From: A systematic review of the evidence for Canada's Physical Activity Guidelines for Adults
Publication Country Study Design Quality Score | Objective | Population | Methods | Outcome | Comments and Conclusions |
---|---|---|---|---|---|
Wisloff et al 2006 [58] | To assess exercise amount and intensity in relation to subsequent CVD mortality (including stroke). | • n = 27,143 men, 28,929 women | 16 year follow up | Multivariate adjusted RR (95% CI) Men | Both high and low- intensity exercise may be associated with a reduced risk of stroke in both men and women. |
Norway |  | • Sex: Men and women | PA Assessment: Questionnaire | G1 = 1.00 (referent) |  |
 |  | • Age: ≥ 20 yr |  | G2 = 0.90 (0.70-1.17) |  |
 |  | • Characteristics: free from CVD | PA | G3a = 0.90 (0.64-1.26) |  |
 |  | • HUNT Study | G1 = None | G3b = 0.59 (0.27-1.27) |  |
 |  |  | G2 = <1/wk | G3c = 0.62 (0.40-0.95) |  |
 |  |  | G3a = 1/wk ≤ 30 min low | G3d = 0.51 (0.31-0.86) |  |
 |  |  | G3b = 1/wk ≤ 30 min high | G4a = 0.72 (0.49-1.05) |  |
 |  |  | G3c = 1/wk > 30 min low | G4b = 0.63 (0.31-1.30) |  |
Prospective cohort | Â | Â | G3d = 1/wk > 30 min high | G4c = 1.02 (0.72-1.44) | Â |
 |  |  | G4a = 2-3/wk ≤ 30 min low | G4d = 0.59 (0.37-0.92) |  |
 |  |  | G4b = 2-3/wk ≤ 30 min high | G5a = 0.97 (0.70-1.36) |  |
D & B score = 12 | Â | Â | G4c = 2-3/wk > 30 min low | G5b = 0.68 (0.27-1.66) | Â |
 |  |  | G4d = 2-3/wk > 30 min high | G5c = 0.81 (0.65-1.20) |  |
 |  |  | G5a = ≥ 4/wk ≤ 30 min low | G5d = 0.67 (0.49-1.11) |  |
 |  |  | G5b = ≥ 4/wk ≤ 30 min high |  |  |
 |  |  | G5c = ≥ 4wk > 30 min low | RR (95% CI) Women |  |
 |  |  | G5d = ≥ 4/wk > 30 min high | G1 = 1.00 (referent) |  |
 |  |  | Outcome Measure: IHD mortality | G2 = 1.01 (0.81-1.25) |  |
 |  |  | Cox proportional HR | G3a = 0.88 (0.68-1.15) |  |
 |  |  |  | G3b = 0.98 (0.46-2.10) |  |
 |  |  |  | G3c = 0.63 (0.42-0.94) |  |
 |  |  |  | G3d = 1.00 (0.50-1.98) |  |
 |  |  |  | G4a = 0.91 (0.70-1.17) |  |
 |  |  |  | G4b = 1.44 (0.78-2.65) |  |
 |  |  |  | G4c = 0.62 (0.44-0.88) |  |
 |  |  |  | G4d = 0.77 (0.36-1.66) |  |
 |  |  |  | G5a = 0.74 (0.56-0.99) |  |
 |  |  |  | G5b = 0.40 (0.10-1.62) |  |
 |  |  |  | G5c = 0.63 (0.45-0.89) |  |
 |  |  |  | G5d = 0.51 (0.21-1.26) |  |
Abbott et al 2003 [69] | To examine the way in which risk factor effects on the incidence of thromboembolic and hemorrhagic stroke can change over a broad range of ages. | • n = 7,589 | 6, 15 and 26 year follow up | Incidence rates per 1000 of stroke: | The protective effect of PA on reducing risk of stroke increased with age. |
USA |  | • Sex: Men |  |    • G1 = 9.0 (49) |  |
 |  | • Age: 45-93 yr | PA assessment: Using PA index over a 24 hour period PA information collected at study enrolment 1965-1968 and updated at physical examinations that occurred at 6, 15 and 26 years into follow-up. |    • G2 = 17.8 (124) |  |
Prospective cohort |  | • Characteristics: Free from CHD and stroke at enrolment; Japanese ancestry living on the island of Oahu, Hawaii. | Grouped into 4 age groups, yr: |    • G3 = 33.4 (112) |  |
D & B score = 14 |  | • Honolulu Heart Program | G1 = 45-54 |    • G4 = 48.1 (111) |  |
 |  |  | G2 = 55-64 | Incidence of stroke event increased with advancing age p <0.001 |  |
 |  |  | G3 = 65-74 | There appeared to be a small protective effect within each age group. Inverse relations increased with age (p = 0.046). The protective effect of PA became significant in men >77 years (p = 0.032) |  |
 |  |  | G4 = 75-93 |  |  |
 |  |  | Outcome Measure: diagnosis of fatal and non fatal stroke during 26 years of follow-up |  |  |
 |  |  | Cox proportional HR |  |  |
Gillium et al 1996 [70] | To examine the relationship between recreational and non-recreational PA and risk of stroke. | • n = 2,368 men, 2,713 women | 11.6 year follow up | Number of Cases: 249 white women, 270 white men, 104 black | Sedentary behaviour was found to be associated with increased risk of stroke. |
USA |  | • Sex: Men and women | PA assessment: Questionnaire divided into tertiles: |  |  |
 |  | • Age: 45-74 yr | T1 = Low | RR (95% CI) Black men and women Recreational PA |  |
Prospective cohort |  | • Ethnicity: Black and white | T2 = Medium |    • T1 = 1.33 (0.67-2.63) |  |
D & B score = 12 |  | • NHANES I | T3 = High |    • T2 = 1.33 (0.63-2.79) |  |
 |  |  |  |    • T3 = 1.00 (referent) |  |
 |  |  | Outcome Measure: Total Stroke | Non-recreational PA |  |
 |  |  | Cox proportional HR |    • T1 = 1.40 (0.90-2.16) |  |
 |  |  |  |    • T2 = 1.41 (0.74-2.70) |  |
 |  |  |  |    • T3 = 1.00 (referent) |  |
 |  |  |  | RR (95% CI) White men age 45-64 Recreational PA |  |
