Association of Physical Activity and Risk of Stroke: A Prospective Cohort Study of Chinese Middle‐aged and Older Adults

PURPOSES: To investigate the relationship between different physical activity (PA) patterns and stroke incidence among middle-aged and elderly populations in China. METHODS: Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative prospective cohort encompassing 2011 to 2020. PA was calculated based on the International Physical Activity Questionnaire. Different patterns of PA included moderate-to-vigorous PA (MVPA, ≥ 150 min/wk vs. < 150 min/wk), vigorous PA (VPA, ≥ 75 min/wk vs. < 75 min/wk), moderate PA (MPA, ≥ 150 min/wk vs. < 150 min/wk), light PA (LPA, ≥ 300 min/wk vs. < 300 min/wk), and total PA (TPA, ≥ 600 metabolic equivalent of task [MET]-min/wk vs. < 600 MET-min/wk). Cox proportional hazards models evaluated stroke risk associations, while restricted cubic splines (RCS) characterized TPA dose-response effects. RESULTS: There were 5090 participants in total (mean age, 59.23 [standard deviation, 9.43] years; 54.5% were female), and 378 (7.4%) incident stroke cases were documented at a 9-year follow-up. Achieving the World Health Organization (WHO) guideline of ≥150 min/wk MVPA was associated with a 24% lower stroke risk (adjusted hazard ratio [HR] = 0.77, 95% confidence interval [CI] = 0.62-0.96, p = 0.019). No significant association was observed between VPA (HR = 0.79, 95% CI 0.63-1.01), MPA (HR = 0.82, 95% CI = 0.67-1.01), LPA (HR = 0.86, 95% CI = 0.70-1.07), or TPA (HR = 0.84, 95% CI = 0.65-1.08) and stroke risk. Additionally, RCS analysis demonstrated a non-significant dose-response relationship between TPA and stroke risk. CONCLUSION: This study validates WHO's MVPA guidelines (≥ 150 min/wk) for stroke prevention in Chinese elders. However, the predominantly self-reported and occupation-based PA in this cohort highlights the need for future research focusing on objective measurements of leisure-time PA.