Physical activity and stroke risk: A meta-analysis

Background and Purpose - Whether physical activity reduces stroke risk remains controversial. We used a meta-analysis to examine the overall association between physical activity or cardiorespiratory fitness and stroke incidence or mortality. Methods - We searched MEDLINE from 1966 to 2002 and identified 23 studies (18 cohort and 5 case-control) that met inclusion criteria. We estimated the overall relative risk (RR) of stroke incidence or mortality for highly and moderately active individuals versus individuals with low levels of activity using the general variance-based method. Results - The meta-analysis documented that there was a reduction in stroke risk for active or fit individuals compared with inactive or unfit persons in cohort, case-control, and both study types combined. For cohort studies, highly active individuals had a 25% lower risk of stroke incidence or mortality (RR=0.75; 95% CI, 0.69 to 0.82) compared with low-active individuals. For case-control studies, highly active individuals had a 64% lower risk of stroke incidence (RR=0.36; 95% CI, 0.25 to 0.52) than their low-active counterparts. When we combined both the cohort and case-control studies, highly active individuals had a 27% lower risk of stroke incidence or mortality (RR=0.73; 95% CI, 0.67 to 0.79) than did low-active individuals. We observed similar results in moderately active individuals compared with inactive persons (RRs were 0.83 for cohort, 0.52 for case-control, and 0.80 for both combined). Furthermore, moderately and highly active individuals had lower risk of both ischemic and hemorrhagic strokes than low-active individuals. Conclusions - We conclude that moderate and high levels of physical activity are associated with reduced risk of total, ischemic, and hemorrhagic strokes.