Association of physical activity and dietary quality with stroke: a population-based observational study

Little is known about the combined association of physical activity (PA) and dietary quality (DQ) with stroke and its mortality outcomes. This study aims to investigate the individual and combined association of PA and DQ on odds of prevalent stroke and mortality among stroke survivors. We analyzed data from 20,225 adults participating in the 2007-2018 National Health and Nutrition Examination Survey, including 838 stroke survivors. PA was measured by the self-reported metabolic equivalent to task (MET) minutes per week, and DQ by Healthy Eating Index 2020 (HEI-2020). Logistic regression models evaluated associations with the odds of prevalent stroke, and Cox proportional hazards regression models assessed mortality risks among stroke survivors. Compared to no PA - lower DQ (reference), low PA - lower DQ (adjusted OR 0.49, 95%CI 0.32-0.75), low PA - higher DQ (adjusted OR 0.56, 95%CI 0.34-0.92), high PA - lower DQ (adjusted OR 0.66, 95%CI 0.44 - 0.99), and high PA - higher DQ (adjusted OR 0.50, 95%CI 0.34-0.73) were significantly associated with lower odds of stroke. Among stroke survivors, reduced mortality was observed for low PA-higher DQ (adjusted HR 0.43; 95% CI, 0.19-0.95), high PA-lower DQ (HR 0.36; 95% CI, 0.17-0.75), and high PA-higher DQ (HR 0.47; 95% CI, 0.27-0.83). This large observational study showed that a combination of appropriate PA and higher DQ is associated with reduced odds of stroke and mortality among stroke survivors. These findings support lifestyle modification as a strategy for stroke prevention and survivor care.