Association between physical activity patterns and the risk of stroke phenotypes: an accelerometer-based prospective...

There is growing evidence of an association between exercise duration and stroke risk. However, there is no high-quality prospective evidence to confirm the equal distribution of the two exercise patterns, weekend warriors and exercise duration, and whether there are differences between different stroke subtypes. Therefore, the aim of this study was to explore the association between different exercise patterns and stroke and its subtypes using exercise data from the UK Biobank.

This study analyzed data from 90,926 UK Biobank participants with long-term follow-up (mean ranging from 7.56 to 7.83 years). Accelerometer-derived MVPA data were used to classify individuals into three groups based on current guidelines: inactive (MVPA < 150 min per week), active conventional (MVPA ≥ 150 min per week with < 50% accumulated in 1-2 days), and active weekend warrior (WW; MVPA ≥ 150 min per week with ≥ 50% accrued in 1-2 days). Multivariable Cox proportional hazards models were applied to estimate the hazard ratios (HRs) for overall stroke, ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH), while adjusting for covariates including age, sex, body mass index, ethnicity, healthy diet score, Townsend Deprivation Index, annual income, smoking status, alcohol consumption, diabetes status, family history of stroke, and education level. Stratified analyses based on MVPA distribution percentiles (25th, 50th, and 75th) were also performed to assess model stability.

Relative to inactive individuals, both the active WW group (HR = 0.70; 95% CI = 0.62-0.80; P < 0.001) and the active conventional group (HR = 0.78; 95% CI = 0.66-0.91; P < 0.001) demonstrated significantly lower overall stroke risk, with no significant difference between the two active patterns (HR = 0.90; 95% CI = 0.77-1.06; P = 0.099). For ischemic stroke, the active WW group exhibited a modest, non-significant risk reduction (HR = 0.88; 95% CI = 0.74-1.05; P = 0.153), whereas the active conventional group showed a significantly elevated risk (HR = 1.31; 95% CI = 1.10-1.55; P = 0.002); direct comparisons indicated that the WW pattern conferred a significantly lower risk than the conventional pattern (HR = 0.67; 95% CI = 0.58-0.77; P < 0.001). For subarachnoid hemorrhage, the active conventional pattern was associated with an increased risk (HR = 2.03; 95% CI = 1.15-3.59; P = 0.015) relative to inactivity, while the risk in the active WW group was not significantly different (HR = 1.40; 95% CI = 0.79-2.49; P = 0.247). No significant differences were observed in the risk for intracerebral hemorrhage across groups.

Meeting the recommended 150 min of weekly MVPA is associated with a reduced overall risk of stroke. Both active exercise patterns provide protection against ischemic stroke; however, a conventional distribution of physical activity may be linked to a higher risk of subarachnoid hemorrhage. These findings suggest that, in addition to total MVPA volume, the temporal pattern of activity accumulation plays a critical role in modulating stroke risk.