The 2008 physical activity guide- lines for Americans recommend that adults should engage in 150 min/wk of moderate-intensity (eg, fast walking) or 75 min/wk of vigorous-intensity aerobic physical activity (eg, running) or an equivalent combination of moderate- and vigorous-intensity aerobic activity. These guidelines also note that some physical activity is better than none and that adults who participate in any amount of physical activity gain some The 2013 AHA/ACC guideline on lifestyle to reduce cardiovascular risk encourages moderate to vigorous aerobic physical activity for at least 40 minutes at a time to be done at least 3 to 4 d/wk for the purpose of reducing BP and improving lipid profile.127 Physical Inactivity: Summary and Gaps A sedentary lifestyle is associated with several adverse health effects, including an increased risk of stroke. Indeed, the global vascular risk prediction scale including the addition of physical activity, waist circumference, and alcohol consump- tion improved prediction of 10-year event rates in multiethnic communities compared with traditional Framingham vari- Clinical trials documenting a reduction in risk of a first or recurrent stroke with regular physical activity have not been conducted. Evidence from observational studies is suf- ficiently strong to make recommendations for routine physical activity to prevent stroke.127 Physical Inactivity: Recommendations 1. Physical activity is recommended because it is associ- ated with a reduction in the risk of stroke (Class I; Level of Evidence B). 2. Healthy adults should perform at least moderate- to vigorous-intensity aerobic physical activity at least 40 (Class I; Level of Evidence B). Meschia et al Guidelines for the Primary Prevention of Stroke 3761 Dyslipidemia Total Cholesterol Most studies have found high total cholesterol to be a risk factor for ischemic stroke. 