'Sit Less, Move More' to Reduce Stroke Risk

June 03, 2022

Spending more time doing light-intensity activities and less time being sedentary was associated with a reduced risk for first stroke in a population-based study of middle aged and older adults.

The study also found relatively short periods of moderate-to-vigorous exercise were associated with reduced stroke risk.

"Our results suggest there are a number of ways to reduce stroke risk simply by moving about,” lead author Steven P. Hooker, PhD, San Diego State University, commented to theheart.org | Medscape Cardiology. "This could be with short periods of moderate-to-vigorous activity each day, longer periods of light activity, or just sedentary for shorter periods of time. All these things can make a difference."

Hooker explained that while it has been found previously that moderate-to-vigorous exercise reduces stroke risk, this study gives more information on light-intensity activities and sedentary behavior and the risk of stroke.

"Our results suggest that you don't have to be a chronic exerciser to reduce stroke risk. Replacing sedentary time with light-intensity activity will be beneficial. Just go for a short walk, get up from your desk and move around the house at regular intervals. That can help to reduce stroke risk," Hooker said.  

"Our message is basically to sit less and move more," he added.  

The study is published online today in JAMA Network Open.

The study involved 7607 US individuals without a history of stroke, with oversampling from the southeastern "Stroke Belt," who were participating in the REGARDS cohort study.

The participants wore an accelerometer to measure physical activity and sedentary behavior for seven consecutive days. The mean age of the individuals was 63 years; 54% were female, 32% were Black.

Over a mean follow up of 7.4 years, 286 incident stroke cases occurred.

Results showed that increased levels of physical activity were associated reduced risk of stroke.

For moderate-to-vigorous activity, compared with participants in the lowest tertile, those in the highest tertile of total daily time in moderate to vigorous activity had a 43% lower risk of stroke.

In the current study, the amount of moderate-to-vigorous activity associated with a significant reduction in stroke risk was approximately 25 minutes per day (3 hours per week).

Hooker noted that moderate-to-vigorous activity included things such as brisk walking, jogging, bike riding, swimming, playing tennis or soccer. "Doing such activities for just 25 minutes per day reduced risk of stroke by 43%. This is very doable. Just commuting to work by bicycle would cover you here," he said.  

In terms of light-intensity activity, individuals who did 4-5 hours of light activities each day had a 26% reduced risk for first stroke compared with those doing less than 3 hours of such light activities.

Hooker explained that examples of light activity included household chores, such as vacuuming, washing dishes, or going for a gentle stroll. "These activities do not require heaving breathing, increased heart rate or breaking into a sweat. They are activities of daily living and relatively easy to engage in."

But he pointed out that the 4-5 hours of light activity every day linked to a reduction in stroke risk may be more difficult to achieve than the 25 minutes of moderate-to-vigorous activity, saying: "You have to have some intentionality here."

Long Bouts of Sedentary Time Are Harmful

The study also showed that sedentary time was associated with a higher risk for stroke.

The authors note that time spent in sedentary behavior is of interest because most adults spend most of their awake time being physically inactive.

They report that participants in the highest tertile of sedentary time (more than 13 hours/day) exhibited a 44% increase in risk of stroke compared with those in the lowest tertile (less than 11 hours/day), and the association remained significant when adjusted for several covariates, including moderate to vigorous activity.

"Even when controlling for the amount of other physical activity, sedentary behavior is still highly associated with risk of stroke. So even if you are active, long bouts of sedentary behavior are harmful," Hooker commented.

They also found that longer bouts of sedentary time (more than 17 minutes at a time) were associated with a 54% higher risk of stroke than shorter bouts (less than 8 minutes).

"This suggests that breaking up periods of sedentary behavior into shorter bouts would be beneficial," Hooker said.  

"If you are going to spend the evening on the couch watching television, try to stand up and walk around every few minutes. Same for if you are sitting at a computer all day — try having a standing workstation, or at least take regular breaks to walk around," he added.

This research was supported by grants from the National Institute of Neurological Disorders and Stroke (NINDS) and the National Institute on Aging (NIA). Additional funding was provided by an unrestricted grant from the Coca-Cola Company. The authors report no disclosures.

JAMA Netw Open. Published online June 3, 2022.  Full text   

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