{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T12:55:58Z","timestamp":1791291358547,"version":"4.3.0"},"reference-count":41,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Brain and Behavior"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The relationship between physical activity intensity and the risk of first\u2010ever stroke in middle\u2010aged and older adults remains incompletely understood. This study aimed to investigate the association between different intensities and total volumes of physical activity and the incidence of first stroke, and to explore potential cardiovascular mediators underlying this relationship.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>This prospective cohort study utilized data from the China Health and Retirement Longitudinal Study (CHARLS), including 4380 stroke\u2010free adults aged \u2265 45 years at baseline. Physical activity was assessed using the International Physical Activity Questionnaire Short Form and classified into sedentary behavior, active physical activity, and highly active physical activity. Total physical activity was quantified in metabolic equivalent task minutes per week (MET\u2010min\/week). Incident stroke was identified through self\u2010reported physician diagnosis during a 7\u2010year follow\u2010up period. Cox proportional hazards models, multivariable logistic regression, restricted cubic spline analyses, subgroup analyses, and mediation analyses were conducted after adjusting for demographic, lifestyle, and clinical confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Finding<\/jats:title>\n                    <jats:p>\n                      During follow\u2010up, 300 participants (6.8%) experienced a first\u2010ever stroke. Highly active physical activity was associated with a significantly reduced risk of first stroke compared with sedentary behavior (adjusted hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.30\u20130.92; adjusted odds ratio [OR], 0.45; 95% CI, 0.36\u20130.55). A nonlinear, flipped\n                      <jats:italic>J<\/jats:italic>\n                      \u2010shaped dose\u2013response relationship was observed between total physical activity and stroke risk, with the lowest risk occurring at approximately 13,045 MET\u2010min\/week. Subgroup analyses showed stronger protective effects of highly active physical activity in men, individuals without heart disease, overweight individuals, and those with hypertension. Mediation analyses indicated that the protective association was largely mediated by improvements in cardiovascular indicators, including blood pressure, high\u2010density lipoprotein cholesterol, body mass index, and the triglyceride\u2013glucose index.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The inverse association between highly active physical activity and first stroke was partially accounted for by cardiovascular biomarkers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/brb3.71601","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T09:37:18Z","timestamp":1784021838000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Physical Activity on Stroke Risk in Middle\u2010Aged and Older Adults"],"prefix":"10.1002","volume":"16","author":[{"given":"Huiping","family":"Bai","sequence":"first","affiliation":[{"name":"Qilu Hospital (Qingdao), Cheeloo College of Medicine Shandong University  Qingdao China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zetai","family":"Bai","sequence":"additional","affiliation":[{"name":"Qilu Hospital, Cheeloo College of Medicine Shandong University  Jinan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8170-7993","authenticated-orcid":false,"given":"Guanzhao","family":"Wu","sequence":"additional","affiliation":[{"name":"Qilu Hospital, Cheeloo College of Medicine Shandong University  Jinan China"},{"name":"Department of Central Laboratory, Qilu Hospital (Qingdao), Cheeloo College of Medicine Shandong University  Qingdao 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