EXERCISE MAY HELP PREVENT STROKE

New guidelines say a daily 30-minute walk reduces risk of “brain attack.”

Just as regular exercise can reduce the risk of a heart attack, physical activity also may help prevent “brain attack“–more commonly known as stroke. In its recently released guidelines, the Prevention Advisory Board of the National Stroke Association recommends taking “a brisk walk for as little as 30 minutes a day” as one of ten strategies to help prevent stroke, America’s leading cause of adult disability.

“Exercise is so important to cardio-vascular health in general and to reducing the risk of coronary heart disease that we’ve long suspected it might protect against stroke as well,” says Dr. Philip B. Gorelick, professor of neurology at Chicago’s Rush Medical College and chairman of the Stroke Association panel. “Now we have the evidence to say that physical activity is an exceedingly important factor.”

A stroke occurs when blood circulation to the brain fails, most often as a result of blockage of a blood vessel in the brain or neck. In recent years, some experts have begun calling this condition “brain attack” to reflect its similarity to heart attack and to increase awareness of its urgent nature. Stroke is the third leading cause of death in the United States after heart disease and cancer, taking an estimated 160,000 lives annually. About 731,000 Americans suffer strokes each year, and total costs for care average $40 billion, according to the Stroke Association; there are four million stroke survivors in this country.

“Although stroke remains a leading cause of death, disability, and healthcare expenditures, it can be prevented,” according to the stroke prevention guidelines published in the March 24/31, 1999, issue of the Journal of the American Medical Association. The guidelines, which constitute the first-ever national-expert consensus on stroke prevention, cite six risk factors: hypertension, history of heart attack, elevated cholesterol levels, atrial fibrillation (a type of abnormal heart rhythm), diabetes mellitus, and asymptomatic carotid artery disease.

The guidelines also highlight several lifestyle factors that can contribute to stroke risk, including smoking, excessive alcohol consumption, and a diet high in fat and sodium. Regular exercise may help prevent strokes, the recommendations note, in part because physical activity positively affects many risk factors.

“Physical activity can help control blood pressure, and that’s the leading risk factor for stroke,” notes Dr. Edgar J. Kenton, professor of clinical neurology at Thomas Jefferson University in Philadelphia and a member of the executive committee of the American Heart Association’s Stroke Council. “Physical activity improves cardiovascular conditioning and helps keep the heart in shape.”

Exercise also can improve cholesterol ratios and reduce the risk of diabetes. In addition, Dr. Kenton says, “People who exercise are more health-conscious and are more likely to have healthy behaviors, such as not smoking or drinking to excess and having a good diet.”

Recent research has helped strengthen the link between physical activity and stroke prevention. People who exercise for an hour a day cut their risk for stroke nearly in half, according to a study of 11,130 Harvard University alumni published last fall in Stroke: Journal of the American Heart Association. Researchers found that people who expended 2,000 calories each week–the equivalent of a one-hour brisk walk five days a week–had a 46 percent lower risk of stroke than those who did little to no exercise. People who expended 1,000 calories a week–the equivalent of walking briskly for 30 minutes a day, five days a week–had about a 24 percent reduction in stroke risk.

“Walking, stair-climbing, and participating in moderately intense activities–such as dancing, bicycling, and gardening–were shown to reduce the risk of stroke,” says the study’s lead author, I-Min Lee, an assistant professor of epidemiology at the Harvard School of Public Health. “Light activity, such as bowling and general housekeeping activity, did not have the same effect.”

Getting regular checkups is essential to stroke prevention, since keeping track of such personal health information as blood pressure and cholesterol levels is important in reducing risks of the disease.

In addition to getting regular exercise, the stroke prevention guidelines recommend:

* Knowing your blood pressure and having it checked at least once a year.

* Finding out whether you have atrial fibrillation or high cholesterol.

* Quitting smoking; drinking alcohol in moderation, if at all; and eating a diet lower in fat and salt.

* Asking your doctor if you have circulation problems, following your doctor’s recommendations if you are diabetic, and seeking immediate medical attention if you experience any stroke symptoms. Stroke symptoms include sudden numbness or weakness of the face, arm, or leg; sudden confusion; trouble speaking or understanding; sudden trouble seeing or walking; and dizziness or sudden severe headache with no known cause.

Since many of the conditions that lead to stroke have roots in childhood, experts say it’s particularly important to get kids active. “When you go to other cultures and you see people walking and bicycling and not eating as much, you don’t see this level of disease,” notes Chicago’s Dr. Gorelick. “Here we have a very sedentary, very obese population, and that leads to a whole host of health problems. If we had a population that exercised throughout the life cycle, beginning in childhood, I think we’d see a tremendous improvement in health.”