Abstract
Purpose
Physical inactivity, a modifiable risk factor for cardiovascular disease, is independently
associated with stroke. Though some prior data have suggested sex differences in levels
of physical activity, whether there are sex differences in the role of physical activity
in primary stroke prevention is largely unknown. This systematic review identifies
and describes recent findings on sex differences in the association between physical
activity and incident (first-ever) stroke. This review also describes the current
evidence on the strength of the association between physical activity and a reduced
stroke risk in women in particular.
Methods
Using a prespecified strategy, PubMed/MEDLINE and Cochrane Central were searched to
identify observational studies or trials published from 2000 to 2020 and reporting
sex differences in physical activity and incident stroke. To be included, among other
criteria, studies had to include sex-specific effect estimates from women, men, or
both. Titles, abstracts, and full-text articles were screened to identify studies
meeting the inclusion criteria, and adjusted sex-specific estimates of the association
between physical activity and incident stroke for total stroke (ischemic plus hemorrhagic)
or ischemic stroke were abstracted.
Findings
Thirty-seven studies met the inclusion criteria. Of 17 studies that included data
on total incident stroke (ischemic and hemorrhagic combined) in both women and men,
7 (41%) showed similar associations between physical activity and incident stroke
between women and men, 6 (35%) suggested a significant effect in women but not in
men, and 3 (18%) showed a significant effect in men but not in women. Of 10 studies
that included data on ischemic stroke in women and men, 5 (50%) suggested similar
effects in women and men, 4 (40%) suggested a significant effect in women but not
in men, and 1 (10%) showed an effect in men but not women. In women specifically,
the majority of included studies demonstrated a reduced risk for incident stroke with
physical activity, with relative risk reductions ranging from 11% to 72%, though most
estimates fell between 20% and 40%.
Implications
The majority of studies indicated a clear association between physical activity and
a reduction in stroke risk. Studies were split as to the potential for sex differences
in this association. Future prospective investigations should identify strategies
for the use of increased physical activity for primary stroke prevention, with sex-specific
considerations as warranted. The data on sex-specific dose–response relationship between
physical activity and stroke risk are inconclusive and warrant more research.
Key words
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Article info
Publication history
Published online: April 10, 2022
Accepted:
February 12,
2022
Identification
Copyright
© 2022 Elsevier Inc.
