Associations between Intensity, Frequency, Duration, and Volume of Physical Activity and the Risk of Stroke in Middle- and Older-Aged Chinese People: A Cross-Sectional Study

Association of physical activity, sedentary behavior and stroke in older adults

Objective

The aim of this study was to investigate the relationship between physical activity, sedentary behavior and stroke in people aged 60 years and older.

Methods

The study included 3,010 participants aged 60 and older from the National Health and Nutrition Examination Survey (NHANES). Data on sedentary behavior, physical activity and stroke were obtained through questionnaires. Statistical analyses were performed using a complex multistage sampling design and weighted multivariate logistic regression. Smoothed curve fitting and threshold effects analyses were used to explore non-linear relationships between physical activity, sedentary behavior and stroke.

Results

There were 244 (7.53%) participants aged 60 years and older who had experienced a stroke. After adjusting for all covariates, physical activity, sedentary behavior and stroke were significantly associated [OR (95% CI) for physical activity: 0.622 (0.443, 0.875), p = 0.009; OR (95% CI) for sedentary behavior: 2.602 (1.557, 4.348), p = 0.003]. C-reactive protein mediated the association between sedentary behavior and stroke among older adults, with a mediation of 3.64%.

Conclusion

In people aged 60 years and older, sedentary behavior was positively associated with stroke, whereas physical activity was negatively associated with stroke, and C-reactive protein mediated the relationship between sedentary behavior and stroke.

Higher triglyceride‑glucose index is associated with increased risk of stroke among middle-aged and elderly Chinese: a national longitudinal study

Stroke is a severe cerebrovascular disease. This study aimed to determine the association between triglyceride‑glucose (TyG) index and stroke among middle-aged and elderly Chinese. Data was extracted from China Health and Retirement Longitudinal Study survey 2015 and survey 2018. Logistic regression, trend test and subgroup analysis were conducted to assess the association. Possible nonlinear relationships were explored with restricted cubic spline (RCS). Propensity score matching (PSM) was conducted to attenuate the effect of confounding factors. ORs of stroke was positively associated with TyG index. The ORs in RCS analysis also increased with the rising TyG, though p for non-linearity was bigger than 0.05. After PSM, the ORs in the full adjusted models were 1.28 (1.01, 1.62). TyG was suggested as an independent risk factor for stroke in the middle aged and elderly Chinese.

Oxidative stress as a bridge between age and stroke: A narrative review

Stroke is the third most common cause of death globally and a leading cause of disability. The cellular and molecular changes following stroke and causes of neuronal death are not fully understood, and there are few effective treatments currently available. A rapid increase in the levels of reactive oxygen species (ROS) post stroke can overwhelm antioxidant defenses and trigger a series of pathophysiologic events including the inflammatory response, blood-brain barrier (BBB) disruption, apoptosis, and autophagy, ultimately leading to neuron degeneration and apoptosis. It is thought that beyond a certain age, the ROS accumulation resulting from stroke increases the risk of morbidity and mortality. In the present review, we summarize the role of oxidative stress (OS) as a link between aging and stroke pathogenesis. We also discuss how antioxidants can play a beneficial role in the prevention and treatment of stroke by eliminating harmful ROS, delaying aging, and alleviating damage to neurons.

The dilution effects of healthy lifestyles on the risk of depressive symptoms attributed to life-course disadvantages among Chinese middle-aged and older adults

BACKGROUND

Life-course disadvantages and unhealthy lifestyles are well-known to independently induce depressive symptoms, but whether adopting healthy lifestyles can dilute the depressive risks attributed to life-course disadvantages remain unknown in China.

METHODS

This population-based cross-sectional study included 5724 middle-aged and older people from the China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms and healthy lifestyles (including regular exercise, reasonable sleep, never smoking, and no heavy alcohol consumption) were collected in 2018 while life-course disadvantages were collected in 2014.

RESULTS

Multiple healthy lifestyles were associated with decreased depressive risks more significantly as the life-course disadvantages increased, with odds ratios (ORs) and 95 % confidence intervals (CIs) of 0.44 (0.25-0.80) and 0.33 (0.21-0.53) for 4 healthy lifestyles in participants with mild and severe life-course disadvantages, respectively. Life-course disadvantages and unhealthy lifestyles had enormous joint effects on depressive symptoms. Finally, adopting multiple healthy lifestyles can dilute the depressive risks attributed to life-course disadvantages and even mask some risks attributed to childhood disadvantages.

LIMITATIONS

Given that dietary data were not gathered by the CHARLS, diet was not included in the lifestyles used in this study. In addition, information on life-course disadvantages was primarily self-reported, which may lead to potential recall bias. Finally, the cross-sectional design of this study cannot capture causal associations well.

CONCLUSIONS

Adopting multiple healthy lifestyles can well-dilute the depressive risks attributed to life-course disadvantages in middle-aged and older Chinese, which is of great importance for reducing the depressive burden and the construction of healthy aging in China.

