Sedentary time wouldn't exist if you had 100% RECOVERY PROTOCOLS! If you can't figure that out; GET THE HELL OUT OF STROKE!
Sitting Time, Leisure-Time Physical Activity, and
Risk of Mortality Among US Stroke Survivors: A Prospective Cohort Study
From the NHANES 2007 to 2018
Abstract
BACKGROUND:
Stroke
survivors are highly sedentary and engage in minimal physical activity.
This study aimed to investigate the independent and joint effects of
daily sitting time and leisure-time physical activity on survival among
stroke survivors.
METHODS:
The
nationally representative cohort included 1446 stroke survivors
(weighted population, 6 968 723) from the National Health and Nutrition
Examination Survey from 2007 to 2018. Mortality data were obtained
through December 31, 2019. Leisure-time physical activity was
categorized as inactive (0 min/wk), insufficiently active (1 to <150
min/wk), and sufficiently active (≥150 min/wk). Daily sitting time was
categorized as <6, 6 to <8, and ≥8 h/d. Survival analyses of
all-cause and specific mortality were performed by weighted Cox
proportional hazards regression models.
RESULTS:
This
cohort study comprised 55.0% females, 68.7% non-Hispanic White, and had
a weighted mean (SE) age of 64.6 (0.5) years. Overall, 70.3% were
inactive, 42.3% sat at least 8 h/d, and 34.9% were both inactive and sat
at least 8 h/d. During a median of 5.2 years of follow-up, 494 deaths
occurred, including 171 associated with cardiovascular disease (CVD) and
323 associated with non-CVD. Active stroke survivors had a lower risk
of all-cause (hazard ratio [HR], 0.26 [95% CI, 0.17–0.40]), CVD (HR,
0.26 [95% CI, 0.13–0.53]), and non-CVD (HR, 0.26 [95% CI, 0.15–0.46])
mortality compared with inactive stroke survivors. Sitting at least 8
h/d was associated with higher risks of all-cause (HR, 1.50 [95% CI,
1.13–1.99]) and non-CVD (HR, 1.61 [95% CI, 1.18–2.20]) mortality
compared with sitting <6 h/d. In the joint analyses, stroke survivors
who were inactive or insufficiently active and sat for at least 8 h/d
had the highest risks of all-cause (HR, 3.73 [95% CI, 2.07–6.73]), CVD
(HR, 3.32 [95% CI, 1.33–8.29]), and non-CVD (HR, 3.91 [95% CI,
1.70–8.95]) mortality when compared with those who were active and sat
for <6 h/d. When stratifying by leisure-time physical activity, daily
sitting time was not associated with mortality among active stroke
survivors. These observations were confirmed in sensitivity analyses.
CONCLUSIONS:
This
study highlights the potential benefits of enhancing leisure-time
physical activity and reducing sitting time to lower mortality rates
among stroke survivors.
Graphical Abstract
Stroke
remains a leading cause of mortality and disability globally, resulting
in 7.3 million stroke-related deaths and 160.5 million
disability-adjusted life-years.1,2
By 2030, the prevalence of stroke among US adults will increase by
20.5% compared with 2012, with an additional 3.4 million adults
suffering from stroke.2 Stroke severely impairs daily functioning, and ≈75% of stroke survivors experience permanent disabilities.2–4
Sedentary
behavior refers to any waking behavior of low energy expenditure (≤1.5
metabolic equivalents of task) while in a sitting, lying, or reclining
posture.5,6
Among stroke survivors, the levels of physical activity are critically
low. It is estimated that 40% of stroke survivors participate in little
or no leisure-time physical activity and spend prolonged time sitting.7,8
The accelerometer-measured time of moderate-to-vigorous physical
activity among stroke survivors is reported to range from 5 to 10 min/d.9,10 In addition, their daily step counts are less than half of those in the age-matched group.9,10
Sedentary behavior has become a crucial concern in the fields of
clinical practice and policy-making, as evidence supports its
detrimental effects on morbidity and mortality.5,6
The American Heart Association/American Stroke Association advocates
for less sitting time and more regular physical activity after stroke,
but quantitative guidelines are not available due to scarce evidence.11
Physical activity is one of the modifiable health behaviors recommended for the prevention and rehabilitation of stroke.12–15
Increasing physical activity can activate neuroprotective mechanisms,
mitigate other cardiovascular risk factors, and enhance overall health
in stroke survivors.14–16
Despite previous research highlighting the beneficial effect of overall
physical activity in stroke survivors, most prior studies have not
distinguished domain-specific physical activity, especially that
performed during leisure time. There is much evidence supporting the
role of leisure-time physical activity in the primary prevention of
stroke,17,18
yet evidence regarding the effects of leisure-time physical activity
after stroke is limited. Epidemiological studies have revealed that
leisure-time physical activity can eliminate the detrimental effects of
prolonged sitting not only in the general population but also in
populations with cancer or diabetes.19–21
A large prospective cohort study involving the general population in
Taiwan concluded that all-cause mortality associated with prolonged
sitting was alleviated by an additional 15 to 30 minutes of daily
leisure-time physical activity.19
Among 1535 US cancer survivors included in the National Health and
Nutrition Examination Survey (NHANES), those engaging in at least 150
minutes of leisure-time physical activity per week showed a reduced risk
of all-cause mortality associated with prolonged sitting.20
In the NHANES cohort of US adults with diabetes, the association
between prolonged sitting and increased all-cause and heart disease
mortality was only observed among those who were insufficiently active.
In contrast, the association was not observed among those who were
sufficiently active.21
Nevertheless, it is less clear whether these findings could apply to
stroke survivors, as epidemiological evidence remains scarce on the
joint associations of leisure-time physical activity and daily sitting
time with survival after stroke. To bridge these knowledge gaps, the
main aim of this study was to assess the independent and joint
associations of daily sitting time and leisure-time physical activity
with all-cause and cause-specific mortality among a US nationally
representative sample of stroke survivors.
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