• Time spent walking by older men was associated with reduced risk of onset of stroke in dose-response fashion.
• There was little evidence for a dose-response relationship between walking pace and stroke.

Older men who want to reduce their risk of stroke should add a long walk to their daily routine, a new study found.

Among community-dwelling elderly men, the research showed a weak, nonsignificant inverse association between total leisure time physical activity and stroke, but a strong inverse, dose-response relationship between time spent walking and stroke risk.

The association was independent of walking pace, activity level and established and novel stroke risk factors, Barbara J. Jefferis, PhD, of University College London, U.K., and colleagues, wrote in the journal Stroke.

Men who walked eight to 14 hours each week had about a one-third lower risk of stroke compared to men who walked no more than three hours a week or did not walk at all, and the risk was about two-thirds lower for men who walked more than 22 hours a week.

“Compared to walking at a slow pace, the men who walked faster had about a one-third reduction in stroke risk, but this was entirely explained by the fact that they walked further than men who walked slower,” Jefferis told MedPage Today. “On balance it seemed that time spent walking, rather than walking pace, was more important in our study.”

Walking is the predominant form of physical activity in older adults, and it is important to understand its impact on stroke risk in this population, the researchers wrote.

“Although slower walking speeds and spending less time walking are associated with elevated total cardiovascular disease mortality risk, few prospective studies of stroke examine the relative importance of pace compared with time spent walking or distance walked,” they wrote. “Some suggest that both faster walking pace and greater time spent walking or MET [metabolic equivalent of task] hours of walking are protective against stroke and others have examined only walking speed.”

They added that few, if any, prospective studies examining walking and stroke risk have addressed the mediating influences of novel cardiovascular markers, including C-reactive protein (CRP), D-dimer, and N-terminal pro-brain natriuretic peptide (NT-proBNP), which is a marker of cardiac dysfunction.

In their latest research, Jefferis and colleagues examined the impact of walking and total leisure time physical activity on stroke risk, while investigating the role of CRP, D-dimer, and NT-proBNP alongside traditional risk factors as intermediate pathways.

The study included 3,435 healthy men between the ages of 60 and 80 from a U.K. population-based British Regional Heart Study cohort followed for a median of 10.9 years.

At study entry, the men were asked how much they walked each week and how fast they walked.

During the follow-up period, 195 first stroke events occurred.

The men in the study walked a median of 7 (interquartile range, 3-12) hours a week and walking more hours was associated with lower heart rate, D-dimer, and higher forced expiratory volume in 1 second.

Among the main study findings:

• Compared to men walking 0 to 3 hours a week, men walking 4 to 7 hours, 8 to 14 hours, 15 to 21 hours, and more than 22 hours a week had age- and region-adjusted hazard ratios for stroke of 0.89 (95% CI 0.60–1.31), 0.63 (95% CI 0.40–1.00), 0.68 (95% CI 0.35–1.32), and 0.36 (95% CI 0.14–0.91), respectively, (P=0.006).

• Hazard ratios were somewhat attenuated by adjustment for established and novel risk markers (inflammatory and hemostatic markers and cardiac function [N-terminal pro-brain natriuretic peptide]) and walking pace, but linear trends remained.

• There was little evidence for a dose-response relationship between walking pace and stroke; comparing average pace or faster to a baseline of slow pace, the hazard ratio for stroke was 0.65 (95% CI 0.44–0.97), which was fully mediated by time spent walking.

“We found that all these (established and novel risk) factors only explained a small amount of the relationship between time spent walking and the onset of stroke,” Jefferis said,” This suggests that there may be other factors operating which explain why walking protects against stroke.”

Although the study only included men and Jefferis said the findings could not be generalized to women, she also said there is no reason to expect that women would not derive the same protective benefits from walking as men.

“Stroke is a major cause of death and disability and it is important to find ways to prevent it, especially in older people who are at high risk,” she said. “Our study suggests that maintaining an active lifestyle, specifically by walking, could be an important part of stroke prevention strategies in older people.”

From the American Heart Association:

• Guidelines for the Primary Prevention of Stroke

Primary source: Stroke