Physical activity, cardiorespiratory fitness, and cardiovascular health: A clinical practice statement of the ASPC Part I: Bioenergetics, contemporary physical activity recommendations, benefits, risks, extreme exercise regimens, potential maladaptations

Regular moderate-to-vigorous physical activity (PA) and increased levels of cardiorespiratory fitness (CRF) or aerobic capacity are widely promoted as cardioprotective measures in the primary and secondary prevention of atherosclerotic cardiovascular (CV) disease (CVD). Nevertheless, physical inactivity and sedentary behaviors remain a worldwide concern. The continuing coronavirus (COVID-19) pandemic has been especially devastating to patients with known or occult CVD since sitting time and recreational PA have been reported to increase and decrease by 28% and 33%, respectively. Herein, in this first of a 2-part series, we discuss foundational factors in exercise programming, with specific reference to energy metabolism, contemporary PA recommendations, the dose-response relationship of exercise as medicine, the benefits of regular exercise training, including the exercise preconditioning cardioprotective phenotype, as well as the CV risks of PA. Finally, we discuss the 'extreme exercise hypothesis,' specifically the potential maladaptations resulting from high-volume, high-intensity training programs, including accelerated coronary artery calcification and incident atrial fibrillation. The latter is commonly depicted by a reverse J-shaped or U-shaped curve. On the other hand, longevity data argue against this relationship, as elite endurance athletes live 3-6 years longer than the general population.

Factors associated with stroke among patients with type 2 diabetes mellitus in China: a propensity score matched study

OBJECTIVE

This study aimed to examine the prevalence of stroke and associated factors of stroke in patients with type 2 diabetes(T2DM) in China.

METHODS

Participants were 18,013 T2DM patients recruited with stratified random cluster sampling method from December 2013 to January 2014 in China. Propensity score matching was used to eliminate confounding effects between groups and logistic regression analysis was used to examine factors associated with stroke among T2DM patients.

RESULTS

Overall, the prevalence of stroke in the subjects with T2DM was 9.5%. After nearest neighbor matching, smoking (OR = 1.60, 95%CI: 1.26-2.03), hypertension (OR = 2.96, 95%CI: 2.55-3.43), dyslipidemia (OR = 2.00, 95%CI: 1.71-2.33), family history of stroke (OR = 2.02, 95%CI: 1.61-2.54), obesity (OR = 1.21, 95%CI: 1.01-1.45) and sleep duration < 6 h/day (OR = 1.44, 95%CI: 1.20-1.73) or > 8 h/day (OR = 1.22, 95%CI: 1.05-1.42) were positively associated with stroke, whereas drinking 1-3 days/week (OR = 0.64, 95%CI: 0.45-0.90) or daily (OR = 0.45, 95%CI: 0.33-0.60), effective exercise (OR = 0.65, 95%CI: 0.57-0.73) and underweight (OR = 0.30, 95%CI: 0.13-0.71) were negatively related to stroke. Besides, the risk of stroke increased substantially with accumulation of above seven modified risk factors. The odds ratio values of stroke in patients having ≥ 5 of the above seven risk factors was 14.39 (95% CI: 8.87-23.26).

CONCLUSIONS

The prevalence of stroke was high among T2DM in China. It is of great significance to strengthen comprehensive management of health-related behaviors including smoking cessation, moderate alcohol consumption, effective exercise, 6-8 h of sleep duration, keeping normal weight and the prevention of hypertension and dyslipidemia to have sustained beneficial effects on improvements of stroke risk factors.

Stroke Risk Factors in United States: An Analysis of the 2013-2018 National Health and Nutrition Examination Survey

Purpose

This research intended to identify significant risk factors of stroke among the elderly population in the United States using the k-means clustering method.

Patients and Methods

In this cross-sectional study, we analyzed data of 4346 subjects aged ≥60 years using the National Health and Nutrition Examination Survey (NHANES) 2013-2018 datasets. Questionnaire data, dietary data, and laboratory data were accessed to acquire measurements of the potential risk factors. A pre-defined classification method was used based on the Medical Condition Questionnaire to define the stroke group. K-means clustering analysis used all potential risk factors for differentiating both groups. A stepwise logistic regression analysis examined the association between significant risk factors and the odds of stroke.

Results

Age (OR:1.053, 95% CI:1.029-1.077), diabetes (OR: 28.019, 95% CI: 19.139-41.020), glycohemoglobin (OR: 2.309, 95% CI: 1.818-2.934), plasma fasting glucose (OR: 1.017, 95% CI: 1.010-1.024), hypertension (OR: 2.343, 95% CI: 1.602-3.426), dietary fiber consumption (OR:0.980, 95% CI:0.964-0.995), and education level (OR:0.541, 95% CI: 0.411-0.713) were identified as significant risk factor for stroke among the elderly population in the k-means clustering method. In the pre-defined grouping method, age (OR:1.093, 95% CI:1.054-1.132), diabetes (OR:2.228, 95% CI: 1.432-3.466), hypertension (OR:2.295, 95% CI:1.338-3.938), and dietary fiber consumption (OR: 0.966, 95CI%:0.947-0.985) were found to influence to the risk of stroke.

Conclusion

Age, hypertension, dietary fiber consumption, and education level are the significant risk factors of stroke among elders aged >60 years. Among all the risk factors, diabetes is the strongest predictor of stroke. Glycohemoglobin and plasma fasting glucose are also associated with stroke risks, implying that glycemic control is particularly crucial in stroke prevention and management among older adults.