Mitigating Stroke Risk in Type 2 Diabetes Through Physical Activity: A Nationwide Population-Based Study in Sweden

Type 2 diabetes (T2DM) is associated with elevated stroke risk. Physical activity may attenuate this excess risk, but large-scale population evidence is limited. This study evaluated whether physical activity mitigates excess stroke risk in individuals with T2DM compared with age- and sex-matched individuals without diabetes.

All adults with T2DM registered in the Swedish National Diabetes Register between 2010 and 2019 were included and matched 1:3 to individuals without diabetes based on age and sex. Participants were stratified into five groups according to physical activity. Stroke incidence was estimated using Kaplan-Meier curves, and Cox proportional hazards models calculated adjusted hazard ratios (HRs) for ischemic and hemorrhagic stroke. Robustness was assessed using competing risks regression.

The cohort included 369,704 individuals with T2DM (mean [standard deviation] age, 64.3 [12.3] years; 156,729 female individuals [42.4%]) and 1,109,112 matched individuals without diabetes. The adjusted HR for ischemic stroke in inactive individuals with T2DM compared with individuals without diabetes was 1.36 (95% confidence interval [CI] 1.23-1.50), declining with higher activity and becoming non-significant among those active ≥3 times/week (HR 1.05, 95% CI 0.96-1.15). The elevated ischemic stroke risk at higher glycated hemoglobin levels was attenuated in individuals with higher physical activity.

Higher physical activity levels were associated with reduced stroke risk in individuals with T2DM. Those active at least three times weekly had stroke risk comparable to individuals without diabetes of the same age and sex. Promoting physical activity should be an integral component of diabetes care and stroke prevention.