 |  |  |  |    • T1 = 1.24 (0.63-2.41) |  |
 |  |  |  |    • T2 = 1.17 (0.61-2.27 |  |
 |  |  |  |    • T3 = 1.00 (referent) |  |
 |  |  |  | Non-recreational PA |  |
 |  |  |  |    • T1 = 1.07 (0.40-2.86) |  |
 |  |  |  |    • T2 = 1.75 (1.04-2.96) |  |
 |  |  |  |    • T3 = 1.00 (referent) |  |
 |  |  |  | RR (95% CI) White women age 45-64 Recreational PA |  |
 |  |  |  |    • T1 = 3.13 (0.95-10.32) |  |
 |  |  |  |    • T2 = 1.80 (0.52-6.22) |  |
 |  |  |  |    • T3 = 1.00 (referent) |  |
 |  |  |  | Non-recreational PA |  |
 |  |  |  |    • T1 = 3.51 (1.66-7.46) |  |
 |  |  |  |    • T2 = 1.07 (0.57-1.99) |  |
 |  |  |  |    • T3 = 1.00 (referent) |  |
 |  |  |  | RR (95% CI) White men age 65-74 Recreational PA |  |
 |  |  |  |    • T1 = 1.29 (0.58-1.88) |  |
 |  |  |  |    • T2 = 0.86 (0.58-1.28) |  |
 |  |  |  |    • T3 = 1.00 (referent) |  |
 |  |  |  | Non-recreational |  |
 |  |  |  |    • T1 = 1.82 (1.15-2.88) |  |
 |  |  |  |    • T2 = 1.20 (0.88-1.64) |  |
 |  |  |  |    • T3 = 1.00 (referent) |  |
 |  |  |  | RR (95% CI) White women age 65-75 Recreational PA |  |
 |  |  |  |    • T1 = 1.55 (0.95-2.53) |  |
 |  |  |  |    • T2 = 1.27 (0.76-2.12) |  |
 |  |  |  |    • T3 = 1.00 (referent) |  |
 |  |  |  | Non-recreational PA |  |
 |  |  |  |    • T1 = 1.82 (1.10-3.02) |  |
 |  |  |  |    • T2 = 1.42 (1.01-2.00) |  |
 |  |  |  |    • T3 = 1.00 (referent) |  |
Lee and Blair 2002 [71] | To examine the association between PF and stroke mortality in men. | • n = 16,878 | Baseline medical evaluation between 1971 and 1994 with average follow up period of 10 years | Average estimated maximal METs | Moderate and high levels of PF were associated with lower risk of stroke mortality in men. |
 |  | • Sex: Men |  |    • T1 = 8.5 MET |  |
 |  | • Age: 40-87 yrs |  |    • T2 = 10.5 MET |  |
USA |  | • Aerobics Center Longitudinal Study |  |    • T3 = 13.1 MET |  |
Prospective cohort | Â | Â | PF assessment: Maximal exercise tolerance test, divided into tertiles | RR (95% CI) adjusted for age and exam year | Â |
 |  |  |  |    • T1 = 1.00 (referent) |  |
D & B score = 13 |  |  | T1 = Low |    • T2 = 0.35 (0.16-0.77) |  |
 |  |  | T2 = Moderate |    • T3 = 0.28 (0.11-0.71) |  |
 |  |  | T3 = High | Trend p = 0.005 |  |
 |  |  | Cox proportional HR |  |  |
Hu et al 2000 [72] | To examine the association between PA and risk of total stroke and stroke sub- types in women. | • n = 72,488 | Baseline measurement in 1986 with follow-up questionnaire in 1988 and 1992 | • 407 cases of stroke (258 ischemic strokes, 67 subarachnoid hemorrhages, 42 intracerebral hemorrhages, and 40 strokes of unknown type) | PA, including moderate-intensity exercise such as walking, is associated with a substantial reduction in risk of total and ischemic stroke in a dose- response manner. |
 |  | • Sex: Women |  |  |  |
 |  | • Age:40-65 yr |  |  |  |
USA |  | • Characteristics: Nurses |  |  |  |
Prospective cohort |  | • Nurses' Health Study | PA assessment: Questionnaire for total PA (MET h/wk), divided into quintiles, walking activity (MET h/wk), divided into quintiles and walking pace | Multivariate RR (95% CI) for total stroke by total PA level |  |
 |  |  |  |    • Q1 = 1.00 (referent) |  |
D & B score = 13 |  |  |  |    • Q2 = 0.98 |  |
 |  |  |  |    • Q3 = 0.82 |  |
 |  |  |  |    • Q4 = 0.74 |  |
 |  |  |  |    • Q5 = 0.66 |  |
 |  |  | Total PA (MET h/wk) |  |  |
 |  |  |  | p = 0.005 |  |
 |  |  | Q1 = 0 - 2.0 |  |  |
 |  |  | Q2 = 2.1 - 4.6 |  |  |
 |  |  |  | Multivariate RR (95% CI) for ischemic Stroke by total PA level |  |
 |  |  | Q3 = 4.7 - 10.4 |  |  |
 |  |  | Q4 = 10.5-21.7 |  |  |
 |  |  |  |    • Q1 = 1.00 (referent) |  |
 |  |  | Q5 = > 21.7 |  |  |
 |  |  |  |    • Q2 = 0.87 |  |
 |  |  | Walking activity (MET h/wk) |    • Q3 = 0.83 |  |
 |  |  | Q1 = 0.5 |    • Q4 = 0.76 |  |
 |  |  | Q2 = 0.6 - 2.0 |    • Q5 = 0.52 |  |
 |  |  | Q3 = 2.1 - 3.8 | p = 0.003 |  |
 |  |  | Q4 = 3.9 - 10 |  |  |
 |  |  | Q5 = 10 | Multivariate RR (95% CI) for total stroke by walking activity |  |
 |  |  | Walking pace (mph) |    • Q1 = 1.00 (referent) |  |
 |  |  | G1 < 2.0 |    • Q2 = 0.76 |  |
 |  |  | G2 = 2-2.9 |    • Q3 = 0.78 |  |
 |  |  | G3 3.0 |    • Q4 = 0.70 |  |
 |  |  |  |    • Q5 = 0.66 |  |
 |  |  | Outcome measure: Stroke incidence | p = 0.01 |  |
 |  |  |  | Multivariate RR (95% CI) for ischemic stroke by walking activity |  |
 |  |  | Pooled logistic regression |  |  |
 |  |  | Cox proportional HR |    • Q1 = 1.00 (referent) |  |
 |  |  |  |    • Q2 = 0.77 |  |
 |  |  |  |    • Q3 = 0.75 |  |
 |  |  |  |    • Q4 = 0.69 |  |
 |  |  |  |    • Q5 = 0.60 |  |
 |  |  |  | p = 0.02 |  |
