In Reply: We analyzed both intensity and duration
of exercise in relation to incidence of stroke. We specifically tested the
threshold theory regarding exercise intensity by examining whether there is
a dose-response relationship between the MET score and risk of stroke by using
a cubic spline. As shown in Figure 1 of our article, there was no indication
of a threshold effect within the range of physical activity levels observed
among the subjects. While there was a graded relationship between walking
pace and risk of stroke (suggesting the importance of exercise intensity in
reducing risk of stroke), we also found an inverse association between walking
time and risk of stroke, even after adjustment for walking pace. These results
suggest that both exercise intensity and duration are important in the relationship
of physical activity to chronic diseases.
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