Willey Joshua Z, Voutsinas Jenna, Sherzai Ayesha, Ma Huiyan, Bernstein Leslie, Elkind Mitchell S V, Cheung Ying K, Wang Sophia S
From the Departments of Neurology (J.Z.W., M.S.V.E.), Epidemiology (M.S.V.E.), and Biostatistics (Y.K.C.), Columbia University, New York; Department of Population Sciences, City of Hope, Duarte, CA (J.V., H.M., L.B., S.S.W.); and Department of Neurology, Cedars Sinai Medical Center, Los Angeles, CA (A.S.).
Stroke. 2017 Sep;48(9):2346-2352. doi: 10.1161/STROKEAHA.117.017465. Epub 2017 Aug 9.
Whether changes in leisure-time physical activity (LTPA) over time are associated with lower risk of stroke is not well established. We examined the association between changes in self-reported LTPA 10 years apart, with risk of incident stroke in the CTS (California Teachers Study). We hypothesized that the risk of stroke would be lowest among those who remained active.
Sixty-one thousand two hundred and fifty-six CTS participants reported LTPA at 2 intensity levels (moderate and strenuous activity) at 2 time points (baseline 1995-96; 10-year follow-up 2005-2006). LTPA at each intensity level was categorized based on American Heart Association (AHA) recommendations (moderate, >150 minutes/week; strenuous, >75 minutes/week). Changes in LTPA were summarized as follows: (1) not meeting recommendations at both time points; (2) meeting recommendations only at follow-up; (3) meeting recommendations only at baseline; and (4) meeting recommendations at both time points. Incident strokes were identified through California state hospitalization records. Using multivariable Cox models, we examined the associations between changes in LTPA with incident stroke.
Nine hundred and eighty-seven women were diagnosed with stroke who completed both questionnaires. Meeting AHA recommendations at both the time points was associated with a lower risk of all stroke (adjusted hazard ratio, 0.84; 95% confidence interval, 0.72-0.98). The protective effects for stroke were driven by meeting AHA recommendations for moderate activity and largely observed for ischemic strokes (adjusted hazard ratio, 0.70; 95% confidence interval, 0.55-0.88).
Meeting AHA recommendations for moderate activity had a protective effect for reducing ischemic stroke risk. Participants who met AHA recommendations at baseline but not at follow-up, however, were not afforded reduced stroke risk.
休闲时间体力活动（LTPA）随时间的变化是否与较低的中风风险相关，目前尚无定论。我们在加利福尼亚教师研究（CTS）中，研究了相隔10年的自我报告的LTPA变化与中风发病风险之间的关联。我们假设中风风险在保持活跃的人群中最低。
61256名CTS参与者在两个时间点（1995 - 1996年基线；2005 - 2006年10年随访）报告了两种强度水平（中等强度和剧烈活动）的LTPA。根据美国心脏协会（AHA）的建议（中等强度，每周>150分钟；剧烈活动，每周>75分钟）对每个强度水平的LTPA进行分类。LTPA的变化总结如下：（1）两个时间点均未达到建议；（2）仅在随访时达到建议；（3）仅在基线时达到建议；（4）两个时间点均达到建议。通过加利福尼亚州住院记录确定中风发病情况。使用多变量Cox模型，我们研究了LTPA变化与中风发病之间的关联。
987名完成两份问卷的女性被诊断为中风。两个时间点均符合AHA建议与所有中风风险较低相关（调整后的风险比，0.84；95%置信区间，0.72 - 0.98）。中风的保护作用是由符合AHA中等强度活动建议驱动的，并且主要在缺血性中风中观察到（调整后的风险比，0.70；95%置信区间，0.55 - 0.88）。
符合AHA中等强度活动建议对降低缺血性中风风险具有保护作用。然而，在基线时符合AHA建议但在随访时不符合的参与者，中风风险并未降低。
