Brain Behav. 2026 Jul;16(7):e71601. doi: 10.1002/brb3.71601.
ABSTRACT
PURPOSE: The relationship between physical activity intensity and the risk of first-ever stroke in middle-aged and older adults remains incompletely understood. This study aimed to investigate the association between different intensities and total volumes of physical activity and the incidence of first stroke, and to explore potential cardiovascular mediators underlying this relationship.
METHOD: This prospective cohort study utilized data from the China Health and Retirement Longitudinal Study (CHARLS), including 4380 stroke-free adults aged ≥ 45 years at baseline. Physical activity was assessed using the International Physical Activity Questionnaire Short Form and classified into sedentary behavior, active physical activity, and highly active physical activity. Total physical activity was quantified in metabolic equivalent task minutes per week (MET-min/week). Incident stroke was identified through self-reported physician diagnosis during a 7-year follow-up period. Cox proportional hazards models, multivariable logistic regression, restricted cubic spline analyses, subgroup analyses, and mediation analyses were conducted after adjusting for demographic, lifestyle, and clinical confounders.
FINDING: During follow-up, 300 participants (6.8%) experienced a first-ever stroke. Highly active physical activity was associated with a significantly reduced risk of first stroke compared with sedentary behavior (adjusted hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.30-0.92; adjusted odds ratio [OR], 0.45; 95% CI, 0.36-0.55). A nonlinear, flipped J-shaped dose-response relationship was observed between total physical activity and stroke risk, with the lowest risk occurring at approximately 13,045 MET-min/week. Subgroup analyses showed stronger protective effects of highly active physical activity in men, individuals without heart disease, overweight individuals, and those with hypertension. Mediation analyses indicated that the protective association was largely mediated by improvements in cardiovascular indicators, including blood pressure, high-density lipoprotein cholesterol, body mass index, and the triglyceride-glucose index.
CONCLUSION: The inverse association between highly active physical activity and first stroke was partially accounted for by cardiovascular biomarkers.
PMID:42444512 | DOI:10.1002/brb3.71601