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    Exercise Decreases the Risk of Ischemic Stroke, Study Shows

    Studies show that exercise protects against heart disease, but less is known about its effect on stroke. Not all studies have found a benefit, and many looked only at men.

    Now a new study of women reveals that the people who exercised the most were almost half as likely to have a stroke as those who exercised the Least. Dr. Frank B. Hu of the Harvard School of Public Health in Boston,
    Mass., and colleagues report their results in the June 14, 2000, Journal of the American Medical Association. This was true only for ischemic strokes, the most common type, which are caused by blockages in the arteries.

    The researchers examined data from the Nurses' Health Study on 72,488 female nurses, aged 40 to 65 years, living throughout the United States. None of the women had signs of heart disease or cancer when the
    study began in 1986. In 1986, 1988, and 1992, the participants completed detailed questionnaires about their physical activity. By 1994, 407 of the nurses had suffered a stroke, 258 of which were ischemic.

    The researchers controlled for other factors that can increase the risk of stroke, including age, body mass index, menopausal status, having high blood pressure, diet, and medications such as anti-hypertensives and cholesterol-lowering medications. They did not control for oral contraceptive use because the women were middle-aged and older. According to Dr. Hu, past use of birth control pills would not have an appreciable impact on the study results.

    Women who were more physically active tended to be leaner and less likely to smoke than their inactive colleagues.

    Each 3.5-hour per week increase in moderate to vigorous physical activity lowered the risk of ischemic stroke by 29 percent, and total stroke by 19 percent, they write. Vigorous activity included jogging, running, biking, aerobic, swimming, and racket sports; all required a six-fold increase in metabolic rate. However, even moderate exercise, such as brisk walking for 30 to 60 minutes five days a week, lowered a person's risk of suffering a stroke, the team
    reports.

    "Any movement is better than nothing," Dr. Hu told HeartInfo/Mediconsult. Having a physically demanding job is beneficial, he said. "People who are more active in their job should also have a lower [stroke] risk," though this isn't an area he studied.

    Sedentary women who became active were less likely to have a ischemic stroke than people who remained sedentary, the team writes. Sedentary is defined as less than one hour per week of even moderate physical activity.

    Dr. Hu concedes that the study relies on self-reports of exercise, and that the cases of stroke from bleeding may have been too few to detect any association with exercise levels.

    But the benefits of walking "are reassuring, since walking is a physical activity that is highly accessible, readily adopted, inexpensive, and rarely associated with exercise-related injury," Dr. Hu and his colleagues write. "Walking is the most popular form of physical activity, especially among middle-aged and older women," the team notes.

    Why does exercise help? It lowers blood pressure, increases HDL (the "good" cholesterol) levels, helps prevent atherosclerosis, burns calories, and helps control blood sugar levels, the team notes.



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