Leisure Time Physical Activity Reduces the Risk for Stroke in Adults: A Reanalysis of a Meta-Analysis Using the Inverse-Heterogeneity Model.

George A Kelley,Kristi S Kelley

doi:10.1155/2019/8264502

Abstract

Objective Apply more robust and additional analyses to a previous meta-analysis that reported statistically significant associations between leisure time physical activity (LTPA) and stroke. Methods A reanalysis of a previous meta-analysis that included nine prospective cohort studies representing 269,594 men and women 25-84 years of age and in which the association between LTPA and incident stroke was examined. Follow-up periods ranged from 7.7 to 32.0 years. Relative risks (RR) from each study were pooled using the inverse-heterogeneity model. Heterogeneity was examined using the Q statistic, inconsistency using I2, and small-study effects using Doi plots and the LFK index. Influence and cumulative meta-analysis were also conducted. Results Using low LTPA as the reference, moderate LTPA was associated with a statistically significant reduction in the risk for stroke in men (RR = 0.79, 95% CI = 0.65 to 0.95) and a trend in women (RR = 0.88, 95% CI = 0.78 to 1.0). High LTPA was associated with a statistically significant reduction in the risk for stroke in both men (RR = 0.72, 95% CI = 0.60 to 0.86) and women (RR = 0.78, 95% CI = 0.66 to 0.92). No statistically significant heterogeneity was observed and inconsistency was low. However, potential small-study effects were observed. With each study deleted once, results remained statistically significant. Cumulative meta-analysis demonstrated stability in results since at least 2005. Conclusions Leisure time physical activity is associated with a reduced risk of stroke in both men and women. However, the small-study effects observed suggest the possibility that results may be exaggerated.

Highlights

Cerebrovascular disease is a major public health problem worldwide
Leisure time physical activity was assessed using a variety of methods and was categorized in the original meta-analysis as either low, moderate, or high, with categories between the lowest and highest levels pooled to represent moderate leisure time physical activity (LTPA) [6]
A forest plot of the association between moderate versus low LTPA is shown in Figure 1 and Supplementary File 1

Summary

Introduction

Cerebrovascular disease is a major public health problem worldwide. When compared to the year 1990, the overall stroke burden with respect to the absolute number of people affected has increased worldwide [1, 2]. An estimated 7.2 million US adults 20 years of age and older reported having a stroke in 2014, with overall prevalence estimated at 2.7% [4]. For the period 2013 to 2014, the annual direct and indirect costs of stroke in the US were estimated at $40.1 billion, with an expected doubling from $36.7 billion to $94.3 billion between 2015 and 2030 [4]. In 27 European countries, the annual economic cost of stroke was estimated at $30.7 billion [5]

Methods

Results

Conclusion