Physical Activity and the Prevention of Stroke

Berlin JA Colditz A. A meta-analysis of physical activity in the prevention of coronary heart disease. Am J Epidemiol 1990; 132: 612–627.

Hermann B Leyten ACH Van Luijk JH Frenken CWGM de Coul AAW Op Schulte BPM. An evaluation of risk factors for stroke in a Dutch community. Stroke 1982; 13: 334–339.

Shinton R Sagar G. Lifelong exercise and stroke. BMJ 1993; 307: 231–234.

Sacco RL Gan R Boden-Albala B Lin IF Kargman DE Hauser WA Leisure-time physical activity and ischaemic stroke risk: the Northern Manhattan Stroke Study. Stroke 1998; 29: 380–387.

Paffenbarger RS Brand RJ Shultz R Jung D. Energy expenditure, cigarette smoking and blood pressure level as related to death from specific diseases. Am J Epidemiol 1978; 108: 12–18.

Wannamethee G Shaper AG. Physical activity and stroke in British middle aged men. BMJ 1992; 304: 597–601.

This prospective study examined the relationship between physical activity and risk of stroke in over 7000 middle-aged British men. An inverse relationship was seen between physical activity and risk of stroke even after adjusting for potential confounders. The inverse association was seen in both men with and without pre-existing CHD.

Lindenstrom E Boysen G Nyboe J. Lifestyle factors and risk of cerebrovascular disease in women. The Copenhagen City Heart Study. Stroke 1993; 24: 1468–1472.

This paper examined the influence of lifestyle on the risk of stroke in over 7000 women aged 35 years or more who took part in the Copenhagen City Heart Study. The relative risks of stroke for cigarette smoking and lack of physical activity were 1.4 (95% CI 1.02–1.94) and 1.45 (95% CI 1.01–2.08) respectively.

Kiely DK Wolf PA Cupples LA Beiser AS Kannel WB. Physical activity and stroke risk: the Framingham Study. Am J Epidemiol 1994; 140: 608–620.

This study examined the influence of increased levels of physical activity on risk of stroke in men and women in the Framingham Study cohort. Physical activity was categorised into tertiles and medium and high levels were compared with low levels. Increased levels of physical activity were protective against stroke even after adjustment for confounders but high levels did not confer additional benefit over medium levels. No significant protective effect was observed in women.

Abbott RD Rodriguez BL Burchfiel CM Curb DJ. Physical activity in older middle-aged men and reduced risk of stroke: the Honolulu Heart Program Am J Epidemiol 1994; 139: 881–893.

This report examined the relationship between levels of physical activity and risk of stroke in 7530 men followed-up for over 22 years. Risk of stroke was examined separately in younger (45–54 years) and older (55–68 years) middle-aged men. Among older men, those who were inactive showed a significant increase in risk of haemorrhagic stroke and intracerebral haemorrhage compared with those who were active. The benefits of physical activity in reducing thromboembolic stroke was only seen in older men who did not smoke cigarettes. Among younger men there was no significant effect of physical activity on risk of stroke seen although the inactive men had higher incidence of haemorrhagic stroke than active men.

Gillum RF Mussolini ME Ingram DD. Physical activity and stroke incidence in women and men. The NHANES I epidemiologic follow-up study. Am J Epidemiol 1996; 143: 860–869.

In white women aged 65–74 years, low levels of non-recreational activity was associated with a significant increased risk of stroke even after adjustment for cardiovascular risk factors. Similar associations were seen for men. A low level of recreational activity was associated with increased risk of stroke in women but not in men.

Paffenbarger RS Wing AL. Characteristics in youth predisposing to fatal stroke in later years. Lancet 1967; I: 753–754.

Medical aspects of exercise: benefits and risk. A report from the Royal College of Physicians. London: The Royal College of Physicians of London; 1991.

Hardman A , Physical activity and cardiovascular risk. Overview. J Cardiovasc Risk 1995; 3: 285–288.

Rauramaa R Salonen JT Seppanen K Salonen R Venalainen JM lhanainen M Inhibition of platelet aggregability by moderate-intensity physical exercise: a randomised clinical trial in overweight men. Circulation 1986; 74: 939–944.

Shaper AG Wannamethee G. Physical activity and ischaemic heart disease in middle-aged British men. Br Heart J 1991; 66: 384–394.

Shaper AG Wannamethee G Walker M. Physical activity, hypertension and risk of heart attack in men without evidence of ischaemic heart disease. J Hum Hypertens 1994; 8: 3–10.

The relationship between physical activity and risk of coronary heart disease was examined in men who had no evidence of pre-existing CHD or stroke at screening (5694 men). Risk of major CHD events decreased significantly with increasing physical activity to levels of moderate/moderately vigorous levels of activity, with a 50% reduction in risk compared with inactive men even after adjustment. However, at the highest level of physical activity (vigorous group) risk of CHD was increased above that seen in the moderate/moderately vigorous group. When separated into normotensives (n = 3888) and hypertensives (n = 1806; SBP ≥ 160 mmHg or DBP ≥ 90 mmHg or on regular antihypertensive treatment) the increased risk of major CHD events in the vigorously active men compared with the moderate/moderately vigorous group was only evident in hypertensive men.

Slattery ML Jacobs DR Nichaman MZ. Leisure time physical activity and coronary heart disease death: the US Railroad Study. Circulation 1989; 79: 304–311.