping psychological well-being (e.g., nightmare frequency) and those reflecting social-behavioral functioning (e.g., measures of the impact of nightmares on waking functioning). RESULTS: Fifty-three participants reported experiencing one or more types of trauma or abuse in childhood. As a group they scored more negatively than those reporting no abuse on measures of sleep dysfunction. Resilient characteristics were only related to measures of social-behavioral functioning, not well-being. CONCLUSIONS: The findings are consistent with current conceptualizations of trauma/abuse recovery as involving multiple dimensions of functioning, some of which are more publicly observable than others. Therefore, some apparently resilient individuals may have good social-behavioral competency while still experiencing psychological pain.     

Physical activity and women in the United States: an overview of health benefits, prevalence, and intervention opportunities

Despite decades of physical activity research and interventions conducted on men, very little is known about the patterns of physical activity among US women. Rates from several national surveys show much lower rates of physical activity for women than for men. Among women, rates may vary by socioeconomic status. Studies relating physical activity and experience with heart disease, cancer, osteoporosis, and mental health are discussed. Interventions in the workplace and the community may increase the level of physical activity among US women. A history of not participating in exercise and lack of time for this activity appear to be important constraints for many women. The Surgeon General's Report on physical activity sanctioned future research on specific groups, such as women. Applied research coupled with community and workplace policies that support women's efforts to be more physically active may decrease the rates of some chronic diseases in this population.     

Exercise and the experience and appraisal of daily stressors: a naturalistic study

Thirty-eight men and 35 women completed diaries of exercise, mood, and the experience and appraisal of daily stressors over 12 consecutive days. It was hypothesized that exercise would be associated with positive moods and with the experience of fewer daily stressors. Positive moods were rated higher and depression lower on exercise days than no-exercise days. Participants low in trait anxiety reported fewer stressful events on the days on which they exercised. Those with strong personal (health, physical appearance, and mood) motives for exercise reported more stressful daily events overall; in addition, they experienced more potentially stressful events as nonstressful on the days during which they engaged in physical exercise. The results are discussed in relation to the acute after-effects of exercise on mood and stress responsivity and the long term of psychological benefits of regular exercise.     

Musculoskeletal complaints and fibromyalgia in patients attending a respiratory sleep disorders clinic

OBJECTIVE: To determine the frequency of fibromyalgia (FM) syndrome and reporting of pain in an unselected group of patients attending a respiratory sleep disorders clinic, and to examine the association of physical activity and levels of reported pain. METHODS: 108 consecutive patients attending a respiratory sleep disorders clinic were interviewed and examined, blind to sleep disorder status. Assessment of musculoskeletal pain symptoms included patient history of pain, painful sites marked on a mannequin, visual analog scale (VAS) pain score, and tender point count. Daily physical activity was recorded, and all patients underwent nocturnal polysomnography, blind to clinical status. RESULTS: FM was identified in 3 patients (2.7%). Pain reporting was more strongly associated with reduced physical activity than with a specific sleep disorder. Patients with reduced physical activity were more likely to have pain symptoms than physically active patients: tender point count > or = 6 (p = 0.002), > or = 3 sites marked on mannequin (p = 0.008), axial pain (p = 0.003), and VAS pain score (p = 0.008). CONCLUSION: FM by defined criteria was uncommon in patients with a primary complaint of disturbed sleep, and in particular, patients with sleep apnea. Reduced physical activity was strongly associated with reported pain symptoms.     

Moderators and mediators of exercise-induced objective sleep improvements in midlife and older adults with sleep complaints.

Objective: Exercise can improve sleep quality, but for whom and by what means remains unclear. We examined moderators and mediators of objective sleep improvements in a 12-month randomized controlled trial among underactive midlife and older adults reporting mild/moderate sleep complaints. Methods: Participants (N = 66, 67% women, 55–79 years) were randomized to moderate-intensity exercise or health education control. Putative moderators were gender, age, physical function, self-reported global sleep quality, and physical activity levels. Putative mediators were changes in BMI, depressive symptoms, and physical function at 6 months. Objective sleep outcomes measured by in-home polysomnography were percent time in Stage I sleep, percent time in Stage II sleep, and number of awakenings during the first third of sleep at 12 months. Results: Baseline physical function and sleep quality moderated changes in Stage I sleep; individuals with higher initial physical function (p = .01) and poorer sleep quality (p = .03) had greater improvements. Baseline physical activity level moderated changes in Stage II sleep (p = .04) and number of awakenings (p = .01); more sedentary individuals had greater improvements. Decreased depressive symptoms (CI:-1.57 to ?0.02) mediated change in Stage I sleep. Decreased depressive symptoms (CI:-0.75 to ?0.01), decreased BMI (CI:-1.08 to ?0.06), and increased physical function (CI: 0.01 to 0.72) mediated change in number of awakenings. Conclusions: Initially less active individuals with higher initial physical function and poorer sleep quality improved the most. Affective, functional, and metabolic mediators specific to sleep architecture parameters were suggested. These results indicate strategies to more efficiently treat poor sleep through exercise in older adults. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Lifelong exercise and stroke

OBJECTIVES: To examine the potential of lifelong patterns of increased physical activity to prevent stroke. DESIGN: Case-control study. SETTING: 11 general practices in west Birmingham. SUBJECTS: 125 men and women who had just had their first stroke and were aged 35-74 and 198 controls frequency matched for age and sex recruited over 24 months during 1988-90. Exclusion criteria were a previous history of stroke, mitral valvular heart disease combined with atrial fibrillation, primary or metastatic cerebral neoplasm, or coagulation disorder or myeloproliferative disease. MAIN OUTCOME MEASURES: Odds ratios for stroke related to lifetime history of exercise after 15 years of age. RESULTS: A history of vigorous exercise during the ages 15-25 appeared to protect from stroke: odds ratio adjusted for age and sex 0.33 (95% confidence interval 0.2 to 0.6). This effect was independent of other potential risk factors. Increasing years of participation in vigorous exercise between the ages of 15 and 55 produced an increasing protection from stroke (p < 0.001). In the 65 cases and 169 controls who were free of cardiac ischaemia, peripheral vascular disease, and poor health recent vigorous exercise and walking were protective against stroke: odds ratios of 0.41 (0.2 to 1.0) for recent vigorous exercise and 0.30 (0.1 to 0.7) for recent walking. CONCLUSIONS: Appreciable protection from stroke in later life is conferred by vigorous exercise in early adulthood. This increased level of physical activity should, if possible, be continued lifelong.