 |  |  |  | Multivariate RR (95% CI) for total stroke by usual Walking Pace |  |
 |  |  |  |    • G1 = 1.00 (referent) |  |
 |  |  |  |    • G2 = 0.81 |  |
 |  |  |  |    • G3 = 0.49 |  |
 |  |  |  | p < 0.001 |  |
 |  |  |  | Multivariate RR (95% CI) for ischemic stroke by usual walking pace |  |
 |  |  |  |    • G1 = 1.00 (referent) |  |
 |  |  |  |    • G2 = 0.71 |  |
 |  |  |  |    • G3 = 0.47 |  |
 |  |  |  | p < 0.001 |  |
Lee et al 1999 [74] | To examine the association between exercise and stroke risk. | • n = 21,823 | 11.1 year follow up | Number of Cases: 533 | VPA is associated with a decreased risk of stroke in men. |
 |  | • Sex: Men |  |  |  |
 |  | • Age: 40-84 yr | PA assessment: Questionnaire for frequency of VPA, divided into 4 groups | Multivariate RR1 (95% CI) for total stroke by VPA |  |
USA | Â | Â | Â | Â | Â |
 |  |  |  |    • G1 = 1.00 (referent) |  |
Prospective cohort |  |  |  |    • G2 = 0.79 (0.61-1.03) | Inverse association with PA seemed to be mediated through beneficial effects on body weight, BP, cholesterol and glucose tolerance. |
 |  |  | G1 < 1 time/week |    • G3 = 0.80 (0.65-0.99) |  |
 |  |  | G2 = 1 time/week |    • G4 = 0.79 (0.61-1.03) |  |
D & B score = 13 | Â | Â | G3 = 2-4 times/week | p = 0.04 | Â |
 |  |  | G4 ≥ 5 times/week | RR2 (95% CI) for total stroke by VPA |  |
 |  |  |  |    • G1 = 1.00 (referent) |  |
 |  |  | RR1 = adjusted for smoking, alcohol consumption, history of angina and parental history of MI at <60 years |    • G2 = 0.81 (0.61-1.07) |  |
 |  |  |  |    • G3 = 0.88 (0.70-1.10) |  |
 |  |  |  |    • G4 = 0.86 (0.65-1.13) |  |
 |  |  |  | p = 0.25 |  |
 |  |  |  | RR2 (95% CI) for ischemic stroke by |  |
 |  |  | RR2 = adjusted for all of the above plus, BMI, history of, hypertension, high cholesterol and diabetes |  |  |
 |  |  |  | VPA |  |
 |  |  |  |    • G1 = 1.00 (referent) |  |
 |  |  |  |    • G2 = 0.90 (0.66-1.22) |  |
 |  |  |  |    • G3 = 0.95 (0.74-1.22) |  |
 |  |  |  |    • G4 = 0.97 (0.71-1.32) |  |
 |  |  | Outcome Measure: Total Stroke (Ischemic and Hemorrhagic) | p = 0.81 |  |
 |  |  |  | RR2 (95% CI) for hemorrhagic stroke by VPA |  |
 |  |  | Cox proportional HR |    • G1 = 1.00 (referent) |  |
 |  |  |  |    • G2 = 0.54 (0.25-1.13) |  |
 |  |  |  |    • G3 = 0.71 (0.41-1.23) |  |
 |  |  |  |    • G4 = 0.54 (0.26-1.15) |  |
 |  |  |  | p = 0.10 |  |
Bijnen et al 1998 [166] | To describe the association between the PA patterns of elderly men and stroke mortality. | • n = 802 | 10 year follow up | Number of Cases: 47 | No significant finding |
 |  | • Sex: Men |  |  |  |
 |  | • Age:64-84 yr | PA assessment: | Multivariate adjusted RR (95% CI) |  |
Denmark |  | • Characteristics: Not all free from previous stroke | Questionnaire for LTPA, divided into tertiles |    • T1= 1. 00 (referent) |  |
 |  |  |  |    • T2 = 0.65 (0.33-1.25) |  |
Prospective cohort |  |  | T1 = Lowest |    • T3 = 0.55 (0.24-1.26) |  |
 |  |  | T2 | p = 0.12 |  |
 |  |  | T3 = Highest |  |  |
D & B score = 15 | Â | Â | Â | Â | Â |
 |  |  | Outcome Measure: Stroke Mortality |  |  |
 |  |  | Cox proportional HR |  |  |
Schnohr et al 2006 [214] | To describe the association between different levels of LTPA and subsequent causes of death (stroke). | • n = 2136 men, 2,758 women | 5 year follow up | RR (95% CI), univariate | Although RR for of death from stroke was below 1 for both moderate and high compared with low PA, this association did not reach the level of statistical significance. |
 |  |  |  |    • G1 = 1.00 (referent) |  |
 |  | • Sex: Men and women | PA assessment: |    • G2 = 0.64 (0.39-1.05) |  |
Copenhagen |  | • Age: 20 -- 79 yr | Questionnaire for LTPA, |    • G3 = 0.70 (0.41-1.21) |  |
 |  | • Characteristics: Healthy, PA level did not change between 2 examinations, 5 years apart | divided into 3 groups | Trend p = 0.4 |  |
Prospective cohort | Â | Â | G1 = Low PA (<4 METS) | Â | Â |
 |  |  | G2 = Moderate PA (4-6 | RR (95% CI), multivariate: |  |
 |  |  | METS) |    • G1 = 1.00 (referent) |  |
D & B score = 13 |  |  | G3 = High PA (>6 METS) |    • G2 = 0.67 (0.40-1.12) |  |
 |  | • Copenhagen City Heart Study |  |    • G3 = 0.76 (0.43-1.34) |  |
 |  |  | Multivariate Analysis Kaplan-Meier Plots | Trend p = 0.6 |  |
 |  |  | Linear, Logistical and Cox Regression. |  |  |
Vatten et al 2006 [253] | To investigate whether obesity- related CV mortality could be modified by PA. | • n = 26,515 men, 27,769 women | 16 year follow up | Number of Cases: 994 women, 771 men | Lower levels of TPA are associated with an increased risk of stroke. |
 |  | • Sex: Men and women | PA assessment: Questionnaire for total amount of PA, divided into 4 groups |  |  |
