Vemuri Ajith Kumar, Hejazian Seyyed Sina, Sadr Alireza Vafaei, Zhou Shouhao, Decker Keith, Hakun Jonathan, Sciamanna Christopher, Abedi Vida, Zand Ramin
Department of Neurology (A.K.V., S.S.H., J.H., R.Z.), College of Medicine, The Pennsylvania State University, Hershey.
Department of Public Health Sciences (A.V.S., S.Z., C.S., V.A.), College of Medicine, The Pennsylvania State University, Hershey.
Stroke. 2025 Jan;56(1):113-121. doi: 10.1161/STROKEAHA.124.048429. Epub 2024 Dec 5.
Physical activity is an effective modifiable behavior for preventing recurrent strokes. This study aims to determine the adherence to physical activity recommendations among stroke survivors in the United States. We further compared our findings with the adherence observed among myocardial infarction (MI) survivors and healthy adults, each assessed against distinct physical activity guidelines specific to their respective populations.
We utilized data from the 2011 to 2019 Behavioral Risk Factor Surveillance System, a nationally representative survey. To establish benchmarks for stroke survivors, we referenced 3 different physical activity recommendations outlined in 2011, 2014, and 2021 American Heart Association stroke prevention guidelines. Similarly, for MI survivors and healthy adults, we used the 2011 guidelines for secondary prevention of coronary vascular diseases and the 2020 World Health Organization physical activity guidelines, respectively. Adherence to recommendations was determined by the respondents' self-reported intensity, duration, and frequency of physical activity. Multivariate logistic regression compared adherence in stroke survivors, MI survivors, and healthy adults.
Among 48 222 stroke survivors in the United States, the overall adherence rates to 2011, 2014, and 2021 physical activity guidelines were 75.4%, 40.2%, and 69.2%. For independently mobile stroke survivors, the adherence rates increased to 78.1%, 42.1%, and 69.9%. Among MI survivors and healthy adults, the adherence rates were 42.7% and 72%. When 2021 recommendations were used as a benchmark, older (aged ≥65 years) stroke survivors were more likely to adhere to recommendations than younger survivors (71.9% versus 62.3%; <0.0001). After adjusting for sociodemographic factors and comorbidities, non-Hispanic Black survivors were less likely to adhere to recommendations (adjusted odds ratio, 0.81 [95% CI, 0.7-0.94]), whereas older and higher educated stroke survivors were more likely to adhere to recommendations. Geographically, stroke belt and nonrural residents were less likely to adhere to recommendations ([63.5% versus 67.9%; <0.0001]; [53.8% versus 58.7%; <0.0001]). Stroke and MI survivors were less likely to adhere to the latest recommendations than healthy adults (adjusted odds ratio, 0.74 [95% CI, 0.69-0.8]; (adjusted odds ratio, 0.24 [95% CI, 0.22-0.26]).
A substantial number of stroke survivors do not meet physical activity recommendations. Tailored interventions should be designed for at-risk populations, for example, non-Hispanic Black survivors and lower educated stroke survivors.
体育活动是预防复发性中风的一种有效的可改变行为。本研究旨在确定美国中风幸存者对体育活动建议的依从性。我们进一步将我们的研究结果与心肌梗死（MI）幸存者和健康成年人的依从性进行比较，他们各自根据针对其特定人群的不同体育活动指南进行评估。
我们利用了2011年至2019年行为危险因素监测系统的数据，这是一项具有全国代表性的调查。为了为中风幸存者建立基准，我们参考了2011年、2014年和2021年美国心脏协会中风预防指南中概述的3种不同的体育活动建议。同样，对于MI幸存者和健康成年人，我们分别使用了2011年冠状动脉疾病二级预防指南和2020年世界卫生组织体育活动指南。对建议的依从性由受访者自我报告的体育活动强度、持续时间和频率来确定。多变量逻辑回归比较了中风幸存者、MI幸存者和健康成年人的依从性。
在美国的48222名中风幸存者中，对2011年、2014年和2021年体育活动指南的总体依从率分别为75.4%、40.2%和69.2%。对于能够独立活动的中风幸存者，依从率分别提高到78.1%、42.1%和69.9%。在MI幸存者和健康成年人中，依从率分别为42.7%和72%。以2021年的建议为基准时，年龄较大（≥65岁）的中风幸存者比年轻幸存者更有可能遵守建议（71.9%对62.3%；<0.0001）。在调整了社会人口因素和合并症后，非西班牙裔黑人幸存者遵守建议的可能性较小（调整后的优势比，0.81[95%CI，0.7 - 0.94]），而年龄较大和受教育程度较高的中风幸存者更有可能遵守建议。在地理上，中风高发地区和非农村居民遵守建议的可能性较小（[63.5%对67.9%；<0.0001]；[53.8%对58.7%；<0.0001]）。中风和MI幸存者比健康成年人更不可能遵守最新建议（调整后的优势比，0.74[95%CI，0.69 - 0.8]；（调整后的优势比，0.24[95%CI，0.22 - 0.26]）。
相当数量的中风幸存者未达到体育活动建议。应针对高危人群设计量身定制的干预措施，例如非西班牙裔黑人幸存者和受教育程度较低的中风幸存者。
