Association Between Change in Leisure-Time Physical Activity During the Postretirement Period and Incident Stroke

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Association Between Change in Leisure-Time Physical Activity During the Postretirement Period and Incident Stroke

Xingxing Li, Shuangyan Liu, Xuanwen Mu, Hui Gao, Yunhua Zi, Handong Yang, Xiaomin Zhang, Meian He, Kuai Yu

First published April 26, 2022, DOI: https://doi.org/10.1212/WNL.0000000000200555

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Abstract

Background and Objectives To investigate the association of change in leisure-time physical activity (LTPA) occurring during the postretirement period with incident stroke.

Methods The current study enrolled 12,644 retired workers from the Dongfeng-Tongji cohort from April to October 2013. The change in LTPA was categorized as follows, according to whether the LTPA time met the WHO recommended minimum (at least 150 minutes per week): (1) stayed inactive at both surveys; (2) stayed inactive at the 2008 survey but became active at the 2013 survey; (3) stayed active at the 2008 survey but became inactive at the 2013 survey; (4) stayed active at both surveys. We used multivariable-adjusted Cox proportional hazards regression models to examine the association between change in LTPA and the risk of incident stroke.

Results During 70,437 person-years of follow-up, we documented 549 incident stroke cases, including 434 incident ischemic stroke cases and 115 incident hemorrhagic stroke (HS) cases. Compared with participants who stayed active at both the 2008 and 2013 surveys, those who were active at the 2008 survey but became inactive at the 2013 survey had significantly higher risks of incident total stroke (hazard ratio [HR] 1.30, 95% CI 1.03, 1.65) and HS (HR 2.34, 95% CI 1.51, 3.63). When stratified by body mass index (BMI) categories, a significant elevated risk of total stroke was seen among overweight participants who stayed active at the 2008 survey but became inactive at the 2013 survey (HR 1.65, 95% CI 1.20, 2.27). The risk of incident stroke decreased with increasing LTPA levels between the 2 surveys (HR of per 150 min/wk increase of LTPA: HR 0.97, 95% CI 0.94, 1.00). In addition, we found that compared with participants who maintained their BMI and stayed active at both the 2008 and 2013 surveys, those who were inactive at both points or who became inactive had higher risks of stroke (HR 2.13, 95% CI 1.09, 4.15; HR 1.50, 95% CI 1.07, 2.08, respectively).

Discussion Among Chinese older adults, increasing LTPA levels during the postretirement period was associated with a lower risk of incident stroke. Retired individuals should be encouraged to participate in LTPA more frequently to lessen future risk of incident stroke.

Glossary

AHA=

American Heart Association;

BMI=

body mass index;

CHD=

coronary heart disease;

DFTG=

Dongfeng-Tongji;

LTPA=

leisure-time physical activity;

HR=

hazard ratio;

HS=

hemorrhagic stroke;

ICD-10=

International Classification of Diseases, 10th Revision;

IS=

ischemic stroke;

PA=

physical activity;

RCS=

restricted cubic spline

Stroke is one of the leading causes of mortality and morbidity worldwide, accounting for 6.37 million premature deaths in 2019.^1,2 Persuasive evidence has showed that greater participation in leisure-time physical activity (LTPA) could effectively reduce stroke risk,^3,-,6 but most previous studies conducted only a single assessment of LTPA, usually at baseline.^7,-,10 As individuals might change their LTPA patterns over time,^11,12 especially after retirement, which has been considered as a critical turning point in life,^13,14 repeat measurements of LTPA would provide more accurate assessment in examination of its association with subsequent risk of stroke.

To date, 3 prospective studies have investigated the association between change in LTPA and incident stroke, but they reported inconclusive findings. One study found that among 61,256 retired American women, even those not meeting the American Heart Association (AHA) recommendations of 150 minutes moderate or 75 minutes vigorous physical activity (PA) per week at baseline, those who transitioned to meet such recommendations after 10 years experienced a 21% lower risk of stroke compared with those being persistently inactive.¹⁵ Another study of 72,488 US women also showed that compared with women reporting less than 1 h/wk of PA in both 1980 and 1986 visits, those maintaining 4 h/wk of PA had a 54% lower risk of ischemic stroke (IS).¹⁶ However, a study of 39,315 US women showed that compared with women reporting less than 2 h/wk of walking at baseline and the follow-up visit after 3 years, those who maintained over 2 h/wk of walking did not gain significant stroke prevention benefit.⁷ Besides the inconsistent findings, these studies were all limited to women from developed countries; data on men or populations from developing countries are lacking. Furthermore, to our knowledge, the joint association of the change in LTPA and body weight indicators such as body mass index (BMI) with incident stroke has not been well-explored.

To narrow the knowledge gap, we conducted a prospective study of 12,644 retired men and women in China to examine the association between change in LTPA occurring during the postretirement period and subsequent risk of stroke.

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