Norway |  | • Age: 20 yr |  | Multivariate HR (95% CI), men |  |
 |  | • Characteristics: Free from CVD at baseline |  |    • Q1 = 1.00 (referent) |  |
Prospective cohort |  |  |  |    • Q2 = 1.05 (0.85-1.30) |  |
 |  | • HUNT study | G1 = High |    • Q3 = 1.21 (0.95-1.54) |  |
 |  |  | G2 = medium |    • Q4 = 1.35 (1.05-1.74) |  |
D & B score = 14 | Â | Â | G3 = low | p = 0.009 | Â |
 |  |  | G4 = never |  |  |
 |  |  |  | Multivariate HR (95% CI), women |  |
 |  |  | Outcome Measure: Stroke mortality |    • Q1 = 1.00 (referent) |  |
 |  |  |  |    • Q2 = 1.16 (0.93-1.45) |  |
 |  |  |  |    • Q3 = 1.45 (1.14-1.86) |  |
 |  |  | Cox proportional HR |  |  |
 |  |  |  |    • Q4 = 1.45 (1.14-1.83) |  |
 |  |  |  | p < 0.001 |  |
Agnarsson et al 1999 [255] | To examine the association of LTPA and pulmonary function with the risk of stroke. | • n = 4,484 | Length of Follow-up: 10.6 ± 3.6 years | Number of Cases: 249 | Apparent protective effect of regular continued LTPA in middle age men on the risk of ischemic stroke. |
 |  | • Sex: Men |  |  |  |
 |  | • Age: 45-80 |  | Adjusted for age and smoking RR (95% CI) for total stroke by LTPA level |  |
Iceland |  | • Characteristics: no history of Stroke | PA assessment: Questionnaire for LTPA (h/wk) and type of activity (intensity), each divided into 3 groups |  |  |
Prospective cohort |  | • Reykjavik Study |  |    • G1 = 1.00 (referent) |  |
 |  |  |  |    • G2 = 0.84 (0.63-1.13) |  |
 |  |  |  |    • G3 = 0.73 (0.40-1.35) |  |
D & B score = 13 | Â | Â | LTPA summer/winter | Â | Â |
 |  |  | G1 = none | Adjusted for age and smoking RR (95% CI) for ischemic stroke by LTPA level |  |
 |  |  | G2 = ≤ 5 h/wk |  |  |
 |  |  | G3 = ≥ 6 h/wk |  |  |
 |  |  |  |    • G1 = 1.00 (referent) |  |
 |  |  | Type of Activity |    • G2 = 0.72 (0.51-1.01) |  |
 |  |  | G1 = none |  |  |
 |  |  |  |    • G3 = 0.78 (0.41-1.48) |  |
 |  |  | G2 = low intensity |  |  |
 |  |  | G3 = high Intensity |  |  |
 |  |  |  | RR (95% CI) for total stroke by type of activity |  |
 |  |  | Outcome Measure: Total and ischemic Stroke |    • G1 = 1.0,0 (referent) |  |
 |  |  |  |    • G2 = 0.75 (0.53-1.08) |  |
 |  |  |  |    • G3 = 1.10 (0.78-1.57) |  |
 |  |  | Cox proportional HR |  |  |
 |  |  |  | RR (95% CI) for ischemic stroke by type of activity |  |
 |  |  |  |    • G1 = 1.00 (referent) |  |
 |  |  |  |    • G2 = 0.72 (0.44-1.07) |  |
 |  |  |  |    • G3 = 0.96 (0.64-1.44) |  |
Ellekjaer et al 2000 [256] | To examine the association between different levels of LTPA and stroke mortality in middle-aged and elderly women. | • n = 14,101 | Baseline 1984-1986: 2 self administered questionnaires and clinical measurements included in the screening program. | Number of cases: 457 | This study demonstrates a consistent, negative association between PA and stroke mortality in women. |
 |  | • Sex: Women |  |  |  |
 |  | • Age: 50 yr |  | Multivariate RR (95% CI), all age groups |  |
Norway |  | • Characteristics: free from stroke at baseline |  |  |  |
 |  |  |  |    • G1 = 1.00 (referent) |  |
Prospective cohort |  |  |  |    • G2 = 0.77 |  |
 |  |  | PA assessment: Questionnaire for LTPA, divided into 3 groups |    • G3 = 0.52 |  |
D & B score = 14 | Â | Â | Â | Multivariate RR (95% CI), age 50--69 years | Â |
 |  |  | G1 = low |  | The most active women had approx. 50% lower risk of death from stroke compare to inactive women. |
 |  |  | G2 = medium |    • G1 = 1.00 (referent) |  |
 |  |  | G3 = high |    • G2 = 0.57 |  |
 |  |  |  |    • G3 = 0.42 |  |
 |  |  | Outcome Measure: Death from stroke | p = 0.0021 |  |
 |  |  |  | Multivariate RR (95% CI), age 70-79 years |  |
 |  |  | Cox proportional HR |  |  |
 |  |  |  |    • G1 = 1.00 (referent) |  |
 |  |  |  |    • G2 = 0.79 |  |
 |  |  |  |    • G3 = 0.56 |  |
 |  |  |  | p = 0.0093 |  |
 |  |  |  | Multivariate RR (95% CI), age 80-101 years |  |
 |  |  |  |    • G1 = 1.00 (referent) |  |
 |  |  |  |    • G2 = 0.91 |  |
 |  |  |  |    • G3 = 0.57 |  |
 |  |  |  | p = 0.1089 |  |
Evenson et al 1999 [257] | To examine the relationship between PA and ischemic stroke risk. | • n = 14,575 | 7.2 year follow up | Number of Cases: 189 | PA was weakly associated with a reduced risk of ischemic stroke among middle aged adults. |
 |  | • Sex: Men and women |  | Number of Dropouts: 0% |  |
 |  | • Age: 45-64 yr | PA assessment: Questionnaire (Baecke questionnaire) |  |  |
USA |  | • Atherosclerosis Risk in Communities Study |  | Sport, Incidence of Ischemic Stroke |  |
Prospective cohort | Â | Â | Â | Multivariate adjusted RR (95% CI) by sport | Â |
 |  |  | Outcome Measure: |  |  |
