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Active commuting and stroke risk: a Swedish population-based cohort study
Annie Palstam1,2,3, Frida Bergman4, Patrik Wennberg4, Katharina S Sunnerhagen1,5, Adam Viktorisson1,5
1: Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; 2: Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.; 3: School of Health and Welfare, Dalarna University, Falun, Sweden; 4: Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.; 5: Department of Rehabilitation Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
Background and aim: Active transportation has been linked to beneficial cardiovascular outcomes, but evidence on long-term associations with stroke is limited. This study aimed to examine the association between primary commuting mode and incident stroke in a large Swedish population, and to explore dose–response relations between commuting distance and stroke risk.
Methods: This population-based cohort study used data from the Västerbotten Intervention Program (1989–2019). Participants reported their primary mode of transportation to work and commuting distance. Individuals consistently using the same transport mode in at least three of four seasons were classified accordingly. Incident stroke diagnoses were obtained from the Swedish Stroke Register. Associations between transportation mode, commuting distance, and stroke incidence were analyzed using cause-specific Cox proportional hazards models, adjusting for sociodemographic and lifestyle factors including leisure-time physical activity.
Results: Among 107,752 participants (mean age 45.7 years; 49.5% female), 3,507 experienced incident stroke during a median 17-year follow-up. Cycling to work was associated with a lower risk of stroke compared with car driving, but this association was attenuated after adjustment for leisure-time physical activity. Among car commuters, longer commuting distance showed linear association with higher stroke risk, whereas cyclists displayed a nonlinear pattern with lowest risk at moderate distances. Walking to work was not associated with stroke risk, likely due to shorter distances and limited physical activity exposure.
Conclusions: Active transportation, particularly cycling, may contribute to stroke prevention as part of an overall physically active lifestyle. Promoting active transport could support sustainable cardiovascular disease prevention at the population level.
