Physical Activity and Risk of Cerebrovascular Disease in the European Prospective Investigation Into Cancer and Nutrition-Spain Study

• Original Contribution

Physical Activity and Risk of Cerebrovascular Disease in the European Prospective Investigation Into Cancer and Nutrition-Spain Study

1. José María Huerta, PhD;
2. María-Dolores Chirlaque, MD;
3. María-José Tormo, PhD;
4. Diana Gavrila, MD;
5. Larraitz Arriola, MSc;
6. Conchi Moreno-Iribas, MD;
7. Pilar Amiano, PhD;
8. Eva Ardanaz, PhD;
9. Aurelio Barricarte, PhD;
10. Miren Dorronsoro, PhD;
11. Nerea Egüés, MD;
12. Nerea Larrañaga, MSc;
13. Esther Molina-Montes, PhD;
14. José Ramón Quirós, PhD;
15. María-José Sánchez, PhD;
16. Carlos A. González, PhD;
17. Carmen Navarro, PhD

+ Author Affiliations

1. From the Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain ((J.M.H., M.-D.C., M.-J.T., D.G., C.N.); CIBER Epidemiología y Salud Pública, Madrid, Spain ((J.M.H., M.-D.C., M.-J.T., D.G., L.A., C.M.-I., P.A., E.A., A.B., M.D., N.L., E.M.-M., M.-J.S., C.N.); Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain (M.-J.T., C.N.); Public Health Department of Gipuzkoa, Basque Government, Donostia-San Sebastián, Spain (L.A., P.A., M.D., N.L.); Public Health Institute of Navarra, Pamplona, Spain (C.M.-I., E.A., A.B., N.E.); Andalusian School of Public Health, Granada, Spain (E.M.-M., M.-J.S.); Public Health and Planning Directorate, Oviedo, Spain (J.R.Q.); Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, l’Hospitalet de Llobregat, Barcelona, Spain (C.A.G.).

1. Correspondence to José María Huerta, PhD, Consejería de Sanidad y Política Social, Servicio de Epidemiología, Ronda de Levante, 11, 30008, Murcia, Spain. E-mail: josem.huerta@carm.es

Abstract

Background and Purpose—Large-scale prospective epidemiological data testing the association between physical activity (PA) and cerebrovascular diseases (CVDs) are scarce, particularly in Europe. The objective was to assess the risk of CVD according to PA levels in adults.

Methods—We included a total of 13 576 men and 19 416 women aged 29 to 69 years and participating in the European Prospective Investigation into Cancer and Nutrition cohort in Spain, recruited between 1992 and 1996 and followed-up until 2006 to ascertain incident CVD events. The validated European Prospective Investigation into Cancer and Nutrition PA questionnaire was used to assess metabolic equivalent × hours per week dedicated to different types of PA. Hazard ratios of CVD by PA levels were estimated using multivariate Cox regression. Extensive baseline data collected on diet, lifestyle habits, medical history, and anthropometry were available to adjust for.

Results—A total of 210 transient ischemic attacks and 442 stroke cases (80% ischemic, 10% hemorrhagic, 7% subarachnoid hemorrhage, and 3% mixed or unspecified) were registered after 12.3 years of mean follow-up. Recreational activity was inversely associated with risk of CVD in women but not in men. Women walking for ≥3.5 hours per week were at lower risk of stroke than those who did not engage in regular walking. No significant associations were found for other leisure time activities or vigorous PA with CVD in either sex.

Conclusions—Recreational PA of moderate intensity was inversely associated with stroke incidence in women, whereas PA showed no effect on CVD risk in men. Increasing time dedicated to activities such as walking would be expected to help to reduce the stroke burden in women.

Key Words:

• cerebrovascular accident
• EPIC
• epidemiology
• physical activity
• Spain
• stroke

• Received July 11, 2012.
• Revision received September 28, 2012.
• Accepted October 17, 2012.

• © 2012 American Heart Association, Inc.