Departments of Clinical Neurosciences (R.A.J., E.E.S.), Cumming School of Medicine, University of Calgary, Canada.
Community Health Sciences (S.B.P., J.V.A.W., R.A.J., E.E.S.), Cumming School of Medicine, University of Calgary, Canada.
Stroke. 2021 Nov;52(11):3562-3568. doi: 10.1161/STROKEAHA.121.034985. Epub 2021 Aug 19.
The association between physical activity (PA) and lower risk of stroke is well established, but the relationship between leisure sedentary time and stroke is less well studied.
We used 9 years of the Canadian Community Health Survey between 2000 and 2012 to create a cohort of healthy individuals without prior stroke, heart disease, or cancer. We linked to hospital records to determine subsequent hospitalization or emergency department visit for stroke until December 31, 2017. We quantified the association between self-reported leisure sedentary time (categorized as <4, 4 to <6, 6 to <8, and 8+ hours/day) and risk of stroke using Cox regression models and competing risk regression, assessing for modification by PA, age, and sex and adjusting for demographic, vascular, and social factors.
There were 143 180 people in our cohort and 2965 stroke events in follow-up. Median time from survey response to stroke was 5.6 years. There was a 3-way interaction between leisure sedentary time, PA, and age. The risk of stroke with 8+ hours of sedentary time was significantly elevated only among individuals <60 years of age who were in the lowest PA quartile (fully adjusted hazard ratio, 4.50 [95% CI, 1.64–12.3]). The association was significant across multiple sensitivity analyses, including adjustment for mood disorders and when accounting for the competing risk of death.
Excess leisure sedentary time of 8+ hours/day is associated with increased risk of long-term stroke among individuals <60 years of age with low PA. These findings support efforts to enhance PA and reduce sedentary time in younger individuals.
身体活动（PA）与较低的中风风险之间存在关联已得到充分证实，但休闲久坐时间与中风之间的关系研究较少。
我们使用了 2000 年至 2012 年的加拿大社区健康调查 9 年的数据，创建了一个没有既往中风、心脏病或癌症的健康个体队列。我们将数据与医院记录相关联，以确定在 2017 年 12 月 31 日之前因中风住院或急诊就诊的情况。我们使用 Cox 回归模型和竞争风险回归来量化自我报告的休闲久坐时间（分为<4、4 至<6、6 至<8 和 8+小时/天）与中风风险之间的关联，评估 PA、年龄和性别对其的修饰作用，并调整人口统计学、血管和社会因素。
我们的队列中有 143180 人，随访中有 2965 例中风事件。从调查响应到中风的中位时间为 5.6 年。休闲久坐时间、PA 和年龄之间存在三向交互作用。仅在年龄<60 岁且处于最低 PA 四分位数的个体中，8+小时久坐时间与中风风险升高显著相关（完全调整后的危险比为 4.50[95%CI，1.64-12.3]）。该关联在多个敏感性分析中均具有统计学意义，包括调整心境障碍和考虑死亡的竞争风险时。
对于 PA 最低四分位且年龄<60 岁的个体，每天超过 8 小时的休闲久坐时间与长期中风风险增加相关。这些发现支持了在年轻人群中增强 PA 和减少久坐时间的努力。
