Meta-analysis finds nonlinear dose-response between physical activity and reduced stroke risk
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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.
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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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