Well-Documented and Modifiable Risk Factors Physical Inactivity Physical inactivity is associated with numerous adverse health effects, including an increased risk of total mortality, cardio- vascular morbidity and mortality, and stroke. The 2008 physi- cal activity guidelines for Americans provide an extensive review and conclude that physically active men and women generally have a 25% to 30% lower risk of stroke or mortality than the least active.111 Two meta-analyses of physical activ- ity reached the same conclusion.112,113 The benefits appear to occur from a variety of activities, including leisure-time phys- ical activity, occupational activity, and walking. Overall, the relationship between activity and stroke is not influenced by age or sex, but some data suggest linkages between these fac- tors and activity levels.114 116 The relationship between the amount or intensity of physi- cal activity and stroke risk remains unsettled and includes the possibility of a sex interaction. One study suggested an increas- ing benefit with greater intensity in women (median relative risk [RR], 0.82 for all strokes for moderate-intensity versus no or light activity; RR, 0.72 for high-intensity versus no or light activity). 