 |  |  | Ischemic Stroke |    • Q1 = 1.00 (referent) |  |
D & B score = 14 |  |  |  |    • Q3= 0.83 (0.52-1.32) |  |
 |  |  | Multivariate Poisson and Cox proportional HR |  |  |
 |  |  |  | Multivariate adjusted RR (95% CI) by LTPA |  |
 |  |  |  |    • Q1 = 1.00 (referent) |  |
 |  |  |  |    • Q2 = |  |
 |  |  |  |    • Q3 = 0.89 (0.57-1.37) |  |
 |  |  |  | Multivariate adjusted RR (95% CI) by OPA |  |
 |  |  |  |    • Q1 = 1.00 (referent) |  |
 |  |  |  |    • Q2 = |  |
 |  |  |  |    • Q3 = 0.69 (0.47-1.00) |  |
Haheim et al 1993 [258] | To determine the risk factors of stroke incidence and mortality. | • n = 14,403 | Baseline Screening from May 1972- December 1973. | HR (95% CI) for stroke incidence | Increased LTPA is associated with a reduced risk of stroke incidence but not mortality. |
 |  | • Sex: Men |  |    • G1 = 1.00 (referent) |  |
 |  | • Age: 40-49 yr |  |    • G2 = 0.64 (0.38-1.08) |  |
Norway |  |  | PA assessment: Questionnaire for LTPA, divided into groups |    • G3 = 0.36 (0.15-0.80) |  |
Prospective cohort | Â | Â | Â | HR (95% CI) for stroke mortality | Â |
 |  |  | G1 = Sedentary |    • G1 = 1.00, (referent) |  |
 |  |  | G2 = Moderate |    • G2 = 0.82 (0.33-2.35) |  |
D & B score = 14 |  |  | G3 = Intermediate or Great |    • G3 = 0.29 (0.03-1.51) |  |
 |  |  | Outcome Measure: Incidence of stroke morbidity and mortality until study end date, December 31, 1984. |  |  |
 |  |  | Cox proportional HR |  |  |
Hu et al 2005 [259] | To assess the relationship of different types of PA with total and type-specific stroke risk. | • n = 47,721 | PA assessement: Mailed questionnaire for LTPA, OPA and commuting PA, divided into groups as follows: | RR (95% CI) by LTPA, men | A high level of LTPA reduces the risk of all subtypes of stroke. Daily active commuting also reduces the risk of ischemic stroke. |
 |  | • Sex: Men and women |  |    • G1 = 1.00 (referent) |  |
 |  |  |  | • G2 = 0.83 |  |
Finland |  | • Age: 25-64 |  |    • G3 = 0.72 |  |
 |  | • Characteristics: Healthy at baseline |  | p < 0.001 |  |
Prospective cohort | Â | Â | Â | Â | Â |
 |  |  | LTPA levels: | RR (95% CI) by LTPA, women |  |
 |  |  | G1 = Low |    • G1 = 1.00 (referent) |  |
D & B score = 13 |  |  | G2 = Moderate |    • G2 = 0.86 |  |
 |  |  | G3 = High |    • G3 = 0.75 |  |
 |  |  |  | p = 0.007 |  |
 |  |  | OPA: |  |  |
 |  |  | G1 = Light | RR (95% CI) by LTPA, men and women |  |
 |  |  | G2 = Moderate |  |  |
 |  |  | G3 = Hard |  |  |
 |  |  |  |    • G1 = 1.00 (referent) |  |
 |  |  |  |    • G2 = 0.85 |  |
 |  |  | Commuting PA: |  |  |
 |  |  | G1 = Motorized or no work, |    • G3 = 0.73 |  |
 |  |  | G2 = walking or cycling 1-29 min G3 = walking or cycling ≥ 30 min. | p <0.001 |  |
 |  |  |  | RR (95% CI) by OPA, men |  |
 |  |  |  | • Not significant |  |
 |  |  | Outcome Measure: Incidence of fatal or non-fatal stroke occurring during follow-up until end of 2003. Mean follow-up of 19 years. |  |  |
 |  |  |  | RR (95% CI) by OPA, women |  |
 |  |  |  | • Not significant |  |
 |  |  |  | RR (95% CI) by OPA, men and women |  |
 |  |  |  |    • G1 = 1.00 (referent) |  |
 |  |  | Cox proportional hazard |    • G2 = 0.90 |  |
 |  |  |  | • G3 = 0.87 |  |
 |  |  |  | p = 0.007 |  |
 |  |  |  | RR (95% CI) by commuting PA, men |  |
 |  |  |  |    • G1 = 1.00 (referent) |  |
 |  |  |  |    • G2 = 0.91 |  |
 |  |  |  |    • G3 = 0.85 |  |
 |  |  |  | p = 0.047 |  |
 |  |  |  | RR (95% CI) by commuting PA, women |  |
 |  |  |  |    • G1 = 1.00 (referent) |  |
 |  |  |  |    • G2 = 0.86 |  |
 |  |  |  |    • G3 = 0.85 |  |
 |  |  |  | p = 0.018 |  |
 |  |  |  | RR (95% CI) by commuting PA, men and women |  |
 |  |  |  |    • G1 = 1.00 (referent) |  |
 |  |  |  |    • G2 = 0.89 |  |
 |  |  |  |    • G3 = 0.85 |  |
 |  |  |  | p = 0.002 |  |
Kiely et al 1994 [260] | To examine the influence of increased PA on stroke risk in members of the Framingham study cohort. | • n = 1,897 men 2,299 women | Baseline measurement in 1954-1955 and follow up in either 1968-1969 or 1971- 1972 | Multivariate adjusted RR (95% CI) at first examination, men (mean age 50 years) | Medium and high levels of PA among men are protective against stroke relative to low levels. |
 |  | • Sex: Men and women |  |  |  |
USA |  |  |  |    • G1 = 1.00 (referent) |  |
 |  | • Age: 28-62 yr |  |    • G2 = 0.90 (0.62-1.31) p = 0.59 |  |
Prospective cohort |  | • Characteristics: Free from stroke | PA assessment: Questionnaire for metabolic work done during a typical 24 hr period, divided into 3 groups |    • G3 = 0.84 (0.59-1.18) p = 0.31 |  |
