Occupational and leisure-time physical activity differentially predict 6-year incidence of stroke and transient ischemic attack in women
Open accessAbstract
Objectives Recent meta-analyses suggest a physical activity health paradox: high levels of occupational physical activity (OPA) increase cardiovascular disease (CVD) risk, while leisure-time physical activity (LTPA) decreases risk. However, studies of women and cerebrovascular disease are limited. This report examines physical activity effects on stroke and transient ischemic attack (TIA) among working women in the United States. Methods OPA history, health status, and lifestyle were assessed by baseline interviews of 31 270 employed Sister Study participants aged 35-74 years. OPA was assessed at six intensity levels (lowest: "mostly sitting"); the highest three were combined as "high intensity work." Independent OPA and LTPA effects on 6-year cerebrovascular disease incidence were estimated in adjusted Cox proportional hazard models. Results Stroke (N=441) and TIA (N=274) risk increased with more standing and higher intensity work at current and longest held job. Compared with mostly sitting, high intensity work at the current job increased TIA risk by 57% [hazard ratio (HR) 1.57, 95% confidence interval (CI) 1.04-2.38]. High intensity OPA at the longest held job increased risk for stroke by 44% (HR 1.44; 95% CI 1.08-1.93). Among women with CVD, sitting and standing equally, especially at the current job, increased risks up to two-fold (TIA HR 1.98, 95% CI 1.10-3.55) compared with mostly sitting at work. LTPA showed inverse associations. Conclusions Higher intensity levels of OPA increased stroke and TIA risks, while LTPA decreased risks; results corroborate the physical activity health paradox for women and cerebrovascular disease. More standing at work increased cerebrovascular disease risks, especially for women with CVD.
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One of the 24 articles that included both sexes reported an effect estimate only for men because of the small sample size of women.
“though one of these articles only reported an effect estimate for men due to the small sample size of women.38”
From Sex Differences in Physical Activity and Incident Stroke: A Systematic Review (2022) · cites this paper as [38]
The Methods (Study population; page not provided) state that the analytic sample comprised 31,270 women. The Discussion (Healthy worker effects; page not provided) likewise says only women employed at baseline were included. This paper therefore did not include both sexes or report a men-only effect estimate because of a small sample of women. (LLM, conf=0.90)
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Experimental — accuracy not yet measuredSix papers reported testing a sex by physical activity interaction term for total stroke, and all showed non-significant interactions.
“Six papers reported the testing of a sex by physical activity interaction term;33,38,40,41,50,52, all showing non-significant interactions.”
From Sex Differences in Physical Activity and Incident Stroke: A Systematic Review (2022) · cites this paper as [38]
The Methods (Study population; page not available) state that the analytic sample comprised 31,270 women, so this study could not test a sex-by-physical-activity interaction. The Methods (Statistical analyses; page not available) describe a possible time-by-covariate interaction, not a sex interaction, and report no non-significant sex-interaction result. (LLM, conf=0.90)
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Experimental — accuracy not yet measuredOne study did not report the effect estimate for women because of small case numbers and was not included in Table 2.
“One study38 did not report the effect estimate for women due to small case numbers; and this study was not included in Table 2.”
From Sex Differences in Physical Activity and Incident Stroke: A Systematic Review (2022) · cites this paper as [38]
The Methods (Study population; page unavailable) say the analytic sample comprised 31,270 women. The Results (page unavailable) explicitly report effect estimates for women and state that the paper’s Table 2 displays hazard ratios for stroke. This contradicts the attributed reason that the study did not report women’s effect estimates because of small case numbers; the citing document’s decision to omit it from its own Table 2 cannot be verified from this source. (LLM, conf=0.90)
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Experimental — accuracy not yet measuredOf the 7 papers showing similar total stroke effect estimates by sex, 5 demonstrated reduced risk of total stroke with increasing physical activity.
“Of the 7 papers showing similar effect estimates by sex, 31,33,38,40,47,50,52 5 papers demonstrated reduced risk of total stroke with increasing physical activity”
From Sex Differences in Physical Activity and Incident Stroke: A Systematic Review (2022) · cites this paper as [38]
The Results (page unavailable) report a monotonic reduction in stroke risk with increasing leisure-time physical activity. But the Methods—Study population (page unavailable) describes a women-only cohort, so this paper cannot establish similar effect estimates by sex or the citing sentence’s count of five papers out of seven. (LLM, conf=0.87)
Experimental — accuracy not yet measuredAmong 17 papers that included both women and men and reported total stroke estimates, 7 (41%) showed similar associations between physical activity and incident stroke in women and men.
“Among these 17 papers, 7 (41%) showed similar associations between physical activity and incident stroke between women and men”
From Sex Differences in Physical Activity and Incident Stroke: A Systematic Review (2022) · cites this paper as [38]
The Methods (Study population; page unavailable) describe a cohort of women, not a comparison of women and men. The passage on prior studies (page unavailable) mentions five with sex-specific results, but does not report that 7 of 17 papers found similar associations. Searches for “17 papers,” “7 (41%),” and sex-specific comparisons did not locate that finding in our copy. (LLM, conf=0.76)
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References 77 · Cited by 65
Research works printed but not linked: 2
- [49]World Health Organization. Global Recommendations on Physical Activity for Health. Geneva; 2010. 26180873
- [66]Palatini P Elevated heart rate as a predictor of increased cardiovascular morbidity. J Hypertens Suppl 1999 8; 17(3): S3– 10. 10489092
- Authors
- Hall, C., Heck, J. E., Sandler, D. P., Ritz, B., Chen, H., & Krause, N.
- Affiliations
- University of California, Los Angeles (US)
- National Institutes of Health (US)
- Michigan State University (US)
- Corresponding author
- Krause, Niklas
- Venue
- Scandinavian Journal of Work, Environment & Health
- Published
- 2018-11-19
- Volume
- 45
- Issue
- 3
- Pages
- 267-279
- ISSN
- 0355-3140 (ISSN-L)
- 1795-990X
- PMC
- PMC7748381
- OpenAlex
- W2901754555
- Cited by
- 65
- References
- 77
- Citations by year
- 2026: 2 · 2025: 13 · 2024: 10 · 2023: 10 · 2022: 11 · 2021: 4 · 2020: 9 · 2019: 6
- FWCI
- 3.26
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- Scandinavian Journal of Work Environment & Health (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute for Occupational Safety and Health (T42OH008412)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Health Professions › General Health Professions › Workplace Health and Well-being
- Keywords
- occupational physical activity, leisure-time physical activity, stroke, transient ischemic attack, cerebrovascular disease, women, standing at work, sitting at work, work intensity, cardiovascular disease, Sister Study
- MeSH terms
- Ischemic Attack, Transient, Employment, Female, Humans, Interviews as Topic, Leisure Activities, Longitudinal Studies, Middle Aged, Prospective Studies, Surveys and Questionnaires, Risk Factors, Time Factors, United States, Exercise, Incidence, Occupational Health, Stroke, Sedentary Behavior, Self Report
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