Minimal Leisure Time Physical Activity Can Prevent Long-Term Stroke

Recently, researchers conducted a comprehensive examination and meta-analysis to gain deeper insights into whether varying degrees of leisure time physical activity (LTPA) can mitigate the occurrence of stroke. This analysis is published in the Journal of Neurology, Neurosurgery, and Psychiatry.

The review was conducted by gathering all pertinent articles accessible in the PubMed and Scopus databases. It’s noteworthy that only articles published in English were considered for this analysis.

Initially, a total of 3,064 articles were retrieved. Following the elimination of duplicates and alignment with eligibility criteria, 15 articles encompassing 16 cohorts were included in the study. Additionally, six more articles were included for quantitative analysis. The quality of the cohort studies incorporated in this systematic meta-analysis was assessed using the ROBINS-I tool.

Physical Activity and Stroke

Stroke, a potentially life-threatening condition, occurs when blood flow to a part of the brain is obstructed. It stands as one of the primary causes of mortality and morbidity worldwide. Hence, it’s imperative to manage factors that elevate the risk of stroke.

Numerous studies have demonstrated that physical activities (PA) diminish the likelihood of stroke. PA encompasses a spectrum of intensities, frequencies, and durations. Both moderate and vigorous levels of leisure time physical activity have been shown to prevent stroke occurrence and reduce mortality rates. Compared to individuals with low activity levels, those engaging in high levels of activity face a reduced risk of ischemic and hemorrhagic strokes.

Mechanistically, PA is linked to heightened levels of neurotrophins, which possess anti-inflammatory and anti-thrombotic properties. Neurotrophins like brain-derived neurotrophic factor and insulin-like growth factor 1 are associated with neuroprotection, synaptic plasticity promotion, neoangiogenesis, and neurogenesis. PA also mitigates common cardiovascular risk factors such as dyslipidemia, obesity, hypertension, and diabetes.

According to international guidelines, individuals should engage in ≥150 minutes of moderate exercise or ≥75 minutes of vigorous activity per week to stave off cardiovascular diseases, including stroke. However, since excessive leisure time physical activity may heighten the risk of cardiovascular events, it’s crucial to ascertain the precise amount or dose-response effect of LTPA to effectively prevent stroke.

It’s been noted that only a quarter of adults meet the minimum LTPA levels recommended by international guidelines. Hence, comprehending the benefits of engaging in physical activities below the recommended threshold is essential for stroke prevention.

The Impact of Varying Levels of Physical Activity on Stroke Prevention In contrast to sedentary behavior, LTPA reduces the risk of stroke by 18% to 29%, depending on its intensity. Moreover, the effectiveness of LTPA in reducing stroke risk appears to be independent of sex and age. Thus, engaging in even minimal LTPA is more beneficial than remaining inactive in preventing stroke.

Inactivity contributes to approximately 8% of global mortality. To advocate for a higher quality of life and health, initiatives like Life’s Essential have been devised to emphasize the importance of physical activities. Considering the lack of consensus regarding the impact of minimal LTPA levels in the past, the current understanding of the efficacy of even low PA in reducing stroke risk is immensely valuable. Furthermore, this insight could significantly benefit individuals with limited physical capabilities and those facing psychological and socioeconomic constraints.

The findings of this review align with the 2020 WHO evidence-based recommendations, which emphasize that some PA is better than none. Notably, this systematic review quantifies the reduction in stroke risk associated with low LTPA levels. While a dose-response curve of LTPA related to stroke risk is unavailable, the authors derived an approximate curve using data on occupational and recreational activities from the Global Burden of Disease meta-analysis on the risk of ischemic stroke and other ailments.

Most previously published meta-analyses have concluded that increasing daily PA levels decreases the risk of ischemic stroke. While various studies have debated the optimal PA pattern for stroke prevention and mortality reduction, this study underscores that any pattern and frequency of PA yield beneficial effects. For instance, the ‘weekend warrior’ PA pattern, characterized by sporadic and intense activity, has been shown to prevent numerous disease occurrences.

Several studies have indicated that women are typically less physically active than men. Hence, disseminating information about the beneficial effects of engaging in any level of PA, regardless of age and sex, could encourage individuals to incorporate some form of PA into their lifestyle.

Conclusions The present systematic review has some limitations, including the inclusion of studies regardless of the heterogeneity in the definition of leisure time physical activity. Additionally, these studies employed different methods for assessing LTPA levels.

Notwithstanding these limitations, this study underscores that, in comparison to inactivity, any level of recreational PA has a favorable impact on reducing stroke risks. It advocates for campaigns to promote any level of PA that could mitigate stroke risk in the general population.

For more information: Risk of stroke with different levels of leisure-time physical activity: a systematic review and meta-analysis of prospective cohort studies, Journal of Neurology, Neurosurgery & Psychiatry, https://doi.org/10.1136/jnnp-2023-332457