Correlation between physical activity and stroke risk in middle-aged and elderly populations: an analysis based on the CHARLS database_West China Medical Journal

Authors：

CHEN Xiaoling ^1,2 , HE Song ³ , TAN Quandan ⁴ , MAO Fengkai ³ , DENG Hongwei ³ , LIN Yapeng ³ ,  ZHU Guoliang ⁴ ,  YANG Jie ^1,2

1. Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;
2. Department of Neurology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610072, P. R. China;
3. Department of Neurology, the First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610072, P. R. China;
4. School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610072, P. R. China;

Corresponding?author：

ZHU Guoliang, Email: zhuguoliangstudy@163.com; YANG Jie, Email: yangjie1126@163.com

Keywords：

Stroke; middle-aged and elderly people; physical activity; China Health and Retirement Longitudinal Study

DOI：

10.7507/1002-0179.202510067

Video：

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Objective To explore the association between different levels of physical activity and the risk of stroke in middle-aged and elderly people. Methods Middle-aged and elderly people from the China Health and Retirement Longitudinal Study in 2020 were selected as the research subjects. According to total physical (TPA) activity levels, the groups were divided into the inactive group, the low TPA group, the medium TPA group, and the high TPA group. This study used a logistic regression model to explore the impact of different levels of physical activity on the risk of stroke in middle-aged and elderly people. Results A total of 16 027 middle-aged and elderly population were included. Among them, 14 557 were physically active and 1 470 were inactive. Among the 14 557 physically active subjects, there were 4 852 in the high TPA group, 4 852 in the medium TPA group, and 4 853 in the low TPA group. 1 096 (6.8%) middle-aged and elderly people suffered from stroke. The research results showed that after correcting for covariates, medium and high TPA were significantly associated with a lower risk of stroke in middle-aged and elderly people (P<0.01). Furthermore, this study found a nonlinear relationship between TPA level and the prevalence of stroke (P for nonlinear=0.042). Conclusion Medium and high TPA levels are associated with a lower risk of stroke in middle-aged and elderly populations.

Citation： CHEN Xiaoling, HE Song, TAN Quandan, MAO Fengkai, DENG Hongwei, LIN Yapeng, ZHU Guoliang, YANG Jie. Correlation between physical activity and stroke risk in middle-aged and elderly populations: an analysis based on the CHARLS database. West China Medical Journal, 2026, 41(4): 605-610. doi: 10.7507/1002-0179.202510067 Copy

