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With Comments by Adriane Fugh-Berman, MD
Source: Hu FB, et al. Physical activity and risk of stroke in women. JAMA 2000;283;
Objective: To examine the association between physical activity and risk of stroke and stroke subtypes in women.
Design/Setting/Subjects: 4,065 nurses, aged 40-65, without cardiovascular disease or cancer in 1986, who completed detailed physical activity questionnaires in 1986, 1988, 1992. This is a subset of the Nurses’ Health Study, a prospective cohort study of 72,488 female nurses.
Outcome Measures: Stroke occurring between 1986 and June 1, 1994. Physical activity level was calculated as metabolic equivalent tasks (METs) and compared among quintiles.
Results: Relative risks in the lowest to highest METs were 1.00, 0.98, 0.82, 0.74, and 0.66 (P for trend = 0.005). Independent of vigorous physical activity, walking was associated with a significant reduction in stroke risk. After multivariate adjustments, walking was associated with reduced risk of total stroke and ischemic stroke; a brisk walking pace was associated with a lower risk of stroke compared with a normal or slow walking pace.
Comments: Even more reason to encourage patients to exercise, and to make time for exercise ourselves! We now can add stroke to the conditions for which exercise reduces the risk; other conditions include coronary heart disease, diabetes, and depression (see Alternative Therapies in Women’s Health, May 2000, pp. 33-35). The authors note that previous prospective cohort studies on physical activity and risk of stroke have shown mixed results, but that negative studies did not collect detailed or repeated information on exercise. One of the pieces of good news from the recent study is that women who had been sedentary in their younger lives but became more active in middle or later adulthood achieved a benefit compared to peers who remained sedentary. Exercise apparently does not have to be vigorous to be effective; if one expends the same amount of energy, walking is as effective in reducing stroke risk as other exercise. As a walker who dislikes almost all other forms of exercise, I would add that the rhythm involved in walking is very conducive to a meditative state.