(Stroke. 1999;30:1-6.)
© 1999 American Heart Association, Inc.
Original Contributions |
Exercise and Risk of Stroke in Male Physicians
From the Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (I.-M.L., C.H.H., J.E.B., J.E.M.); the Department of Epidemiology, Harvard School of Public Health, Boston, Mass (I.-M.L., C.H.H., J.E.B., J.E.M.); Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany (K.B.); and the Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, Mass (C.H.H., J.E.B.).
Correspondence and reprint requests to I-Min Lee, MBBS, ScD, Brigham and Women's Hospital, 900 Commonwealth Ave East, Boston, MA 02215. E-mail i-min.lee{at}channing.harvard.edu
Background and Purpose—From a physiological perspective, physical activity might be expected to decrease the risk of developing stroke. However, epidemiological studies of physical activity and stroke risk have yielded divergent findings. We therefore sought to examine the association between exercise and stroke risk.
Methods—This was a prospective cohort study of 21 823 men, followed up for an average of 11.1 years. Participants were from the Physicians' Health Study, a randomized trial of low-dose aspirin and beta carotene. Men, aged 40 to 84 years at baseline, were free of self-reported myocardial infarction, stroke, transient ischemic attack, and cancer. At baseline, they reported on the frequency of exercise vigorous enough to work up a sweat. Stroke occurrence was reported by participants and confirmed after medical record review (n=533). We used Cox proportional hazards regression to analyze the data.
Results—With adjustment for age, treatment assignment,
smoking, alcohol intake, history of angina, and parental history of
myocardial infarction, the relative risks of total stroke associated
with vigorous exercise <1 time, 1 time, 2 to 4 times, and 
5 times
per week at baseline were 1.00 (referent), 0.79 (95% confidence
interval [CI], 0.61 to 1.03), 0.80 (95% CI, 0.65 to 0.99), and 0.79
(95% CI, 0.61 to 1.03), respectively; P for trend=0.04.
In subgroup analyses, the inverse association appeared stronger
with hemorrhagic than ischemic stroke. When we additionally
adjusted for body mass index, history of hypertension, high
cholesterol, and diabetes mellitus, corresponding relative
risks for total stroke were 1.00 (referent), 0.81 (95% CI, 0.61 to
1.07), 0.88 (95% CI, 0.70 to 1.10), and 0.86 (95% CI, 0.65 to 1.13),
respectively; P for trend=0.25.
Conclusions—Exercise vigorous enough to work up a sweat is associated with decreased stroke risk in men. In the present study, the inverse association with physical activity appeared to be mediated through beneficial effects on body weight, blood pressure, serum cholesterol, and glucose tolerance. Apart from its favorable influences on these variables, physical activity had no significant residual association with stroke incidence.
Key Words: epidemiology • exercise • risk factors • stroke prevention
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