Changes in physical activity and risk of ischemic stroke: The ARIC study

Abstract

Background: Limited data exist regarding the impact of changes in physical activity (PA) over time on ischemic stroke risk. Exploring this understudied area could help improve stroke prevention strategies and promote PA during the lifespan. Methods: We evaluated 11,089 ARIC participants recruited in 1987-9 who completed visit 3 (1993-1995). We classified PA as meeting recommendations, not meeting recommendations, or no PA. Categories of increased, decreased, stable high, and stable low PA and a continuous PA variable were also evaluated. Crude and adjusted Cox regression models were used to characterize the association of 6-year changes in PA and ischemic stroke risk. Results: Participants had a mean age of 60 years. During a median of 21 years, 762 ischemic stroke events occurred. Compared to the participants with recommended PA at both visits, those with no PA had 46% higher hazards of ischemic stroke [HR=1.46, (95%: 1.17, 1.82)], and those with recommended PA at visit 1 and no PA at visit 3 also had 37% higher hazards [HR=1.37, (95%: 1.02, 1.83)]. Participants who increased their PA from visit 1 to visit 3 had 23% lower hazard than those with stable low PA at both visits [HR =0.77, (95%: 0.63, 0.94)], while those who decreased their PA had 25% higher hazards compared to those with stable high PA at both visits [HR =1.25, (95%: 1.01, 1.54)]. Conclusions: Physical inactivity during midlife increases ischemic stroke risk, while meeting PA recommendations reduces it. Data access statement: The data can be accessed from the National Heart, Lung, and Blood Institute’s ARIC website.

Trends in deaths and disability-adjusted life-years of stroke attributable to low physical activity worldwide, 1990–2019

“…Similarly, vigorous physical activity was associated with a lower risk of stroke in middle-aged and older adults (especially in males) in China [24]; moderate activity may be the best prevention for stroke in Japan [25]. Different types, frequencies, and intensities of physical activity were associated with a decreased incidence of stroke in the National Health and Nutrition Examination Survey (NHANES) study [26]; longer sedentary times besides low-intensity and moderate-vigorous physical activity were independently associated with an increased risk of stroke [27]; low physical activity was also associated with an increased risk of stroke incidence [28], which is the same as physical inactivity on ischaemic stroke [29]. The pathophysiological mechanism of how physical activity works should exactly be that physical activity is able to strengthen heart function, improve blood vessel function by lowering blood viscosity, platelet aggregation, and thrombosis [30,31], and promote blood circulation and lipid metabolism by pumping blood into the brain and releasing high-density lipoprotein cholesterol in the blood, respectively [32].…”

The paradigm change from reactive medical services to 3PM in ischemic stroke: a holistic approach utilising tear fluid multi-omics, mitochondria as a vital biosensor and AI-based multi-professional data interpretation

“…Physical inactivity/sedentary lifestyle is a strong contributor to IS [ 22 , 23 ] as a multi-faceted risk factor including mitochondrial stress and chronic inflammation with characteristic cardiovascular and metabolic alterations, that in sum contribute to a pathophysiological status to be defined as biomolecular allostatic load [ 24 – 28 ].…”

Physical Activity Over the Lifecourse and Cardiovascular Disease

“…Long-term physical activity is certainly associated with lower CVD risk, but initiation of physical activity in middle age may provide similar benefits and should be a goal for all individuals at this life stage. [118][119][120] While higher levels of physical activity are associated with slower disease progression (and potentially regression of atherosclerosis 121 ), it is important to recognize the "physical activity paradox" wherein leisure time physical activity is associated with clinical benefit, but occupational physical activity (ie, manual labor) is not. 122,123 Holtermann et al 124 postulated the reasons why this paradox exists.…”

“…Long-term physical activity is certainly associated with lower CVD risk, but initiation of physical activity in middle age may provide similar benefits and should be a goal for all individuals at this life stage. 118–120…”