Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Rehabilitation Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
JAMA Netw Open. 2024 May 1;7(5):e2413453. doi: 10.1001/jamanetworkopen.2024.13453.
Associations of domain-specific physical activity with stroke incidence and poststroke outcomes have not been extensively studied using long-term, population-based data.
To investigate associations of leisure time, work time, transport, and household physical activity with stroke incidence and death or dependency in activities of daily living (ADL) 3 months after stroke.
DESIGN, SETTING, AND PARTICIPANTS: The prospective, population-based Interplay Between Genetic Susceptibility and External Factors (INTERGENE) cohort study was conducted among a random sample of individuals from an urban-rural area covering western Sweden; 3614 individuals aged 24 to 77 years were examined in 2001 to 2004, and 1394 individuals were reexamined in 2014 to 2016. The median (range) follow-up was 20.0 years (56 days to 21.9 years). Data were analyzed from September through October 2023.
Physical activity levels were self-reported for leisure time, work time, transportation, and household domains. The mean number of steps taken over a 6-day period was collected in a subgroup of participants using a sealed pedometer.
Follow-up for stroke incidence and mortality rates continued until December 31, 2022. The composite outcome of death or ADL dependency was assessed at 3 months after stroke.
Among 3614 individuals (mean [SD] age, 51.4 [13.1] years; 1910 female [52.9%]); 269 individuals (7.4%) developed stroke, of whom 120 individuals (44.6%) were dead or ADL dependent at 3 months. Intermediate (adjusted hazard ratio [aHR], 0.54; 95% CI, 0.38-0.77) and high (aHR, 0.47; 95% CI, 0.31-0.73) levels of leisure time physical activity were associated with a reduced incidence of stroke compared with low levels, as was an intermediate level of physical activity in transportation (aHR, 0.69; 95% CI, 0.52-0.93). High levels of leisure time physical activity were also associated with a reduced risk of poststroke death or ADL dependency (adjusted odds ratio, 0.34; 95% CI, 0.16-0.71) compared with low levels. Work time and household physical activity were not associated with stroke incidence or stroke outcomes. In exploratory subgroup analyses, there were interactions between physical activity and smoking (current smoking or smoking in the past year associated with stroke risk only in participants with low or intermediate physical activity: aHR, 2.33; 95% CI, 1.72-3.15) and family history of stroke (first-degree relative with a history of stroke associated with stroke risk only in participants with low or intermediate physical activity: aHR, 1.73; 95% CI, 1.27-2.38).
In this study, leisure time and transport-related physical activities were associated with a reduced risk of stroke. A high level of leisure time physical activity was also associated with a lower risk of death or ADL dependency 3 months after stroke.
使用长期、基于人群的数据，专门研究特定领域的体力活动与中风发病率和中风后结局之间的关系尚未得到广泛研究。
调查休闲时间、工作时间、交通和家庭体力活动与中风发病以及中风后 3 个月内死亡或日常生活活动（ADL）依赖的关系。
设计、地点和参与者：前瞻性、基于人群的遗传易感性与外部因素相互作用（INTERGENE）队列研究在瑞典西部城乡地区的一个随机样本中进行；2001 年至 2004 年对 3614 名年龄在 24 至 77 岁的个体进行了检查，2014 年至 2016 年对 1394 名个体进行了复查。中位（范围）随访时间为 20.0 年（56 天至 21.9 年）。数据于 2023 年 9 月至 10 月进行分析。
休闲时间、工作时间、交通和家庭领域的体力活动水平由自我报告。在参与者的一个亚组中，使用密封计步器收集了 6 天内的平均步数。
中风发病率和死亡率的随访持续到 2022 年 12 月 31 日。中风后 3 个月评估死亡或 ADL 依赖的复合结局。
在 3614 名参与者中（平均[SD]年龄，51.4[13.1]岁；1910 名女性[52.9%]）；269 人（7.4%）发生中风，其中 120 人（44.6%）在中风后 3 个月时死亡或 ADL 依赖。与低水平相比，中等（调整后的危险比[aHR]，0.54；95%CI，0.38-0.77）和高水平（aHR，0.47；95%CI，0.31-0.73）的休闲时间体力活动与中风发病率降低相关，而交通中的中等水平体力活动（aHR，0.69；95%CI，0.52-0.93）也与中风发病率降低相关。与低水平相比，高水平的休闲时间体力活动也与中风后死亡或 ADL 依赖的风险降低相关（调整后的优势比，0.34；95%CI，0.16-0.71）。工作时间和家庭体力活动与中风发病率或中风结局无关。在探索性亚组分析中，体力活动与吸烟之间存在交互作用（目前吸烟或过去一年吸烟仅与低或中等体力活动的参与者的中风风险相关：aHR，2.33；95%CI，1.72-3.15）和中风家族史（一级亲属有中风史仅与低或中等体力活动的参与者的中风风险相关：aHR，1.73；95%CI，1.27-2.38）。
在这项研究中，休闲时间和与交通相关的体力活动与中风风险降低有关。高水平的休闲时间体力活动也与中风后 3 个月内死亡或 ADL 依赖的风险降低有关。
