Risk of stroke with different levels of leisure-time physical activity: a systematic review and meta-analysis of prospective cohort studies

De Santis, Federico; Romoli, Michele; Foschi, Matteo; Sciancalepore, Francesco Domenico; D'Anna, Lucio; Barba, Lorenzo; Abu-Rumeileh, Samir; Sacco, Simona; Ornello, Raffaele

doi:10.1136/jnnp-2023-332457

Cited by 3 publications

(3 citation statements)

References 45 publications

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“… 33 A recent systematic review and meta‐analysis of prospective cohort studies investigating vascular diseases found that physical activity, “even at the lowest levels,” was beneficial for stroke and vascular disease prevention. 34 This is in line with our findings that both MVPA (min/d) and adherence to the guideline MVPA threshold (min/wk) were associated with a reduction in CeVD risk, with the latter conferring a stronger protective effect. 35 …”

Section: Discussionsupporting

confidence: 91%

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Accelerometer‐Measured Behavior Patterns in Incident Cerebrovascular Disease: Insights for Preventative Monitoring From the UK Biobank

Zawada,

Ganjizadeh,

Conte

et al. 2024

JAHA

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Background The goal was to compare patterns of physical activity (PA) behaviors (sedentary behavior [SB], light PA, moderate‐to‐vigorous PA [MVPA], and sleep) measured via accelerometers for 7 days between patients with incident cerebrovascular disease (CeVD) (n=2141) and controls (n=73 938). Methods and Results In multivariate models, cases spent 3.7% less time in MVPA (incidence rate ratio [IRR], 0.963 [95% CI, 0.929–0.998]) and 1.0% more time in SB (IRR, 1.010 [95% CI, 1.001–1.018]). Between 12 and 24 months before diagnosis, cases spent more time in SB (IRR, 1.028 [95% CI, 1.001–1.057]). Within the year before diagnosis, cases spent less time in MVPA (IRR, 0.861 [95% CI, 0.771–0.964]). Although SB time was not associated with CeVD risk, MVPA time, both total min/d (hazard ratio [HR], 0.998 [95% CI, 0.997–0.999]) and guideline threshold adherence (≥150 min/wk) (HR, 0.909 [95% CI, 0.827–0.998]), was associated with decreased CeVD risk. Comorbid burden had a significant partial mediation effect on the relationship between MVPA and CeVD. Cases slept more during 12:00 to 17:59 hours (IRR, 1.091 [95% CI, 1.002–1.191]) but less during 0:00 to 5:59 hours (IRR, 0.984 [95% CI, 0.977–0.992]). No between‐group differences were significant at subgroup analysis. Conclusions Daily behavior patterns were significantly different in patients before CeVD. Although SB was not associated with CeVD risk, the association between MVPA and CeVD risk is partially mediated by comorbid burden. This study has implications for understanding observable behavior patterns in cerebrovascular dysfunction and may help in developing remote monitoring strategies to prevent or reduce cerebrovascular decline.

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Section: Discussionsupporting

confidence: 91%

“…It is unsurprising that no significant association was found between SB and CeVD risk, as evidence supporting the value of reducing or replacing SB is inconclusive. 34 Alternatively, the negative influence of SB may be most noticeable in individuals who spend the least amount of time in MVPA. 35 …”

Section: Discussionmentioning

confidence: 99%

Accelerometer‐Measured Behavior Patterns in Incident Cerebrovascular Disease: Insights for Preventative Monitoring From the UK Biobank

Zawada,

Ganjizadeh,

Conte

et al. 2024

JAHA

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“…18 Furthermore, another meta-analysis of 752,050 follow-up participants also found that all levels of leisure-time physical activity were beneficial in preventing stroke. 19 Notably, our study did not find that all kinds of physical activity could prevent stroke, possibly due to the exclusion of occupational physical activities.…”

Section: Discussioncontrasting

confidence: 57%

Impact of Physical Activity Intensity on Stroke Risk in Middle-aged and Older Adults

