Schlaganfälle: Einfluss körperlicher Aktivität auf die Prävalenz und die Behinderung

C. D. Reimers; G. Knapp; A. K. Reimers; B. Griewing

doi:10.1055/s-0032-1304620

Aktuelle Neurologie, Table of Contents

Aktuelle Neurologie 2012; 39(05): 220-235
DOI: 10.1055/s-0032-1304620

Übersicht

Schlaganfälle: Einfluss körperlicher Aktivität auf die Prävalenz und die Behinderung

Impact of Physical Activity on the Prevalence and Course of Stroke

C. D. Reimers

¹Klinik für Neurologie, Zentralklinik Bad Berka GmbH

,

G. Knapp

²Fakultät Statistik, Technische Universität Dortmund

,

A. K. Reimers

³Sportwissenschaft, Universität Konstanz

,

B. Griewing

⁴Akutneurologie – Klinische Neurophysiologie – Stroke Unit, Neurologische Klinik GmbH, Bad Neustadt

› Author Affiliations

Abstract

Zusammenfassung

Schlaganfälle sind in Industrienationen die dritthäufigste Todesursache. Hauptursache ist Arteriosklerose. Regelmäßige körperliche Aktivität beeinflusst verschiedene zerebrovaskuläre Risikofaktoren günstig (arterielle Hypertonie, Diabetes mellitus, Dyslipidämien, Adipositas) und beugt damit der Schlaganfallentstehung vor. Nach wie vor nicht generell akzeptiert ist ein direkter präventiver Effekt körperlicher Aktivität unabhängig von diesen atherogenen Faktoren. Die vorliegende Übersicht kommt anhand einer Meta-Analyse von prospektiven randomisierten Kohortenstudien zu dem Ergebnis, dass Hirninfarkte unabhängig von anderen Risikofaktoren bei körperlich aktiven Männern um 27%, Hirnblutungen 40% seltener auftreten als bei inaktiven. Bei Frauen sind die Unterschiede geringer und erreichen das Signifikanzniveau nicht. Körperliche Aktivität ist daher zumindest bei Männern eine effektive, nebenwirkungsfreie und kostenarme Primärprävention von Schlaganfällen.

Abstract

Stroke is the third most common cause of death in industrialised countries. Most strokes are due to arteriosclerosis. Regular physical activity has beneficial impacts on several cerebrovascular risks, e. g., arterial hypertension, diabetes mellitus, dyslipidaemia, and obesity, and thus may prevent strokes. A direct preventive effect of regular physical activity on the stroke-incidence, independently from other risk factors, however is still not generally accepted. This review is based on a meta-analysis of prospective, randomized cohort studies and proves that physically active men have a 27% reduced risk of suffering from cerebral infarcts and a 40% reduced risk of cerebral bleedings. In women the differences between active and inactive individuals are less clear and do not reach statistical significance. Physical activity thus serves as an effective and inexpensive primary prevention of strokes, at least in males.

Schlüsselwörter

Schlaganfall - Hirninfarkt - Hirnblutung - Sport - körperliche Aktivität

Key words

stroke - cerebral infarction - cerebral hemorrhage - exercise - physical activity