1.	Herpich F, Rincon F. Management of Acute Ischemic Stroke. Crit Care Med, 2020, 48(11): 1654-1663.
2.	Kuriakose D, Xiao Z. Pathophysiology and treatment of stroke: present status and future perspectives. Int J Mol Sci, 2020, 21(20): 7609.
3.	Ji C, Ge X, Zhang J, et al. The stroke burden in China and its long-term trends: insights from the global burden of disease (GBD) study 1990-2021. Nutr Metab Cardiovasc Dis, 2025, 35(7): 103848.
4.	毛凡, 姜瑩瑩, 劉寧, 等. 中國居民心腦血管疾病流行現況及危險因素分析: 基于 2017 年中國心血管健康指數研究. 中華預防醫學雜志, 2021, 55(11): 1280-1286.
5.	Salmantabar P, Abzhandadze T, Viktorisson A, et al. Pre-stroke physical inactivity and stroke severity in male and female patients. Front Neurol, 2022, 13: 831773.
6.	Kubota Y, Iso H, Yamagishi K, et al. Daily Total Physical Activity and Incident Stroke: The Japan Public Health Center-Based Prospective Study. Stroke, 2017, 48(7): 1730-1736.
7.	MacDonald CJ, Madika AL, Gomes R, et al. Physical activity and stroke among women: a non-linear relationship. Prev Med, 2021, 150: 106485.
8.	Ding M, Jia N, Zhou Y, et al. The dose-response relationships of different dimensions of physical activity with daily physical function and cognitive function in Chinese adults with hypertension: a cross-sectional study. Int J Environ Res Public Health, 2021, 18(23): 12698.
9.	Kim SY, Jeon SW, Shin DW, et al. Association between physical activity and depressive symptoms in general adult populations: AN analysis of the dose-response relationship. Psychiatry Res, 2018, 269: 258-263.
10.	Bai A, Tao L, Huang J, et al. Effects of physical activity on cognitive function among patients with diabetes in China: a nationally longitudinal study. BMC Public Health, 2021, 21: 481.
11.	Jiang C, Chen T, Xiang J, et al. Association between physical activity levels and stroke risk among Chinese adults aged 45 and over based on CHARLS. Sci Rep, 2024, 14(1): 31739.
12.	Zheng F, Yan L, Zhong B, et al. Progression of cognitive decline before and after incident stroke. Neurology, 2019, 93(1): e20-e28.
13.	Lee CD, Folsom AR, Blair SN. Physical activity and stroke risk: a meta-analysis. Stroke, 2003, 34(10): 2475-2481.
14.	Figueiró TH, Arins GCB, Santos CESD, et al. Association of objectively measured sedentary behavior and physical activity with cardiometabolic risk markers in older adults. PLoS One, 2019, 14(1): e0210861.
15.	Manolis AS, Manolis AA. Exercise and Arrhythmias: A Double-Edged Sword. Pacing Clin Electrophysiol, 2016, 39(7): 748-762.
16.	Maeda S, Tanabe T, Otsuki T, et al. Moderate regular exercise increases basal production of nitric oxide in elderly women. Hypertens Res, 2004, 27(12): 947-953.
17.	Di Francescomarino S, Sciartilli A, Di Valerio V, et al. The effect of physical exercise on endothelial function. Sports Med, 2009, 39(10): 797-812.
18.	Mora S, Lee IM, Buring JE, et al. Association of physical activity and body mass index with novel and traditional cardiovascular biomarkers in women. JAMA, 2006, 295(12): 1412-1419.
19.	Pescatello LS, Buchner DM, Jakicic JM, et al. Physical activity to prevent and treat hypertension: a systematic review. Med Sci Sports Exerc, 2019, 51(6): 1314-1323.
20.	Zhou L, Feng W, Xiang N, et al. Association between physical activity dimensions and the risk of hypertension among middle and older adults: a cross-sectional study in China. Front Public Health, 2022, 10: 995755.
21.	Zhang Y, Meng F, Fei X, et al. Association between physical activity level and diabetes incidence among Chinese middle-aged and older adults: a cross-sectional study from the China health and retirement longitudinal study. Front Public Health, 2024: 1430229.
22.	Pelletier CA, Omidvar M, Miyatani M, et al. Participation in moderate-to-vigorous leisure time physical activity is related to decreased visceral adipose tissue in adults with spinal cord injury. Appl Physiol Nutr Metab, 2018, 43(2): 139-144.
23.	Sattelmair JR, Kurth T, Buring JE, et al. Physical activity and risk of stroke in women. Stroke, 2010, 41(6): 1243-1250.
24.	Kyu HH, Bachman VF, Alexander LT, et al. Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013. BMJ, 2016, 354: i3857.
25.	German CA, Fanning J, Singleton MJ, et al. Physical activity, coronary artery calcium, and cardiovascular outcomes in the multi-ethnic study of atherosclerosis (MESA). Med Sci Sports Exerc, 2022, 54(5): 800-806.
26.	Florido R, Kwak L, Lazo M, et al. Six-Year Changes in Physical Activity and the Risk of Incident Heart Failure: ARIC Study. Circulation, 2018, 137(20): 2142-2151.