 |  |  |  | Multivariate adjusted RR (95% CI) at first examination, women (mean age 50 years) | Protective effect of PA was slightly less for high levels of PA compared to medium levels for older men. |
D & B score = 12 | Â | Â | Â | Â | Â |
 |  |  | G1 = Low |    • G1 = 1.00 (referent) |  |
 |  |  | G2 = Medium |    • G2 = 1.21 (0.89-1.63) p = 0.23 |  |
 |  |  | G3 = High |    • G3 = 0.89 (0.60-1.31) p = 0.54 |  |
 |  |  | Outcome Measure: Incidence of stroke, as defined by the first occurrence of atherothrombotic brain infarctions, cerebral embolism or other type of stroke, during 32 years of follow-up. |  |  |
 |  |  |  | Multivariate adjusted RR (95% CI) at second examination, men (mean age 63 years) |  |
 |  |  |  |    • G1 = 1.00 (referent) |  |
 |  |  |  |    • G2 = 0.41 (0.24-0.89) p = 0.0007 |  |
 |  |  |  |    • G3 = 0.53 (0.34-0.84) p = 0.007 |  |
 |  |  |  | Multivariate adjusted RR (95% CI) at second examination, women (mean age 64 years) |  |
 |  |  | Cox proportional HR |  |  |
 |  |  |  |    • G1 = 1.00 (referent) |  |
 |  |  |  |    • G2 = 0.97 (0.64-1.47) p = 0.67 |  |
 |  |  |  |    • G3 = 1.21 (0.75-1.96) p = 0.43 |  |
Krarup et al 2007 [261] | To compare the reported level of PA performed during the week preceding an ischemic stroke with that of community controls. | • n = 127 cases 301 controls | PA assessment: | Univariate OR (95% CI) | Stroke patients are less physically active in the week preceding an ischemic stroke when compared to age and sex-matched controls. Increasing PASE score was inversly, log-linearly and significantly associated with OR for ischemic stroke. |
 |  |  | Questionnaire about PA 1 week prior to stroke (cases) and 1 week prior to questionnaire (controls), divided into PASE scores and quartiles | PASE Score |  |
 |  | • Sex: Men and women |  |    • Q1 = 1.00 (referent) |  |
Denmark |  |  |  |    • Q2 = 0.51 (0.28-0.95) |  |
 |  | • Age: ≥ 40 yr |  | • Q3 = 0.27 (0.14-0.54) |  |
Case control |  | • Characteristics: Case: Stroke Patients (20% had history of Stroke), Controls: 4% had history of stroke |  | • Q4 = 0.08 (0.03-0.20) |  |
D & B score = 14 | Â | Â | Q1 = 0-49 | Multivariate OR (95% CI) PASE Score | Â |
 |  |  | Q2 = 50-99 |  |  |
 |  |  | Q3 = 100-149 |    • Q1 = 1.00 (referent) |  |
 |  |  | Q4 = 150+ |    • Q2 = 0.53 (0.26-1.08) |  |
 |  |  |  |    • Q3 = 0.27 (0.12-0.59) |  |
 |  |  | Outcome measure: |  |  |
 |  |  | Ischemic stroke |    • Q4 = 0.09 (0.03-0.25) |  |
 |  |  | Chi squared Kruskal-Wallis Statistics Multivariate conditional logistic regression |  |  |
Kurl et al 2003 [262] | To examine the relationship of PF with subsequent incidence of stroke. Also to compare PF with conventional risk factors as a predictor for future stroke. | • n = 2,011 | Baseline examinations conducted between March 1984 and December 1989 with average follow up period of 11 years | Multivariate HR (95% CI), any stroke | Low PF was associated with an increased risk of any stroke and ischemic stroke. |
 |  | • Sex: Men |  |    • Q1 = 1.00 (referent) |  |
 |  | • Age: 42, 48, 54 or 60 yrs |  |    • Q2 = 1.39 (0.70-2.77) |  |
Finland |  |  |  |    • Q3 = 1.32 (0.66-2.65) |  |
 |  | • Characteristics: Free from stroke or pulmonary disease • Kuopio Ischaemic Heart Disease Risk Factor Study |  |    • Q4 = 2.30 (1.18-4.06) |  |
Prospective cohort | Â | Â | Â | Trend p = 0.01 | Â |
 |  |  | PF assessment: Maximal exercise test on cycle ergometer. VO2 max (ml/kg/min) divided into quartiles |  |  |
 |  |  |  | Multivariate HR (95% CI), ischemic stroke |  |
D & B score = 14 | Â | Â | Â | Â | Â |
 |  |  |  |    • Q1 = 1.00 (referent) |  |
 |  |  |  |    • Q2 = 1.28 (0.56-2.94) |  |
 |  |  |  |    • Q3 = 1.64 (0.74-3.65) |  |
 |  |  | Q1 = >35.3 |  |  |
 |  |  |  |    • Q4 = 2.40 (1.09-5.25) |  |
 |  |  | Q2 = 30.3-35.3 |  |  |
 |  |  |  | Trend p = 0.01 |  |
 |  |  | Q3 = 25.2-30.2 |  |  |
 |  |  | Q4 = <25.2 |  |  |
 |  |  | Outcome Measure: Stroke incidence |  |  |
 |  |  | Cox proportional HR |  |  |
Myint et al 2006 [263] | To examine the association between a combination of OPA and LTPA with risk of subsequent stroke. | • n = 22,602 | Baseline measurement in | Model A: Used all 4 categories of PA | Higher levels of PA assessed using a single simple pragmatic tool based on both OPA and LTPA is associated with reduced stroke risk. |
 |  | • Sex: Men | 1993-1997 | HR (95% CI), men and women |  |
 |  | • Age: 40-79 yr |  |    • G1 = 1.00 (referent) |  |
UK |  | • Characteristics: Healthy at baseline | PA assessment: Questionnaire for PA (includes LTPA and OPA) divided into 4 groups |    • G2 = 0.78 (0.61-1.00) |  |
 |  |  |  |    • G3 = 0.66 (0.49-0.91) |  |