Full Text

References

Literatur
1 Endres M, Gertz K, Lindauer U et al. Mechanisms of stroke protection by physical activity. Ann Neurol 2003; 54: 582-590
2 Vinereanu D. Risk factors for atherosclerotic disease: present and future. Herz 2006; 31 (iii) 5-24
3 Lee CD, Folsom AR, Blair SN. Physical activity and stroke risk. A meta-analysis. Stroke 2003; 34: 2475-2482
4 Dobkin BH. Rehabilitation after stroke. N Eng J Med 2005; 352: 1677-1684
5 Goldstein LB, Adams R, Alberts MJ et al. Primary prevention of ischemic stroke. A guideline from the American Heart Association/American Stroke Association Council: Cosponsored by the Artherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Stroke 2006; 37: 1583-1633
6 Chrysohoou C, Pitsavos C, Kokkinos P et al. The role of physical activity in the prevention of stroke. Cent Eur J Publ Health 2005; 13: 132-136
7 Wendel-Vos GCW, Schuit AJ, Feskens EJM et al. Physical activity and stroke. A meta-analysis of observational data. Int J Epidemiol 2004; 33: 787-798
8 R Development Core Team . R. A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria 2011; URL http://www.R-project.org
9 Abbott RD, Rodriguez BL, Buchfiel CM et al. Physical activity in older middle-aged men and reduced risk of stroke: The Honolulu Heart Program. Am J Epidemiol 1994; 139: 881-893
10 Agnarsson U, Thorgeirsson G, Sigvaldason H et al. Effects of leisure-time physical and ventilator function on risk for stroke in men: The Reykjavík Study. Ann Intern Med 1999; 130: 987 -990
11 Chiuve SE, Rexrode KM, Spiegelman D et al. Primary prevention of stroke by healthy lifestyle. Circulation 2008; 118: 947-954
12 Evenson KR, Rosamond WD, Cai J et al. Physical activity and ischemic stroke risk. The arteriosclerosis risk in communities study. Stroke 1999; 30: 1333-1339
13 Gillum RF, Mussolino ME, Ingram DD. Physical activity and stroke incidence in women and men. The NHANES I Epidemiologic Follow-up Study. Am J Epidemiol 1996; 143: 860-869
14 Harmsen P, Rosengren A, Tsipogianni A et al. Risk factors for stroke in middle-aged men in Göteborg, Sweden. Stroke 1990; 21: 223-229
15 Hu FB, Stampfer MJ, Colditz GA et al. Physical activity and risk of stroke in women. JAMA 2000; 283: 2961-2967
16 Hu G, Sarti C, Jousilahti P et al. Leisure time, occupational, and commuting physical activity and the risk of stroke. Stroke 2005; 36: 1994-1999
17 Lee I-M, Henneckens CH, Berger K et al. Exercise and risk of stroke in male physicians. Stroke 1999; 30: 1-6
18 Mora S, Cook N, Buring JE et al. Physical activity and reduced risk of cardiovascular events. Potential mediating mechanisms. Circulation 2007; 116: 2110-2118
19 Nakayama T, Date C, Yokoyama T et al. A 15.5-year follow-up study of stroke in a Japanese provincial city. The Shibata Study. Stroke 1997; 28: 45-52
20 Noda H, Iso H, Tokoshima H et al. Walking and sports participation and mortality from coronary heart disease and stroke. J Am Coll Cardiol 2005; 46: 1761-1767
21 Okada H, Horibe H, Yoshiyuki O et al. A prospective study of cerebrovascular disease in Japanese rural communities, Akabane and Asahi. Part 1: evaluation of risk factors in the occurrence of cerebral hemorrhage and thrombosis. Stroke 1976; 7: 599-607
22 Paganini-Hill A, Perez Barreto M. Stroke risk in older men and women: aspirin, estrogen, exercise, vitamins, and other factors. J Gend Specif Med 2001; 4: 18-28
23 Willey JZ, Moon YP, Paik MC et al. Physical activity and risk of ischemic stroke in the Northern Manhattan Study. Neurology 2009; 73: 1774-1779
24 Willey JZ, Moon YP, Paik MC et al. Lower prevalence of silent brain infarcts in the physically active. The Northern Manhattan Study. Neurology 2011; 76: 2112-2118
25 Zhang Y, Tuomilehto J, Jousilahti P et al. Lifestyle factors on the risks of ischemic and hemorrhagic stroke. Arch Intern Med 2011; 171: 1811-1818
26 Bijnen FCH, Caspersen CJ, Feskens EJM et al. Physical activity and 10-year mortality from cardiovascular diseases and all causes. Arch Intern Med 1998; 158: 1499-1505
27 Ellekjær EF, Holemn J, Ellekjær E et al. Physical activity and stroke mortality in women. Ten-year follow-up of the Nord-Trøndelag Healthy Survey, 1984–1986. Stroke 2000; 31: 14-18
28 Folsom AR, Prineas RJ, Kaye SA et al. Incidence of hypertension and stroke in relation to body fat distribution and other risk factors in older women. Stroke 1990; 21: 701-706
29 Håheim LL, Holme I, Hjermann I et al. Risk factors of stroke incidence and mortality. A 12-year follow-up of the Oslo Study. Stroke 1993; 24: 1484-1489
30 Harmsen P, Lappas G, Rosengren A et al. Long-term risk factors for stroke. Twenty-eight years of follow-up of 7457 middle-aged men in Göteborg, Sweden. Stroke 2006; 37: 1663-1667
31 Kiely DK, Wolf PA, Cupples LA et al. Physical activity and stroke risk: The Framingham Study. Am J Epidemiol 1994; 140: 608-620