1. Herpich F, Rincon F. Management of Acute Ischemic Stroke. Crit Care Med, 2020, 48(11): 1654-1663.
2. Kuriakose D, Xiao Z. Pathophysiology and treatment of stroke: present status and future perspectives. Int J Mol Sci, 2020, 21(20): 7609.
3. Ji C, Ge X, Zhang J, et al. The stroke burden in China and its long-term trends: insights from the global burden of disease (GBD) study 1990-2021. Nutr Metab Cardiovasc Dis, 2025, 35(7): 103848.
4. 毛凡, 姜瑩瑩, 劉寧, 等. 中國居民心腦血管疾病流行現況及危險因素分析: 基于 2017 年中國心血管健康指數研究. 中華預防醫學雜志, 2021, 55(11): 1280-1286.
5. Salmantabar P, Abzhandadze T, Viktorisson A, et al. Pre-stroke physical inactivity and stroke severity in male and female patients. Front Neurol, 2022, 13: 831773.
6. Kubota Y, Iso H, Yamagishi K, et al. Daily Total Physical Activity and Incident Stroke: The Japan Public Health Center-Based Prospective Study. Stroke, 2017, 48(7): 1730-1736.
7. MacDonald CJ, Madika AL, Gomes R, et al. Physical activity and stroke among women: a non-linear relationship. Prev Med, 2021, 150: 106485.
8. Ding M, Jia N, Zhou Y, et al. The dose-response relationships of different dimensions of physical activity with daily physical function and cognitive function in Chinese adults with hypertension: a cross-sectional study. Int J Environ Res Public Health, 2021, 18(23): 12698.
9. Kim SY, Jeon SW, Shin DW, et al. Association between physical activity and depressive symptoms in general adult populations: AN analysis of the dose-response relationship. Psychiatry Res, 2018, 269: 258-263.
10. Bai A, Tao L, Huang J, et al. Effects of physical activity on cognitive function among patients with diabetes in China: a nationally longitudinal study. BMC Public Health, 2021, 21: 481.
11. Jiang C, Chen T, Xiang J, et al. Association between physical activity levels and stroke risk among Chinese adults aged 45 and over based on CHARLS. Sci Rep, 2024, 14(1): 31739.
12. Zheng F, Yan L, Zhong B, et al. Progression of cognitive decline before and after incident stroke. Neurology, 2019, 93(1): e20-e28.
13. Lee CD, Folsom AR, Blair SN. Physical activity and stroke risk: a meta-analysis. Stroke, 2003, 34(10): 2475-2481.
14. Figueiró TH, Arins GCB, Santos CESD, et al. Association of objectively measured sedentary behavior and physical activity with cardiometabolic risk markers in older adults. PLoS One, 2019, 14(1): e0210861.
15. Manolis AS, Manolis AA. Exercise and Arrhythmias: A Double-Edged Sword. Pacing Clin Electrophysiol, 2016, 39(7): 748-762.
16. Maeda S, Tanabe T, Otsuki T, et al. Moderate regular exercise increases basal production of nitric oxide in elderly women. Hypertens Res, 2004, 27(12): 947-953.
17. Di Francescomarino S, Sciartilli A, Di Valerio V, et al. The effect of physical exercise on endothelial function. Sports Med, 2009, 39(10): 797-812.
18. Mora S, Lee IM, Buring JE, et al. Association of physical activity and body mass index with novel and traditional cardiovascular biomarkers in women. JAMA, 2006, 295(12): 1412-1419.
19. Pescatello LS, Buchner DM, Jakicic JM, et al. Physical activity to prevent and treat hypertension: a systematic review. Med Sci Sports Exerc, 2019, 51(6): 1314-1323.
20. Zhou L, Feng W, Xiang N, et al. Association between physical activity dimensions and the risk of hypertension among middle and older adults: a cross-sectional study in China. Front Public Health, 2022, 10: 995755.
21. Zhang Y, Meng F, Fei X, et al. Association between physical activity level and diabetes incidence among Chinese middle-aged and older adults: a cross-sectional study from the China health and retirement longitudinal study. Front Public Health, 2024: 1430229.
22. Pelletier CA, Omidvar M, Miyatani M, et al. Participation in moderate-to-vigorous leisure time physical activity is related to decreased visceral adipose tissue in adults with spinal cord injury. Appl Physiol Nutr Metab, 2018, 43(2): 139-144.
23. Sattelmair JR, Kurth T, Buring JE, et al. Physical activity and risk of stroke in women. Stroke, 2010, 41(6): 1243-1250.
24. Kyu HH, Bachman VF, Alexander LT, et al. Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013. BMJ, 2016, 354: i3857.
25. German CA, Fanning J, Singleton MJ, et al. Physical activity, coronary artery calcium, and cardiovascular outcomes in the multi-ethnic study of atherosclerosis (MESA). Med Sci Sports Exerc, 2022, 54(5): 800-806.
26. Florido R, Kwak L, Lazo M, et al. Six-Year Changes in Physical Activity and the Risk of Incident Heart Failure: ARIC Study. Circulation, 2018, 137(20): 2142-2151.

West China Medical Journal

Correlation between physical activity and stroke risk in middle-aged and elderly populations: an analysis based on the CHARLS database

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