Dose-response association of total and leisure-time physical activity with the risk of different subtypes of stroke: a systematic-review and meta-analysis

Background: This study aimed to investigate the dose-response relationship of total physical activity (TPA), leisure-time physical activity (LTPA), and occupational physical activity (OPA) with the risk of stroke. Methods: PubMed, Cochrane Library, Embase, and Web of Science were searched to collect relevant studies on PA and stroke risk up to December 2024, and cohort research was considered to include. The Newcastle-Ottawa Scale was used to assess the quality of included studies. Egger's test and sensitive analysis were conducted. Dose-response meta-analysis and methodological quality evaluation were performed. Results: A total of 23, 15, and 10 studies assessed the relationship between TPA, LTPA, and OPA with stroke. Meta-analyses results showed that higher levels of TPA, LTPA, and OPA were associated with a lower stroke risk. A nonmonotonic non-linear dose-response relationship was detected between TPA and the risk of total, hemorrhagic, and ischemic stroke. An inverse linear dose-response relationship between LTPA and the risk of total, hemorrhagic stroke, and ischemic stroke. Conclusion: Stroke risk is significantly reduced with increasing levels of TPA when it is lower, and has an inverse linear dose-response relationship with LTPA. A higher level of OPA is associated with lower stroke risk, but inconsistent data result in high heterogeneity.