IJE Advance Access originally published online on May 27, 2004
International Journal of Epidemiology 2004 33(4):787-798; doi:10.1093/ije/dyh168
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IJE vol.33 no.4 © International Epidemiological Association 2004; all rights reserved.
Article |
Physical activity and stroke. A meta-analysis of observational data
1 National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, Bilthoven, The Netherlands
2 Wageningen University and Research Centre, Division of Human Nutrition, Wageningen, The Netherlands
3 Maastricht University, Nutrition and Toxicology Research Institute (NUTRIM), Maastricht, The Netherlands
Correspondence: Wanda Wendel-Vos, National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, PO Box 1, 3720 BA Bilthoven, The Netherlands. E-mail: Wanda.Vos{at}rivm.nl
Background Based on studies published so far, the protective effect of physical activity on stroke remains controversial. Specifically, there is a lack of insight into the sources of heterogeneity between studies.
Methods Meta-analysis of observational studies was used to quantify the relationship between physical activity and stroke and to explore sources of heterogeneity. In total, 31 relevant publications were included. Risk estimates and study characteristics were extracted from original studies and converted to a standard format for use in a central database.
Results Moderately intense physical activity compared with inactivity, showed a protective effect on total stroke for both occupational (RR = 0.64, 95% CI: 0.48–0.87) and leisure time physical activity (RR = 0.85, 95% CI: 0.78–0.93). High level occupational physical activity protected against ischaemic stroke compared with both moderate (RR = 0.77, 95% CI: 0.60–0.98) and inactive occupational levels (RR = 0.57, 95% CI: 0.43–0.77). High level compared with low level leisure time physical activity protected against total stroke (RR = 0.78, 95% CI: 0.71–0.85), haemorrhagic stroke (RR = 0.74, 95% CI: 0.57–0.96) as well as ischaemic stroke (RR = 0.79, 95% CI: 0.69–0.91). Studies conducted in Europe showed a stronger protective effect (RR = 0.47, 95% CI: 0.33–0.66) than studies conducted in the US (RR = 0.82, 95% CI: 0.75–0.90).
Conclusions Lack of physical activity is a modifiable risk factor for both total stroke and stroke subtypes. Moderately intense physical activity is sufficient to achieve risk reduction.
Keywords Physical activity, stroke, haemorrhagic, ischaemic, meta-analysis, heterogeneity
Accepted 9 February 2004
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