Bai,

Li,

Meng

et al. 2024

Preprint

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Background The relationship between weekly physical activity intensity and the incidence of initial stroke among middle-aged and elderly populations remains uncertain. Therefore, this study endeavors to elucidate this association through an analysis of a nationally representative cohort study.To contrast the incidence rates of initial stroke among participants engaging in varying levels of physical activity intensity with those leading sedentary lifestyles. Methods Cox regression analysis was employed to investigate the relationship between the intensity of physical activity and stroke incidence. Multimodel Cox regression analysis was conducted to evaluate the risk of initial stroke occurrence among patients with chronic diseases across varying levels of physical activity intensity. Restricted cubic splines were utilized to explore the correlation between overall physical activity and first stroke incidence, while mediation effects analysis was employed to elucidate the impact of highly active physical activity on first stroke occurrence through cardiovascular indicators. Subgroup analysis further delved into the relationship between highly active physical activity and initial stroke occurrence within diverse population subsets. Results Over a 7-year follow-up period, among the 4,380 participants (mean baseline age of 58 ± 9 years; 1,997 females), 300 individuals experienced a stroke, constituting 6.8% of the cohort. Of these cases, 43 (8.9%) occurred in sedentary participants, 173 (7.37%) in active individuals, and 84 (5.42%) in highly active individuals. In the overall population, the lowest risk of first stroke was observed at 13,045 MET-minutes/week of total physical activity. Following adjustment for potential confounders, highly active physical activity was found to significantly reduce the risk of first stroke (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.30 to 0.92). Furthermore, multivariate logistic regression revealed that highly active physical activity was associated with a decreased risk of first stroke (odds ratio [OR], 0.45; 95% CI, 0.36 to 0.55). Among participants with chronic diseases, those with hypertension demonstrated a reduced risk of first-ever stroke with highly active physical activity (HR, 0.55; 95% CI, 0.31 to 0.96), whereas such a benefit was not observed in other chronic conditions. Adjusting for confounding factors revealed that highly active physical activity might mitigate the risk of first stroke through mediating effects involving cardiovascular indicators, including blood pressure (effect, -0.003; 95% CI, -0.018 to -0.003), HDL (effect, -0.003; 95% CI, -0.018 to -0.005), BMI (effect, -0.001; 95% CI, -0.009 to -0.001), and TyG index (effect, -0.001; 95% CI, -0.008 to 0.000). Subgroup analyses, adjusted for confounders, revealed that compared to sedentary behavior, highly active physical activity was associated with a reduced risk of first-ever stroke in men (HR, 0.41; 95% CI, 0.22 to 0.75), individuals without heart disease (HR, 0.52; 95% CI, 0.33 to 0.82), and overweight individuals (HR, 0.40; 95% CI, 0.21 to 0.79). Conclusions These findings suggest that participation in highly active physical activity may mitigate the risk of first stroke among middle-aged and elderly individuals through modulation of cardiovascular indicators.

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Physical Activity, Sedentary Behaviors, and Venous Thromboembolism: A Narrative Review of the Current Evidence

Kunutsor,

Laukkanen

2024

Heart and Mind

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This narrative review aims to synthesize existing research on the impact of physical activity and sedentary behaviors on the risk of venous thromboembolism (VTE). It also delves into the biological mechanisms through which these lifestyle factors might influence VTE risk, assesses the clinical and public health implications of these findings, and highlights gaps in the current research landscape. Furthermore, it evaluates the causal relevance of physical activity and sedentary behaviors to VTE using Mendelian randomization studies. We conducted a literature search for interventional, observational cohort and genetic studies from MEDLINE and Embase up to April 2024. High physical activity levels are associated with a reduced risk of first-time VTE, independent of factors such as body mass index, age, sex, or geographical location. Nonetheless, the exact nature of the dose–response relationship between physical activity levels and VTE risk remains unclear, particularly regarding the optimal intensity, frequency, and duration needed for VTE prevention. Unlike its effects on initial VTE risk, physical activity does not appear to influence the risk of recurrent VTE. Conversely, sedentary behaviors such as prolonged television viewing and long-distance travel (e.g., long-haul flights) are linked to an increased risk of VTE, a risk that persists despite adherence to physical activity guidelines. The causality of these associations is supported by evidence suggesting biological pathways such as alterations in blood flow and coagulation, inflammation, endothelial and platelet function, and the modulation of cardiometabolic risk factors. Future research should aim to delineate the dose–response curves for the relationships, explore the use of objective measures to more accurately assess both physical activity and sedentary behaviors, and clarify their causal roles in VTE risk, potentially guiding targeted prevention strategies.

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Risk of stroke with different levels of leisure-time physical activity: a systematic review and meta-analysis of prospective cohort studies

Cited by 3 publications

References 45 publications

Accelerometer‐Measured Behavior Patterns in Incident Cerebrovascular Disease: Insights for Preventative Monitoring From the UK Biobank

Accelerometer‐Measured Behavior Patterns in Incident Cerebrovascular Disease: Insights for Preventative Monitoring From the UK Biobank

Impact of Physical Activity Intensity on Stroke Risk in Middle-aged and Older Adults

Physical Activity, Sedentary Behaviors, and Venous Thromboembolism: A Narrative Review of the Current Evidence

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