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Meta-analysis finds nonlinear dose-response between physical activity and reduced stroke riskHow much exercise protects against stroke? A new analysis finds the sweet spot

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Key Takeaway
Consider nonlinear dose-response between physical activity and stroke risk in prevention counseling.

This meta-analysis pooled data from 14 international prospective cohort studies involving 2,639,086 participants followed for 4.9 to 17.9 years. It examined dose-response associations between total physical activity (PA) and moderate-to-vigorous physical activity (MVPA) with incident stroke risk.

The analysis revealed a nonlinear inverse association between total PA and stroke risk, with each 10 MET-h/week increment reducing risk by 1% up to 130 MET-h/week, corresponding to a maximum 13% reduction. For MVPA, an L-shaped association was observed with the greatest benefit (19% reduction) at 19 MET-h/week. Sex-stratified analysis showed a J-shaped pattern in females with optimal reduction (18%) at 10-15 MET-h/week, while evidence in males was limited with a hazard ratio of 0.89 (95% CI: 0.70-1.13).

No safety or tolerability data were reported. Key limitations include limited evidence in males and for hemorrhagic stroke specifically, and the observational nature of the included studies precludes causal inference. The findings suggest optimal prevention targets but should be interpreted cautiously given the evidence gaps.

We all know exercise is good for us, but when it comes to preventing a devastating stroke, how much movement actually makes a difference? A new analysis of data from over 2.6 million people across 14 international studies provides some of the clearest answers yet on the dose of activity that seems most protective.

The research looked at total physical activity and more intense, moderate-to-vigorous activity. For overall movement, the benefit increased up to a high level—about 130 MET-hours per week, which is like several hours of brisk walking daily. For the more intense activity, the biggest drop in stroke risk happened at a more moderate level, around 19 MET-hours per week (think a few vigorous workouts). Interestingly, the pattern differed by sex; for women, the relationship was a gentle 'J' shape, with an optimal zone of activity, while for men, the data was too limited to draw a firm conclusion.

This is a powerful look at patterns across millions of people, showing a strong association between being active and having a lower stroke risk. However, the authors are clear about the limits: because these are observational studies, they can show a link but not prove that exercise directly caused the lower risk. They also note that evidence is particularly thin for men and for specific stroke types like hemorrhagic stroke. Still, it paints a compelling picture that finding your movement sweet spot could be a key part of guarding your health.

What this means for you:
Exercise is strongly linked to lower stroke risk, with a clear 'sweet spot' for maximum benefit.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedApr 2026
View Original Abstract ↓
BACKGROUND: Stroke is the second leading cause of death and third leading cause of disability globally. The dose-response relationship between physical activity (PA), particularly moderate-to-vigorous physical activity (MVPA), and stroke risk remains unclear, with limited sex-specific evidence. AIMS: To examine the dose-response associations of total PA and MVPA with stroke risk, considering sex and subtype differences. METHODS: A systematic review and dose-response meta-analysis of prospective cohort studies published between 2013 and 2024, with follow-up durations ranging from 4.9 to 17.9 years, were conducted. PA exposures were standardized to MET-hours per week (MET-h/wk), and incident stroke was the primary outcome. Study-specific hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled using random-effects models. Dose-response associations were assessed using restricted cubic spline models. Analyses stratified by sex and subtype were performed when available. RESULTS: Fourteen cohorts (n = 2,639,086) were included. Total PA showed a nonlinear inverse association with stroke risk: each 10 MET-h/wk increment reduced risk by 1% up to 130 MET-h/wk, corresponding to a 13% maximum reduction, after which benefits plateaued. MVPA exhibited an L-shaped association (P < 0.001), with the greatest benefit (19% reduction) at 19 MET-h/wk, followed by a gradual increase in risk. Sex-stratified analysis revealed a J-shaped pattern in females (optimal 10-15 MET-h/wk; 18% reduction). For males, the HR was 0.89 (95% CI: 0.70-1.13), and a nonlinear model could not be established due to limited data. In ischemic stroke, dose-response patterns paralleled those for total stroke. CONCLUSIONS: The study found a significant dose-response relationship between total PA and MVPA with stroke risk. Optimal prevention was observed at 130 MET-h/wk for total PA and 19 MET-h/wk for MVPA. Evidence in males and for hemorrhagic stroke remains limited and warrants further study.
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