Prospective cohort |  | • European Prospective Investigation in Cancer-Norfolk |  |    • G4 = 0.70 (0.49-0.99) |  |
 |  |  |  | p = 0.024 |  |
D & B score = 11 | Â | Â | G1 = Inactive | HR (95% CI), men | Â |
 |  |  | G2 = moderately inactive |    • G1 = 1.00 (referent) |  |
 |  |  | G3 = moderately active |    • G2 = 0.75 (0.52-1.09) |  |
 |  |  | G4 = active |  |  |
 |  |  |  |    • G3 = 0.55 (0.35-0.86) |  |
 |  |  |  |    • G4 = 0.67 (0.43-1.05) |  |
 |  |  | Outcome Measure: Incidence of fatal and non fatal stroke. |  |  |
 |  |  |  | p = 0.41 |  |
 |  |  |  | Women not significant p = 0.50 |  |
 |  |  | Cox proportional HR |  |  |
 |  |  |  | Model B: Used 3 categories of PA (G3 and G4 combined combined) |  |
 |  |  |  | HR (95% CI), men and women |  |
 |  |  |  |    • G1 = 1.00 (referent) |  |
 |  |  |  |    • G2 = 0.78 (0.61-1.00) |  |
 |  |  |  |    • G3 = 0.68 (0.52-0.88) |  |
 |  |  |  | p = 0.009 |  |
 |  |  |  | HR (95% CI), men |  |
 |  |  |  |    • G1 = 1.00 (referent) |  |
 |  |  |  |    • G2 = 0.75 (0.52-1.09), |  |
 |  |  |  |    • G3 = 0.61 (0.43-0.86) |  |
 |  |  |  | p = 0.019 |  |
 |  |  |  | Women not significant p = 0.34 |  |
Noda et al 2005 [264] | To examine the impact of exercise on CVD (stroke) mortality in Asian populations. | • n = 31,023 men, 42,242 women | 9.7 year follow up | Number of Cases: 186 men, 141 women | PA through walking and sports participation may reduce the risk of mortality from ischemic stroke |
 |  | • Sex: Men and women | PA assessment: Questionnaire for PA (walking and sports participation (h/day), divided into quartiles: | Number of Dropouts: 3.4% |  |
Japan |  | • Age: 40 -79 yr |  |  |  |
 |  | • Ethnicity: Asian |  | Multivariate adjusted HR (95% CI) by duration of walking PA, men |  |
Prospective cohort | Â | Â | Â | Â | Â |
 |  |  |  |    • Q1 = 1.03 (0.63-1.69) |  |
 |  |  | Q1 = <0.5 |    • Q2 = 1.00 (referent) |  |
D & B score = 13 |  |  | Q2 = 0.5 |    • Q3 = 0.56 (0.35-0.91) |  |
 |  |  | Q3 = 0.6-0.9 |    • Q4 = 0.71 (0.49-1.02) |  |
 |  |  | Q4 = >1.0 |  |  |
 |  |  |  | Multivariate adjusted HR (95% CI) by duration of walking PA, women |  |
 |  |  | Outcome Measure: Death from ischemic stroke |  |  |
 |  |  |  |    • Q1 = 1.38 (0.82-2.33) |  |
 |  |  |  |    • Q2 = 1.00 (referent) |  |
 |  |  | Cox proportional HR |  |  |
 |  |  |  |    • Q3 = 0.56 (0.32-0.97) |  |
 |  |  |  |    • Q4 = 0.73 (0.48-1.13) |  |
 |  |  |  | Multivariate adjusted HR (95% CI) by sport PA, men |  |
 |  |  |  |    • Q1 = 1.34 (0.86-2.08) |  |
 |  |  |  |    • Q2 = 1.00 (referent) |  |
 |  |  |  |    • Q3 = 1.22 (0.66-2.25) |  |
 |  |  |  |    • Q4 = 0.84 (0.45-1.57) |  |
 |  |  |  | Multivariate adjusted HR (95% CI) by sport PA, women |  |
 |  |  |  |    • Q1 = 1.07 (0.64-1.77) |  |
 |  |  |  |    • Q2 = 1.00 (referent) |  |
 |  |  |  |    • Q3 = 0.62 (0.25-1.58) |  |
 |  |  |  |    • Q4 = 0.73 (0.31-1.70) |  |
Paganini-Hill and Barreto 2001 [265] | To identify risk factors and preventative measures for stroke in elderly men and women. | • n = 4,722 men, 8,532 women | Baseline survey in 1981- 1982. | Multivariate adjusted RR (95% CI) for total hemorrhagic occlusion by exercise, men | Emphasized role of lifestyle modification in the primary prevention of stroke. |
 |  | • Sex: Men and women |  |  |  |
 |  |  | PA assessment: Questionnaire on amount of hours per day of exercise |    • Q1 = 1.00 (referent) |  |
USA |  | Age: 44-101 yr |  |    • Q2 = 0.88 |  |
 |  | • Characteristics: no previous history of stroke. Residence of a retirement community in Southern California |  | Q3 = 0.83 |  |
Prospective cohort | Â | Â | G1 = <0.5 | Â | Â |
 |  |  | G2 = <0.1 | Multivariate adjusted RR (95% CI) for total hemorrhagic occlusion by exercise, women |  |
 |  |  | G3 = 1+ |  |  |
D & B score = 13 | Â | Â | Â | Â | Â |
 |  |  | Outcome Measure: Incidence of hemorrhagic occlusion strokes up until December 31, 1998. |    • Q1 = 1.00 (referent) |  |
 |  |  |  |    • Q2 = 0.91 |  |
 |  |  |  |    • Q3 = 0.85 |  |
 |  |  | Poisson Regression 40 year follow up |  |  |
Pitsavos et al 2004 [266] | To investigate the interaction between PA in men with LVH on stroke mortality. | • n = 489 |  | Number of cases: 67 | PA reduced the risk of stroke in men without LVH. |
 |  | • Sex: Men |  |  |  |
 |  |  | PA assessment: Questionnaire | RR (95% CI) |  |
USA |  | • Age: 40-59 yr |  |    • G1 = 1.00 (referent) |  |
 |  | • Characteristics: Those without LVH | G1 = Sedentary |    • G2 = 0.64 (0.45-0.91) |  |
Prospective cohort |  |  | G2 = Moderate |    • G3 = 0.72 (0.51-1.02) |  |
 |  | • Corfu Cohort (Greece) from Seven Countries Study | G3 = Hard |  |  |
