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
This article has been cited by other articles:
 |
|
 |
|
  S. P. Hooker, X. Sui, N. Colabianchi, J. Vena, J. Laditka, M. J. LaMonte, and S. N. Blair Cardiorespiratory Fitness as a Predictor of Fatal and Nonfatal Stroke in Asymptomatic Women and Men Stroke, November 1, 2008; 39(11): 2950 - 2957. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. Rosamond, K. Flegal, K. Furie, A. Go, K. Greenlund, N. Haase, S. M. Hailpern, M. Ho, V. Howard, B. Kissela, et al. Heart Disease and Stroke Statistics--2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, January 29, 2008; 117(4): e25 - e146. [Full Text] [PDF]
|
|
|
|
 |
|
 T. G. Neilan and M. J. Wood From altus to parvus: cardiac fatigue in athletes: reply Eur. Heart J., May 1, 2007; 28(9): 1172 - 1172. [Full Text] [PDF]
|
|
|
|
|
|
W. Rosamond, K. Flegal, G. Friday, K. Furie, A. Go, K. Greenlund, N. Haase, M. Ho, V. Howard, B. Kissela, et al. Heart Disease and Stroke Statistics--2007 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, February 6, 2007; 115(5): e69 - e171. [Full Text] [PDF]
|
|
|
|
 |
|
 E. Kasikcioglu The Other Face of the Medal: The Risks of Exercise Training J. Am. Coll. Cardiol., July 4, 2006; 48(1): 220 - 221. [Full Text] [PDF]
|
|
|
|
 |
|
 F. Pitta, T. Troosters, V. S. Probst, M. A. Spruit, M. Decramer, and R. Gosselink Quantifying physical activity in daily life with questionnaires and motion sensors in COPD. Eur. Respir. J., May 1, 2006; 27(5): 1040 - 1055. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Thom, N. Haase, W. Rosamond, V. J. Howard, J. Rumsfeld, T. Manolio, Z.-J. Zheng, K. Flegal, C. O'Donnell, S. Kittner, et al. Heart Disease and Stroke Statistics--2006 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, February 14, 2006; 113(6): e85 - e151. [Full Text] [PDF]
|
|
|
|
|
|
G. Hu, C. Sarti, P. Jousilahti, K. Silventoinen, N. C. Barengo, and J. Tuomilehto Leisure Time, Occupational, and Commuting Physical Activity and the Risk of Stroke Stroke, September 1, 2005; 36(9): 1994 - 1999. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. A. Allen Social Cognitive Theory in Diabetes Exercise Research: An Integrative Literature Review The Diabetes Educator, September 1, 2004; 30(5): 805 - 819. [PDF]
|
|
|
|
 |
|
 G. Wendel-Vos, A. Schuit, E. Feskens, H. Boshuizen, W. Verschuren, W. Saris, and D Kromhout Physical activity and stroke. A meta-analysis of observational data Int. J. Epidemiol., August 1, 2004; 33(4): 787 - 798. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. A Brooks, N. F Butte, W. M Rand, J.-P. Flatt, and B. Caballero Chronicle of the Institute of Medicine physical activity recommendation: how a physical activity recommendation came to be among dietary recommendations Am. J. Clinical Nutrition, May 1, 2004; 79(5): 921S - 930S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. D. Lee, A. R. Folsom, and S. N. Blair Physical Activity and Stroke Risk: A Meta-Analysis Stroke, October 1, 2003; 34(10): 2475 - 2481. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Kurl, J. A. Laukkanen, R. Rauramaa, T. A. Lakka, J. Sivenius, and J. T. Salonen Cardiorespiratory Fitness and the Risk for Stroke in Men Arch Intern Med, July 28, 2003; 163(14): 1682 - 1688. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G D. Batty and I-M. Lee Physical activity for preventing strokes BMJ, August 17, 2002; 325(7360): 350 - 351. [Full Text] [PDF]
|
|
|
|
|
|
R. S Paffenbarger Jr, S. N Blair, and I-M. Lee A history of physical activity, cardiovascular health and longevity: the scientific contributions of Jeremy N Morris, DSc, DPH, FRCP Int. J. Epidemiol., October 1, 2001; 30(5): 1184 - 1192. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. E Hardman Physical activity and health: current issues and research needs Int. J. Epidemiol., October 1, 2001; 30(5): 1193 - 1197. [Full Text] [PDF]
|
|
|
|
|
|
P. Saloheimo, S. Juvela, and M. Hillbom Use of Aspirin, Epistaxis, and Untreated Hypertension as Risk Factors for Primary Intracerebral Hemorrhage in Middle-Aged and Elderly People Stroke, February 1, 2001; 32(2): 399 - 404. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J R Fann, W A Kukull, W J Katon, and W T Longstreth Jr Physical activity and subarachnoid haemorrhage: a population based case-control study J. Neurol. Neurosurg. Psychiatry, December 1, 2000; 69(6): 768 - 772. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. T. Katzmarzyk, N. Gledhill, and R. J. Shephard The economic burden of physical inactivity in Canada Can. Med. Assoc. J., November 1, 2000; 163(11): 1435 - 1440. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. B. Hu, M. J. Stampfer, G. A. Colditz, A. Ascherio, K. M. Rexrode, W. C. Willett, and J. E. Manson Physical Activity and Risk of Stroke in Women JAMA, June 14, 2000; 283(22): 2961 - 2967. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Ellekjar, J. Holmen, E. Ellekjar, and L. Vatten Physical Activity and Stroke Mortality in Women : Ten-Year Follow-Up of the Nord-Trondelag Health Survey, 1984-1986 Stroke, January 1, 2000; 31(1): 14 - 18. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. R. Evenson, W. D. Rosamond, J. Cai, J. F. Toole, R. G. Hutchinson, E. Shahar, and A. R. Folsom Physical Activity and Ischemic Stroke Risk : The Atherosclerosis Risk in Communities Study Stroke, July 1, 1999; 30(7): 1333 - 1339. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 U. Agnarsson, G. Thorgeirsson, H. Sigvaldason, and N. Sigfusson Effects of Leisure-Time Physical Activity and Ventilatory Function on Risk for Stroke in Men: The Reykjavik Study Ann Intern Med, June 15, 1999; 130(12): 987 - 990. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. H. Messerli, R. G. Ketelhut, K. Ketelhut, I. Thune, I. Njolstad, and M. L. Lochen Cardiovascular Risk Factors and Physical Activity: How Much Is Enough? Arch Intern Med, April 26, 1999; 159(8): 882 - 883. [Full Text] [PDF]
|
|
|
|
|
|
I-M. Lee, C. H. Hennekens, K. Berger, J. E. Buring, and J. E. Manson Exercise and Risk of Stroke in Male Physicians Stroke, January 1, 1999; 30(1): 1 - 6. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Tanaka, D. R. Seals, K. D. Monahan, C. M. Clevenger, C. A. DeSouza, and F. A. Dinenno Regular aerobic exercise and the age-related increase in carotid artery intima-media thickness in healthy men J Appl Physiol, April 1, 2002; 92(4): 1458 - 1464. [Abstract] [Full Text] [PDF]
|
|