Association of Physical Activity and Risk of Stroke: A Prospective Cohort Study of Chinese Middle‐aged and Older Adults

ABSTRACT Purposes To investigate the relationship between different physical activity (PA) patterns and stroke incidence among middle‐aged and elderly populations in China. Methods Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative prospective cohort encompassing 2011 to 2020. PA was calculated based on the International Physical Activity Questionnaire. Different patterns of PA included moderate‐to‐vigorous PA (MVPA, ≥ 150 min/wk vs. < 150 min/wk), vigorous PA (VPA, ≥ 75 min/wk vs. < 75 min/wk), moderate PA (MPA, ≥ 150 min/wk vs. < 150 min/wk), light PA (LPA, ≥ 300 min/wk vs. < 300 min/wk), and total PA (TPA, ≥ 600 metabolic equivalent of task MET‐min/wk vs. < 600 MET‐min/wk). Cox proportional hazards models evaluated stroke risk associations, while restricted cubic splines (RCS) characterized TPA dose‐response effects. Results There were 5090 participants in total (mean age, 59.23 standard deviation, 9.43 years; 54.5% were female), and 378 (7.4%) incident stroke cases were documented at a 9‐year follow‐up. Achieving the World Health Organization (WHO) guideline of ≥150 min/wk MVPA was associated with a 24% lower stroke risk (adjusted hazard ratio HR = 0.77, 95% confidence interval CI = 0.62–0.96, p = 0.019). No significant association was observed between VPA (HR = 0.79, 95% CI 0.63–1.01), MPA (HR = 0.82, 95% CI = 0.67–1.01), LPA (HR = 0.86, 95% CI = 0.70–1.07), or TPA (HR = 0.84, 95% CI = 0.65–1.08) and stroke risk. Additionally, RCS analysis demonstrated a non‐significant dose‐response relationship between TPA and stroke risk. Conclusion This study validates WHO's MVPA guidelines (≥ 150 min/wk) for stroke prevention in Chinese elders. However, the predominantly self‐reported and occupation‐based PA in this cohort highlights the need for future research focusing on objective measurements of leisure‐time PA.