Monday, June 5, 2023
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Health Sciences Clinical Professor of Family Medicine
University of California, Irvine School of Medicine
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This activity is intended for primary care physicians, neurologists, cardiologists, nurses, pharmacists, physician assistants, and other members of the healthcare team who treat and manage adults at risk for stroke.
The goal of this activity is for learners to be better able to discuss exercise plans with patients in an effort to reduce stroke risk.
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Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
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Health Sciences Clinical Professor of Family Medicine
University of California, Irvine School of Medicine
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Members of the healthcare team are likely aware of the benefits of exercise, which can help prevent a wide range of serious illness. However, which cardiometabolic factors are influenced by exercise? A previous meta-analysis of randomized controlled trials by Lin and colleagues answered this question. Their results were published in the July 17, 2015, issue of the Journal of the American Heart Association.[1]
The researchers included 160 studies involving a total of 7487 participants. Exercise was associated with higher levels of high-density lipoprotein cholesterol (HDL-C) and lower levels of triglycerides. But it did not affect low-density lipoprotein cholesterol (LDL-C) levels. Exercise also improved a measure of insulin resistance and circulating levels of fasting insulin. Finally, exercise was associated with a reduction in levels of leptin, fibrinogen, and angiotensin II.
Exercise has beneficial effects on cardiovascular outcomes beyond risk factor modification. Still, the ideal quantity and intensity of exercise is not clear. The current study evaluates these issues with regard to the risk for stroke.
Spending more time doing light-intensity activities and less time being sedentary was associated with a reduced risk for first stroke in a population-based study of middle aged and older adults.
The study also found that relatively short periods of moderate to vigorous exercise were associated with reduced stroke risk.
"Our results suggest there are a number of ways to reduce stroke risk simply by moving about," lead author Steven P. Hooker, PhD, from San Diego State University in California, commented "This could be with short periods of moderate to vigorous activity each day, longer periods of light activity, or just [being] sedentary for shorter periods of time. All these things can make a difference."
Dr Hooker explained that although it previously has been found that moderate to vigorous exercise reduces stroke risk, this study gives more information on light-intensity activities and sedentary behavior and the risk for stroke.
The study was published online June 3 in JAMA Network Open.[2]
The study involved 7607 US individuals without a history of stroke (with oversampling from the southeastern "Stroke Belt") who were participating in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study.[3]
The participants wore an accelerometer to measure physical activity and sedentary behavior for 7 consecutive days. The mean age of the individuals was 63.4 years, 54.5% were women, and 31.6% were Black.
During a mean follow-up of 7.4 years, 286 incident stroke cases occurred.
Results showed that increased levels of physical activity were associated with reduced risk for stroke.
For moderate to vigorous activity, compared with participants in the lowest tertile, those in the highest tertile of total daily time in moderate to vigorous activity had a 43% lower risk for stroke.
In the current study, the amount of moderate to vigorous activity associated with a significant reduction in stroke risk was approximately 25 minutes per day (3 hours per week).
Dr Hooker noted that moderate to vigorous activity included things such as brisk walking, jogging, bike riding, swimming, and playing tennis or soccer.
In terms of light-intensity activity, individuals who did 4 to 5 hours of light activities each day had a 26% reduced risk for first stroke compared with those doing less than 3 hours of such light activities.
Dr Hooker explained that examples of light activity included household chores, such as vacuuming, washing dishes, or going for a gentle stroll. "These activities do not require heaving breathing, increased heart rate or breaking into a sweat. They are activities of daily living and relatively easy to engage in."
But he pointed out that the 4 to 5 hours of light activity every day linked to a reduction in stroke risk may be more difficult to achieve than the 25 minutes of moderate-to-vigorous activity, saying: "You have to have some intentionality here."
Long Bouts of Sedentary Time Are HarmfulThe study also showed that sedentary time was associated with a higher risk for stroke.
The authors note that time spent in sedentary behavior is of interest because most adults spend most of their awake time being physically inactive.
They report that participants in the highest tertile of sedentary time (more than 13 hours/day) exhibited a 44% increase in risk for stroke compared with those in the lowest tertile (less than 11 hours/day), and the association remained significant when adjusted for several covariates, including moderate to vigorous activity.
"Even when controlling for the amount of other physical activity, sedentary behavior is still highly associated with risk of stroke. So even if you are active, long bouts of sedentary behavior are harmful," Dr Hooker commented.
The researchers also found that longer bouts of sedentary time (more than 17 minutes at a time) were associated with a 54% higher risk for stroke than shorter bouts (less than 8 minutes).
"This suggests that breaking up periods of sedentary behavior into shorter bouts would be beneficial," Dr Hooker said.
This research was supported by grants from the National Institute of Neurological Disorders and Stroke and the National Institute on Aging. The authors have disclosed no relevant financial relationships.
