Stroke
remains a leading cause of mortality and disability globally, resulting
in 7.3 million stroke-related deaths and 160.5 million
disability-adjusted life-years.1,2
By 2030, the prevalence of stroke among US adults will increase by
20.5% compared with 2012, with an additional 3.4 million adults
suffering from stroke.2 Stroke severely impairs daily functioning, and ≈75% of stroke survivors experience permanent disabilities.2–4
remains a leading cause of mortality and disability globally, resulting
in 7.3 million stroke-related deaths and 160.5 million
disability-adjusted life-years.1,2
By 2030, the prevalence of stroke among US adults will increase by
20.5% compared with 2012, with an additional 3.4 million adults
suffering from stroke.2 Stroke severely impairs daily functioning, and ≈75% of stroke survivors experience permanent disabilities.2–4
Sedentary
behavior refers to any waking behavior of low energy expenditure (≤1.5
metabolic equivalents of task) while in a sitting, lying, or reclining
posture.5,6
Among stroke survivors, the levels of physical activity are critically
low. It is estimated that 40% of stroke survivors participate in little
or no leisure-time physical activity and spend prolonged time sitting.7,8
The accelerometer-measured time of moderate-to-vigorous physical
activity among stroke survivors is reported to range from 5 to 10 min/d.9,10 In addition, their daily step counts are less than half of those in the age-matched group.9,10
Sedentary behavior has become a crucial concern in the fields of
clinical practice and policy-making, as evidence supports its
detrimental effects on morbidity and mortality.5,6
The American Heart Association/American Stroke Association advocates
for less sitting time and more regular physical activity after stroke,
but quantitative guidelines are not available due to scarce evidence.11
behavior refers to any waking behavior of low energy expenditure (≤1.5
metabolic equivalents of task) while in a sitting, lying, or reclining
posture.5,6
Among stroke survivors, the levels of physical activity are critically
low. It is estimated that 40% of stroke survivors participate in little
or no leisure-time physical activity and spend prolonged time sitting.7,8
The accelerometer-measured time of moderate-to-vigorous physical
activity among stroke survivors is reported to range from 5 to 10 min/d.9,10 In addition, their daily step counts are less than half of those in the age-matched group.9,10
Sedentary behavior has become a crucial concern in the fields of
clinical practice and policy-making, as evidence supports its
detrimental effects on morbidity and mortality.5,6
The American Heart Association/American Stroke Association advocates
for less sitting time and more regular physical activity after stroke,
but quantitative guidelines are not available due to scarce evidence.11
Physical activity is one of the modifiable health behaviors recommended for the prevention and rehabilitation of stroke.12–15
Increasing physical activity can activate neuroprotective mechanisms,
mitigate other cardiovascular risk factors, and enhance overall health
in stroke survivors.14–16
Despite previous research highlighting the beneficial effect of overall
physical activity in stroke survivors, most prior studies have not
distinguished domain-specific physical activity, especially that
performed during leisure time. There is much evidence supporting the
role of leisure-time physical activity in the primary prevention of
stroke,17,18
yet evidence regarding the effects of leisure-time physical activity
after stroke is limited. Epidemiological studies have revealed that
leisure-time physical activity can eliminate the detrimental effects of
prolonged sitting not only in the general population but also in
populations with cancer or diabetes.19–21
A large prospective cohort study involving the general population in
Taiwan concluded that all-cause mortality associated with prolonged
sitting was alleviated by an additional 15 to 30 minutes of daily
leisure-time physical activity.19
Among 1535 US cancer survivors included in the National Health and
Nutrition Examination Survey (NHANES), those engaging in at least 150
minutes of leisure-time physical activity per week showed a reduced risk
of all-cause mortality associated with prolonged sitting.20
In the NHANES cohort of US adults with diabetes, the association
between prolonged sitting and increased all-cause and heart disease
mortality was only observed among those who were insufficiently active.
In contrast, the association was not observed among those who were
sufficiently active.21
Nevertheless, it is less clear whether these findings could apply to
stroke survivors, as epidemiological evidence remains scarce on the
joint associations of leisure-time physical activity and daily sitting
time with survival after stroke. To bridge these knowledge gaps, the
main aim of this study was to assess the independent and joint
associations of daily sitting time and leisure-time physical activity
with all-cause and cause-specific mortality among a US nationally
representative sample of stroke survivors.
Increasing physical activity can activate neuroprotective mechanisms,
mitigate other cardiovascular risk factors, and enhance overall health
in stroke survivors.14–16
Despite previous research highlighting the beneficial effect of overall
physical activity in stroke survivors, most prior studies have not
distinguished domain-specific physical activity, especially that
performed during leisure time. There is much evidence supporting the
role of leisure-time physical activity in the primary prevention of
stroke,17,18
yet evidence regarding the effects of leisure-time physical activity
after stroke is limited. Epidemiological studies have revealed that
leisure-time physical activity can eliminate the detrimental effects of
prolonged sitting not only in the general population but also in
populations with cancer or diabetes.19–21
A large prospective cohort study involving the general population in
Taiwan concluded that all-cause mortality associated with prolonged
sitting was alleviated by an additional 15 to 30 minutes of daily
leisure-time physical activity.19
Among 1535 US cancer survivors included in the National Health and
Nutrition Examination Survey (NHANES), those engaging in at least 150
minutes of leisure-time physical activity per week showed a reduced risk
of all-cause mortality associated with prolonged sitting.20
In the NHANES cohort of US adults with diabetes, the association
between prolonged sitting and increased all-cause and heart disease
mortality was only observed among those who were insufficiently active.
In contrast, the association was not observed among those who were
sufficiently active.21
Nevertheless, it is less clear whether these findings could apply to
stroke survivors, as epidemiological evidence remains scarce on the
joint associations of leisure-time physical activity and daily sitting
time with survival after stroke. To bridge these knowledge gaps, the
main aim of this study was to assess the independent and joint
associations of daily sitting time and leisure-time physical activity
with all-cause and cause-specific mortality among a US nationally
representative sample of stroke survivors.
