From the Department of Epidemiology, Harvard School of Public Health,
Boston, Mass (I-M.L., R.S.P); Division of Preventive Medicine, Department of
Medicine, Brigham and Women's Hospital and Harvard Medical School,
Boston, Mass (I-M.L.); and Division of Epidemiology, Stanford University
School of Medicine, Stanford, Calif (R.S.P.).
Correspondence to I-Min Lee, MBBS, ScD, Brigham and Women's Hospital, 900 Commonwealth Ave E, Boston, MA 02215. E-mail i-min.lee{at}channing.harvard.edu
Background and
Purpose—Physiologically, it appears
plausible for physical activity to decrease stroke risk; however,
epidemiological studies have produced mixed findings. Furthermore, few
studies have examined specific kinds and intensities of activities. The
purpose of this study was to examine the association between physical
activity, including its various components (walking, climbing stairs,
participation in sports and recreational activities), and stroke
risk.
Methods—This was a prospective cohort study of 11 130 Harvard
University alumni (mean age, 58 years) without
cardiovascular disease and cancer at baseline. Men
reported their walking, stair climbing, and participation in sports or
recreation on baseline questionnaires in 1977. Stroke occurrence was
assessed with another questionnaire in 1988. Death certificates were
obtained for decedents through 1990 to determine strokes not previously
reported (total strokes=378). We used Cox proportional hazards
regression to estimate the relative risks and 95% CIs for stroke
occurrence associated with physical activity.
Results—After adjustment for age, smoking, alcohol intake, and
early parental death, the relative risks of stroke associated with
<1000, 1000 to 1999, 2000 to 2999, 3000 to 3999, and
Conclusions—Physical activity is associated with decreased stroke
risk in men. A decreased risk was observed at energy expenditures of
1000 to 1999 kcal/wk, with further risk decrement seen at 2000 to 2999
kcal/wk but not beyond. Confirmation of the U-shaped relation observed
in these data requires similar observations in other populations.
© 1998 American Heart Association, Inc.
Original Contributions
Physical Activity and Stroke Incidence
The Harvard Alumni Health Study
4000 kcal/wk of
energy expenditure at baseline were 1.00 (referent), 0.76 (95% CI,
0.59 to 0.98), 0.54 (0.38 to 0.76), 0.78 (0.53 to 1.15), and 0.82 (0.58
to 1.14), respectively; P=0.05 for linear trend. Walking
20 km/wk was associated with significantly lower risk, independent of
other physical activity components. Climbing stairs and activities of
at least moderate intensity (4.5 METs, or multiples of resting
metabolic rate) each showed U-shaped relations to stroke
risk, with the risk being significantly lower at the nadir of the
curve. Light intensity activities (<4.5 METs), however, were unrelated
to stroke risk.
Key Words: epidemiology • exercise • risk factors • stroke prevention
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