D & B score = 12 | Â | Â | Outcome Measure: Stroke mortality | Â | Â |
 |  |  | Cox proportional HR |  |  |
Sacco et al 1998 [267] | To investigate the association between LTPA and ischemic stroke. | • n = 369 case, 678 control | Case Subjects were recruited during hospitalization, self referral or from monitoring non hospitalized stroke. Controls were eligible if they had never been diagnosed with stroke and were >39 years. |  | LTPA was related to a decreased occurrence of ischemic stroke in elderly, multiethnic, urban subjects. |
 |  | • Sex: Men and women |  | O R (95% CI) for duration of LTPA and stroke |  |
USA | Â | Â | Â | Â | Â |
 |  | • Age: > 39 yr |  |    • G1 = 1.00 (referent) |  |
Case control |  | • Characteristics: Case Subjects: Diagnosed with first cerebral infarction after July 1, 1993. Control Subjects: Never diagnosed with stroke |  |    • G2 = 0.42 |  |
 |  |  |  |    • G3 = 0.35 |  |
D & B score = 14 |  |  |  |    • G4 = 0.31 |  |
 |  |  | PA assessment: |  |  |
 |  |  | Questionnaire |  |  |
 |  |  | Divided into duration of LTPA (h/wk) |  |  |
 |  | • Northern Manhattan Stroke Study |  |  |  |
 |  |  | G1 = 0 |  |  |
 |  |  | G2 = <2 |  |  |
 |  |  | G3 = 2-<5 |  |  |
 |  |  | G4 = ≥ 5 |  |  |
 |  |  | Multivariate conditional logistic regression Baseline data collection from 1982-1983 in East Boston (MA), New Haven (CT) and Iowa and Washington counties (IA). |  |  |
Simonsick et al 1993 [268] | To examine the association between recreational PA among physically capable older adults and incidence of selected chronic diseases and mortality over 3 and 6 years. | • n = 1,815 |  | After 3 years Iowa | No consistent relationship between PA and stroke was found after 3 or 6 years across all 3 population cohorts. |
 |  | • Sex: Men and women |  |  |  |
 |  | • Age: ≥ 65 yrs |  | OR (95% CI) Stroke and activity level |  |
USA |  | • Characteristics: Physically capable to do heavy work around the house, walk up and down a flight of stairs and walk a half mile without help. |  |    • T1 = 0.22 (0.08-0.61) |  |
 |  |  |  |    • T2 = 1.05 (0.60-1.84) |  |
Prospective cohort |  |  |  |    • T3 = 1.00 (Referent) |  |
 |  |  | PA assessment: Questionnaire |  |  |
 |  |  |  | New Haven |  |
D & B score = 12 | Â | Â | T1 = High | OR (95% CI) Stroke and activity level | Â |
 |  |  | T2 = Moderate and |    • T1 = 1.06 (0.38-2.95) |  |
 |  |  | T3 = Inactive |    • T2 = 1.26 (0.54-2.92) |  |
 |  | • Established Populations for Epidemiologic Studies of the Elderly |  |    • T3 = 1.00 (Referent) |  |
 |  |  | Outcome Measure: Stroke incidence during 3 and 6 year follow-ups. |  |  |
 |  |  |  | East Boston |  |
 |  |  |  | OR (95% CI) Stroke and activity level |  |
 |  |  |  |    • T1 = 0.59 (0.17-1.95) |  |
 |  |  | Logistic Regression |  |  |
 |  |  |  |    • T2 = 1.08 (0.52-2.27) |  |
 |  |  |  |    • T3 = 1.00 (Referent) |  |
 |  |  |  | After 6 years |  |
 |  |  |  | Iowa |  |
 |  |  |  | OR (95% CI) Stroke and activity level |  |
 |  |  |  |    • T1 = 0.56 (0.31-1.00) |  |
 |  |  |  |    • T2 = 0.97 (0.64-1.48) |  |
 |  |  |  |    • T3 = 1.00 (Referent) |  |
 |  |  |  | New Haven |  |
 |  |  |  | OR (95% CI) Stroke and activity level |  |
 |  |  |  |    • T1 = 1.05 (0.52-2.12) |  |
 |  |  |  |    • T2 = 1.29 (0.72-2.32) |  |
 |  |  |  |    • T3 = 1.00 (Referent) |  |
 |  |  |  | East Boston |  |
 |  |  |  | OR (95% CI) Stroke and activity level |  |
 |  |  |  |    • T1 = 1.21 (0.56-2.61) |  |
 |  |  |  |    • T2 = 1.73 (0.98-3.06) |  |
 |  |  |  |    • T3 = 1.00 (Referent) |  |
Thrift et al 2002 [269] | To examine whether intracerebral hemorrhage is associated with dynamic or static exercise. | • n = 662 | PA assessment: Interview, divided into 3 groups: frequency of vigorous activity | Number of Cases: 331 | Findings not significant after multivariate analysis. |
 |  | • Sex: Men and women |  |  |  |
 |  | • Age: 18-80 yr |  | Multivariate OR (95% CI) by frequency of VPA |  |
Australia |  | • Characteristics: Cases: first episode ofintracerebral hemorrhage Controls: Neighbours of cases |  |  |  |
 |  |  | G1 = Never |    • G1 = 1.00 (referent) |  |
Case control |  |  | G2 = Rarely |    • G2 = 0.68 (0.36-1.27) |  |
 |  |  | G3 = Once or more per month |    • G3 = 0.66 (0.39-1.11) |  |
D & B score = 14 | Â | Â | Â | p = 0.094 | Â |
 |  |  | OPA level | Multivariate OR (95% CI) by OPA level |  |
 |  |  | G1 = Sedentary |    • G1 = 1.00 (referent) |  |
 |  |  | G2 = Light to moderate |    • G2 = 0.94 (0.59-1.48), p = 0.773 |  |
 |  |  | G3 = Heavy |    • G3 = 1.18 (0.57-2.46), p = 0.650 |  |
 |  |  | Outcome Measure: Intracerebral hemorrhage |  |  |
 |  |  | Multiple logistic regression |  |  |