32 Lapidus L, Bengtsson C. Socioeconomic factors and physical activity in relation to cardiovascular disease and death. A 12 year follow up of participation in a population study of women in Gothenburg, Sweden. Br Heart J 1986; 55: 295-301
33 Lee I-M, Paffenbarger Jr. RS. Physical activity and stroke incidence. The Havard Alumni Healthy Study. Stroke 1998; 29: 2049-2054
34 Lindenstrøm E, Boysen G, Nyboe J. Lifestyle factors and risk of cerebrovascular disease in women. The Copenhagen City Heart Study. Stroke 1993; 24: 1468-1472
35 Lindsted KD, Tonstad S, Kuzma JW. Self-report of physical activity and patterns of mortality in Seventh-Day Adventist men. J Clin Epidemiol 1991; 44: 355-364
36 Menotti A, Seccareccia F. Physical activity at work and job responsibility as risk factors for fatal coronary heart disease and other causes of death. J Epidemiol Community Health 1985; 39: 325-329
37 Myint PK, Luben RN, Wareham NJ et al. Combined work and leisure physical activity and risk of stroke in men and women in the European Prospective Investigation into Cancer-Norfolk Prospective Population Study. Neuroepidemiol 2006; 27: 122-129
38 Paffenbarger RS, Hyde DT, Wing AL et al. A natural history of athleticism and cardiovascular health. JAMA 1984; 252: 491-495
39 Panagiotakos DB, Chrysohoou C, Pitsavos C et al. Risk factors of stroke mortality: A 40-year follow-up of the Corfu Cohort from the Seven-Country Study. Neuroepidemiology 2003; 22: 332-338
40 Salonen JT, Puska P, Tuomilehto J. Physical activity and risk of myocardial infarction, cerebral stroke and death. Am J Epidemiol 1982; 115: 526-537
41 Sieverdes JC, Sui X, Lee D-C et al. Independent and joint associations of physical activity and fitness on stroke in men. Phys Sportsmed 2011; 39: 119-126
42 Simonsick EM, Lafferty ME, Phillips CL et al. Risk due to inactivity in physically capable older adults. Am J Public Health 1993; 83: 1443-1450
43 Wannamethee G, Shaper AG. Physical activity and stroke in British middle aged men. BMJ 1992; 304: 597-601
44 Wannamethee SG, Shaper AG, Walker M et al. Lifestyle and 15-year survival free of heart attack, stroke, and diabetes in middle-aged British men. Arch Intern Med 1998; 158: 2433-2440
45 Williams PT. Reduction in incident stroke risk with vigorous physical activity. Evidence from 7.7-year follow-up of the National Runners’ Health Study. Stroke 2009; 40: 1921-1923
46 Wiiliams PT. Vigorous exercise, fitness and incident hypertension, high cholesterol, and diabetes. Med Sci Sports Exerc 2008; 40: 998-1006
47 http://www.cochrane.de/de/evidenz-empfehlung
48 Rincon F, Sacco RL. Secondary stroke prevention. J Cardiovasc Nurs 2008; 23: 34-41
49 Diener HC, Putzki N Hrsg Leitlinien für Diagnostik und Therapie in der Neurologie. 4. Aufl. Stuttgart: Thieme; 2008: XI
50 Diep L, Kwagyan J, Kurantsin-Mills J et al. Association of physical activity level and stroke outcomes in men and women: a meta-analysis. J Womens Health (Larchmt) 2010; 19: 1815-1822
51 Reimers CD, Knapp G, Reimers AK. Bewegung zur Prophylaxe von Schlaganfällen. Dtsch Ärztebl 2009; 106: 715-721
52 Alevizos A, Lentzas J, Kokkoris S et al. Physical activity and stroke risk. Int J Clin Pract 2005; 59: 922-930
53 Schlesinger S, Neuhaus A, Thiele A et al. Sind Mobilitätseinschränkungen bei Patienten mit Multipler Sklerose messbar?. Klein Neurophysiol 2011; 42: 1-5
54 Sofi F, Capalbo A, Cesari F et al. Physical activity during leisure time and primary prevention of coronary heart disease: an update meta-analysis of cohort studies. Eur J Cardiovasc Prev Rehabil 2008; 15: 247-257
55 Ainsworth BE, Haskell WL, Whitt MC et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 2000; 32 (Suppl.) S498-S516
56 Boysen G, Krarup L-H. Benefits of physical activity for stroke survivors. Expert Rev Neurother 2009; 9: 147-149
57 Globas C, Macko RF, Luft AR. Role of walking-exercise therapy after stroke. Expert Rev Neurother 2009; 7: 905-910
58 Cumming TB, Tyedin K, Churilov L et al. The effect of physical activity on cognitive function after stroke: a systematic review. Int Psychologist Oct 2011; 14: 1-11 [Epub ahead of print]
59 States RA, Salem Y, Pappas E. Overground gait training for individuals with chronic stroke: a Cochrane systematic review. JNPT 2009; 33: 179-186
60 Saunders DH, Greig CA, Mead GE et al. Physical fitness training for stroke patients. Cochrane Database Syst Rev 2009; CD003316
61 English C, Hillier SL. Circuit class therapy for improving mobility after stroke. Cochrane Database Syst Rev 2010; CD007513
62 English C, Hillier S. Circuit class therapy for improving mobility after stroke: a systematic review. J Rehabil Med 2011; 43: 565-571
63 Mehrholz J, Kugler J, Pohl M. Water-based exercises for improving activities of daily living after stroke. Cochrane Database Syst Rev 2011; CD008186