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Hu FB, Stampfer MJ, Colditz GA, et al. Physical Activity and Risk of Stroke in Women. JAMA. 2000;283(22):2961–2967. doi:10.1001/jama.283.22.2961
Author Affiliations: Departments of Nutrition (Drs Hu, Stampfer, Ascherio, and Willett) and Epidemiology (Drs Stampfer, Colditz, Ascherio, Willett, and Manson), Harvard School of Public Health, Channing Laboratory (Drs Stampfer, Colditz, Willett, and Manson) and the Division of Preventive Medicine (Drs Rexrode and Manson), Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Mass.
Context Persuasive evidence has demonstrated that increased physical activity
is associated with substantial reduction in risk of coronary heart disease.
However, the role of physical activity in the prevention of stroke is less
Objective To examine the association between physical activity and risk of total
stroke and stroke subtypes in women.
Design and Setting The Nurses' Health Study, a prospective cohort study of subjects residing
in 11 US states.
Subjects A total of 72,488 female nurses aged 40 to 65 years who did not have
diagnosed cardiovascular disease or cancer at baseline in 1986 and who completed
detailed physical activity questionnaires in 1986, 1988, and 1992.
Main Outcome Measure Incident stroke occurring between baseline and June 1, 1994, compared
among quintiles of physical activity level as measured by metabolic equivalent
tasks (METs) in hours per week.
Results During 8 years (560,087 person-years) of follow-up, we documented 407
incident cases of stroke (258 ischemic strokes, 67 subarachnoid hemorrhages,
42 intracerebral hemorrhages, and 40 strokes of unknown type). In multivariate
analyses controlling for age, body mass index, history of hypertension, and
other covariates, increasing physical activity was strongly inversely associated
with risk of total stroke. Relative risks (RRs) in the lowest to highest MET
quintiles were 1.00, 0.98, 0.82, 0.74, and 0.66 (P
for trend=.005). The inverse gradient was seen primarily for ischemic stroke
(RRs across increasing MET quintiles, 1.00, 0.87, 0.83, 0.76, and 0.52; P for trend=.003). Physical activity was not significantly
associated with subarachnoid hemorrhage or intracerebral hemorrhage. After
multivariate adjustment, walking was associated with reduced risk of total
stroke (RRs across increasing walking MET quintiles, 1.00, 0.76, 0.78, 0.70,
and 0.66; P for trend=.01) and ischemic stroke (RRs
across increasing walking MET quintiles, 1.00, 0.77, 0.75, 0.69, and 0.60; P for trend=.02). Brisk or striding walking pace was associated
with lower risk of total and ischemic stroke compared with average or casual
Conclusion These data indicate that physical activity, including moderate-intensity
exercise such as walking, is associated with substantial reduction in risk
of total and ischemic stroke in a dose-response manner.
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