To the Editor: Dr Hu and colleagues1 found a linear inverse association between physical
activity and ischemic stroke. Their study used a metabolic equivalent (MET)
task measure that is derived by multiplying the self-reported intensity of
physical activity by its duration. The MET measure is associated with the
"volume theory," which assumes that the amount (caloric expenditure or duration)
of physical activity is a critical part of the protective stimulus and that
combinations of intensity and duration are relatively interchangeable.2 Therefore, with the MET measure, a person could
perform an activity at a 4-MET level (intensity) for an hour and receive an
MET score of 4. The same score would be obtained by performing an 8-MET activity
for 30 minutes. However, these different levels of intensity may have significantly
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