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Association of Sedentary Time and Physical Activity With Risk of Stroke
Quick Takes
- Light-intensity physical activity is associated with a lower risk for stroke.
- Moderate- to vigorous-intensity physical activity is associated with a lower risk for stroke.
- Sedentary time is associated with a higher risk for stroke.
Study Questions:
Are sedentary time and physical activity associated with incident stroke?
Methods:
Data from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study were used for the present analysis. Accelerometer data were collected from 7,607 Black and White adults aged ≥45 years between May 12, 2009–January 5, 2013. Participants were enrolled in REGARDS between February 5, 2003–October 30, 2007. The exposure of interest included sedentary time, light-intensity physical activity, and moderate to vigorous-intensity physical activity measured using a hip-mounted accelerometer worn for 7 consecutive days and stratified by tertile for the analyses. The primary outcome of interest was an incident stroke.
Results:
A total of 7,607 participants were included (mean age 63.4 [SD ± 8.5] years; 54.5% female, and 31.6% Black race). A total of 2,523 participants (33.2%) resided in the stroke belt, and 1,638 (21.5%) resided in the stroke buckle. Over a mean of 7.4 (SD 2.5) years of follow-up, 286 incident stroke cases (244 ischemic [85.3%]) occurred. For those in the highest tertile of light-intensity physical activity, compared to the lower tertile, the adjusted hazard ratio (HR) for stroke was 0.74 (95% confidence interval [CI], 0.53-1.04). The risk was lower for moderate- to vigorous-intensity physical activity (HR, 0.57; 95% CI, 0.38-0.84). Higher sedentary time was associated with a 44% greater risk of incident stroke (HR, 1.44; 95% CI, 0.99-2.07). When comparing the highest with the lowest tertile, mean sedentary bout duration was associated with a significantly greater risk of incident stroke (HR, 1.53; 95% CI, 1.10-2.12). After adjustment for sedentary time, the highest tertile of unbouted moderate- to vigorous-intensity physical activity (shorter bouts [1-9 minutes]) was associated with a significantly lower risk of incident stroke compared with the lowest tertile (HR, 0.62; 95% CI, 0.41-0.94). When expressed as continuous tertiles, sedentary time was positively associated with incident stroke risk (HR per 1-hour/day increase in sedentary time, 1.14; 95% CI, 1.02-1.28). Light-intensity physical activity was inversely associated with incident stroke risk (HR per 1-hour/day increase in light-intensity physical activity, 0.86; 95% CI, 0.77-0.97).
Conclusions:
The investigators concluded that objectively measured light-intensity physical activity, moderate- to vigorous-intensity physical activity, and sedentary time were significantly and independently associated with incident stroke risk. Longer sedentary bout duration was also independently associated with an increased risk of incident stroke.
Perspective:
These findings contribute to current evidence regarding the importance of physical activity in reducing cardiovascular events, with this study supporting the benefits related to stroke. It is important to note two additional findings. First, short bouts of regular physical activity are beneficial, and second, sedentary time is associated with an increased risk of stroke. Thus, replacing sedentary behaviors with physical activity is likely wise advice to provide our patients in addition to being an important public health message.
Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Prevention, Sports and Exercise Cardiology, Exercise
Keywords: Accelerometry, Exercise, Heart Disease Risk Factors, High-Intensity Interval Training, Primary Prevention, Race Factors, Risk Assessment, Sedentary Behavior, Stroke, Vascular Diseases
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