Moderate-to-Vigorous Physical Activity Beneficial in Stroke Reduction

Stroke risk reduction is increased with a moderate amount of moderate-to-vigorous physical activity (MVPA), which is unaffected by hypertension, according to study findings published in Stroke.

Investigators characterized the dose-response relationship between stroke and MVPA in hypertensive and normotensive individuals. Incident stroke (fatal and nonfatal) was the primary outcome. Assessing whether the use of antihypertensive medication alters the dose-response association was the secondary outcome.

The investigators conducted a cohort study using data from the Lifeline Cohort Study, a prospective, population-based study in the Netherlands examining health-related behaviors in 167,729 individuals in the Northern Netherlands. In the current study, participants (N=139,930) were aged at least 18 years with a physical examination and completed baseline questionnaires between 2006 and 2013. A follow-up questionnaire was administered every 1.5 years to evaluate the occurrence of stroke. Those with cardiovascular disease or limited ability to be physically active were excluded.

Participants (mean age, 44 [SD, 13] years; 41% men) were stratified at baseline as hypertensive (44%) or normotensive (56%) then categorized into moderate-to-vigorous quartiles, lowest (Q1) to highest (Q4) self-reported physical activity. Hypertensive individuals were further stratified into medicated (21%) or non-medicated (79%). Median follow-up was 6.75 years. Individuals with hypertension were more often older men with lower education and higher body mass index with more comorbidities. Within the hypertension group, individuals using antihypertensive medication vs those not were more often older women with lower education and more comorbidities.

Across the study period, 640 strokes occurred (467 in hypertensive individuals; 173 in normotensive individuals).

Overall, compared with Q1, adjusted hazard ratios were 0.87 for Q2 (95% CI, 0.69-1.10; P =.23), 0.75 for Q3 (95% CI, 0.59-0.95; P =.02), and 0.94 for Q4 (95% CI, 0.74-1.20; P =.64).

Adjusted hazard ratios in hypertensive individuals were 0.89 for Q2 (95% CI, 0.68-1.17; P =.41), 0.74 for Q3 (95% CI, 0.56-0.98; P =.03), and 0.92 for Q4 (95% CI, 0.69-1.23; P =.56). Adjusted hazard ratios in normotensive individuals were 0.79 for Q2 (95% CI, 0.50-1.25; P =.32), 0.75 for Q3 (95% CI, 0.48-1.18; P =.22), and 0.97 for Q4 (95% CI, 0.62-1.51; P =.90).

There was no significant interaction between hypertension status for the relationship between physical activity and risk for stroke.

Among medicated hypertensive individuals compared with nonmedicated individuals, analysis showed a smaller benefit for MVPA, although there was no significant interaction effect.

Study limitations include the MVPA was self-reported, no data was collected on sedentary behaviors, and there is an overall low event rate of stroke in the normotensive population.

“Regular moderate-to-vigorous physical activity is beneficial for stroke risk reduction (Q3 compared with Q1), which is not affected by hypertension,” the investigators concluded. “Antihypertensive medication may be associated with a smaller benefit of moderate-to-vigorous physical activity on the risk of stroke…”

This article originally appeared on The Cardiology Advisor