All Levels of Physical Activity Can Mitigate Stroke Risk in Adults

Among adults, stroke risk can be reduced with any amount of leisure-time physical activity, according to study results published in the Journal of Neurology, Neurosurgery, and Psychiatry.

Researchers conducted a systematic review and meta-analysis to assess the effects of varying levels of leisure-time physical activity vs inactivity on stroke risk.

The primary outcomes of interest included incidence of any stroke type, ischemic stroke, and hemorrhagic stroke, all of which were measured using random effects models.

Meta-regression was performed by grouping patients by activity level: none, low to moderate, and high or vigorous. Quality prospective cohort studies that were published in English through April 2023 and involved healthy adults were identified in PubMed and Scopus for inclusion in this study.

The researchers selected 15 studies encompassing 16 cohorts comprised 752,050 patients for meta-analysis. The mean follow-up period across all 15 studies was 125.7 months. All cohort studies measured leisure-time physical activity via self-report questionnaires and 2 studies performed in-person interviews as well.

Five studies identified 3 levels of leisure-time physical activity (none, below target, and ideal). Compared with no leisure-time physical activity, below target and ideal leisure-time physical activity had pooled risk ratios (RRs) for any stroke of 0.82 (95% CI, 0.75-0.88; I2=16%) and 0.71 (95% CI, 0.58-0.86; I2=81%), respectively.

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Six studies identified 4 levels of leisure-time physical activity (none, low, moderate, and intense). Compared with no leisure-time physical activity, low, moderate, and intense leisure-time physical activity had pooled RRs of any stroke of 0.76 (95% CI, 0.63-0.90; I2=77%), 0.73 (95% CI, 0.62-0.87; I2=73%), and 0.75 (95% CI, 0.61-0.92; I2=78%), respectively.

Two studies identified 5 levels of leisure-time physical activity (none, insufficient, low, moderate, and intense). Compared with no leisure-time physical activity, the other 4 levels of leisure-time physical activity had pooled RRs of:

Insufficient : 0.89 (95% CI, 0.79-1.0; I 2 =0%);

: 0.89 (95% CI, 0.79-1.0; I =0%); Low : 0.87 (95% CI, 0.77-0.98; I 2 =0%);

: 0.87 (95% CI, 0.77-0.98; I =0%); Moderate : 0.71 (95% CI, 0.58-0.88; I 2 =0%); and

: 0.71 (95% CI, 0.58-0.88; I =0%); and Intense: 0.98 (95% CI, 0.73-1.32; I2=12%).

Three studies reported the risk for ischemic stroke using 3 categories of leisure-time physical activity (none, below target, ideal). Compared with no leisure-time physical activity, below target and ideal leisure-time physical activity had pooled RRs of 0.87 (95% CI, 0.80-0.95; I2=0%) and 0.80 (95% CI, 0.64-1.01; I2=71%), respectively.

Two studies reported the risk for hemorrhagic stroke using 3 levels of leisure-time physical activity (none, below target, ideal). Compared with no leisure-time physical activity, below target and ideal leisure-time physical activity had pooled RRs of 0.84 (95% CI, 0.68-1.04; I2=12%) and 0.87 (95% CI, 0.72-1.04; I2=0%).

Study limitations included statistical heterogeneity, as well as clinical and methodological heterogeneity of the included studies. Additionally, the small sample of included studies was a limiting factor in terms of conducting subgroup analyses on race and ethnicity. “Our data encourage campaigns to overcome sedentary lifestyle and to strive to do the best level of LTPA [leisure-time physical activity] that people can achieve according to their possibilities, an approach that will pay in terms of stroke prevention even if LTPA goals are met only in part,” the researchers concluded.