Letter by Du et al Regarding Article, “Long-Term Leisure-Time Physical Activity Intensity and All-Cause and Cause-Specific Mortality: A Prospective Cohort of US Adults”

HomeCirculationVol. 147, No. 9Letter by Du et al Regarding Article, “Long-Term Leisure-Time Physical Activity Intensity and All-Cause and Cause-Specific Mortality: A Prospective Cohort of US Adults” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Du et al Regarding Article, “Long-Term Leisure-Time Physical Activity Intensity and All-Cause and Cause-Specific Mortality: A Prospective Cohort of US Adults” Lixin Du, Pan Wang and Hongwei Chen Lixin DuLixin Du https://orcid.org/0000-0002-5976-190X Department of Medical Imaging, Shenzhen Longhua District Central Hospital, Shenzhen, China. Search for more papers by this author , Pan WangPan Wang Department of Medical Imaging, Shenzhen Longhua District Central Hospital, Shenzhen, China. Search for more papers by this author and Hongwei ChenHongwei Chen Department of Medical Imaging, Shenzhen Longhua District Central Hospital, Shenzhen, China. Search for more papers by this author Originally published27 Feb 2023https://doi.org/10.1161/CIRCULATIONAHA.122.061896Circulation. 2023;147:e625–e626To the Editor:In their cohort study, Lee and colleagues1 revealed an important finding that ≈150 to 300 min/wk of long-term leisure-time vigorous physical activity (PA) or 300 to 600 min/wk of long-term leisure-time moderate PA was associated with the nearly lowest mortality. This finding is of clinical and public health importance. However, we are surprised by the results of the stroke outcome. As shown in Table S5 by Lee et al,1 according to the multivariable-adjusted hazard ratios (HRs) and 95% CIs, vigorous PA and moderate PA were not significantly (P>0.05) associated with reduced stroke in most of the subgroups stratified by the duration of exercise per week. The significant association of vigorous PA with reduced stroke outcome was observed only in the subgroup of 300 to 374 min/wk (HR, 0.73 [95% CI, 0.58–0.92]) and the subgroup of ≥600 min/wk (HR, 0.40 [95% CI, 0.26–0.62]) but not in the other 6 subgroups (P>0.05). The significant association of moderate PA with reduced stroke was observed only in the subgroup of ≥600 min/wk (HR, 0.76 [95% CI, 0.64–0.90]) but not in the other 7 subgroups (P>0.05). These results did not suggest a definite association between PA and the reduced risk of stroke. However, previous studies2–5 have consistently suggested that PA was associated with reduced risk of stroke. It would be helpful if the authors could give some explanations for this discrepancy.Almost all the age-adjusted HRs published by Lee et al1 were much smaller than the corresponding multivariable-adjusted HRs. Because the multivariable-adjusted HRs adjusted more confounding factors, they were more approximate to real effect sizes than the age-adjusted HRs. Therefore, the authors used the multivariable-adjusted HRs to report their study results. However, the obvious differences between the age-adjusted HRs and the multivariable-adjusted HRs suggested that there were probably some modifying factors that significantly affected the associations of vigorous and moderate PA with study outcomes. For example, as shown in Table S1 by Lee et al.,1 body mass index significantly affected the association of vigorous PA with all-cause mortality (P<0.001) and smoking significantly affected the association of moderate PA with all-cause mortality (P=0.02). Are there underlying factors that significantly affected the associations of vigorous and moderate PA with stroke? This needs to be investigated further. Moreover, is it possible that vigorous or moderate PA is significantly associated with certain types of stroke such as ischemic stroke but not with other types such as hemorrhagic stroke? This needs to be studied. Addressing these issues might contribute to identifying reasons for the discrepancy in stroke outcome results between this study and previous studies.Article InformationSources of FundingThis work was supported by the Key Laboratory of Neuroimaging, Longhua District, Shenzhen (Shen Long Hua Ke Chuang Ke Ji Zi [2022] No. 7); and Shenzhen Fundamental Research Program (Natural Science Foundations), General Programme for Fundamental Research (grant JCYJ20210324142404012).Disclosures None.FootnotesCirculation is available at www.ahajournals.org/journal/circReferences1. Lee DH, Rezende L, Joh HK, Keum N, Ferrari G, Rey-Lopez JP, Rimm EB, Tabung FK, Giovannucci EL. Long-term leisure-time physical activity intensity and all-cause and cause-specific mortality: a prospective cohort of US adults.Circulation. 2022; 146:523–534. doi: 10.1161/CIRCULATIONAHA.121.058162LinkGoogle Scholar2. Hummel M, Hantikainen E, Adami HO, Ye W, Bellocco R, Bonn SE, Lagerros YT. Association between total and leisure time physical activity and risk of myocardial infarction and stroke: a Swedish cohort study.BMC Public Health. 2022; 22:532. doi: 10.1186/s12889-022-12923-5CrossrefMedlineGoogle Scholar3. Ghozy S, Zayan AH, El-Qushayri AE, Parker KE, Varney J, Kallmes KM, Morsy S, Abbas AS, Diestro J, Dmytriw AA, et al. Physical activity level and stroke risk in US population: a matched case-control study of 102,578 individuals.Ann Clin Transl Neurol. 2022; 9:264–275. doi: 10.1002/acn3.51511CrossrefMedlineGoogle Scholar4. Silva D, Ribeiro A, Marinho F, Naghavi M, Malta DC. Physical activity to prevent stroke mortality in Brazil (1990–2019).Rev Soc Bras Med Trop. 2022; 55:e252. doi: 10.1590/0037-8682-0252-2021CrossrefGoogle Scholar5. Kodali NK, Bhat LD. Prevalence and associated factors of stroke among older adults in India: analysis of the Longitudinal Aging Study in India—wave 1, 2017–2018.Indian J Public Health. 2022; 66:128–135. doi: 10.4103/ijph.ijph_1659_21CrossrefMedlineGoogle Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetails February 28, 2023Vol 147, Issue 9 Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.122.061896PMID: 36848408 Originally publishedFebruary 27, 2023 PDF download Advertisement