ESOC 2026 | Active commuting, physical activity, and stroke risk: insights from a Swedish cohort study

Yes, so there is well-established evidence of physical activity, leisure-time physical activity, and reduced stroke risk. But there are very few studies investigating active commuting as a means of physical activity on the risk of stroke. So we wanted to explore if active commuting could be associated with a reduced stroke risk and we did this in a large population cohort from the north of Sweden. So we used data from a population cohort which has been collected over time during three decades in routine healthcare and health visits with people turning 30, 40, 50, and 60 years, and they have then collected data on lifestyle behaviors, including active commuting and physical activity. So we combined this cohort data with the data from the Swedish Stroke Register to identify stroke cases within this cohort, and during a median follow-up time of around 17 years, 3,500 people in the cohort developed a stroke or had a stroke. And when we analyzed the transport modes in this whole group, we found that around a little bit more than 50% drove a car to work as a primary mode of transport, which we defined as three out of four seasons. And then the second-largest group of transport was cycling, 20%, and then smaller groups walking and going by bus. And when we looked at associations, we found that when adjusting for age and sex, we found that cycling to work was associated with a reduced risk of stroke. But in the fully adjusted models, we also included leisure-time physical activity, and this association was attenuated. But then we wanted to go further and look at if there was an association between commuting distance and stroke risk, and we found a linear association with increasing car driving to work and stroke risk. So, actually, when driving 40 kilometers to work compared to 15 kilometers, which was a median distance, there was a 10% increased stroke risk. Among cyclists, there was a reverse association. So, if you cycled a little bit further, you had a decreased risk of stroke, but with the highest impact in moderate distances around four kilometers or so. So, I think the take-home message of this study is that active transportation can be – we didn’t find any independent explanatory value of active commuting on stroke risk other than it’s part of a physically active lifestyle. But I think this is very good information that you don’t need to also do the exercise, the real aerobic exercises, you could actually move actively to and from work and have a reduced stroke risk in being physically active in your daily life.

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