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Physical activity as risk factor in amyotrophic lateral sclerosis: a systematic review and meta-analysis



Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder with rapid progression and high mortality. Physical activity (PA) has been identified as a major risk factor for ALS. However, the results across studies are still controversial. We aimed to explore the association between different types of PA and ALS.


The PubMed, EMBASE, Cochrane and Web of Science databases were systematically searched for case–control and cohort studies which explored the relationship between PA and ALS from inception to October 2022. The data were analyzed to generate a pooled effect and 95% confidence interval (CI).


A total of 16,686 articles were included in the systematic search. After filtering, 28 studies from online database and 6 studies from references of relevant articles remained in the analysis. Individuals with a history of vigorous physical activity (OR 1.26, 95% CI 1.06–1.49), occupational-related activity (OR 1.14, 95% CI 1.04–1.25), leisure time activity (OR 1.08, 95% CI 1.04–1.12), unclassified PA (OR 1.05 95% CI 1.02–1.09) and professional athletes (SMR 5.23, 95% CI 2.67–10.25; SIR 2.54, 95% CI 1.37–4.69) were in higher risk of developing ALS. In contrast, sport-related activity (OR 0.97, 95% CI 0.76–1.26) was not associated with ALS.


Vigorous physical activity, occupational-related activity, leisure time activity, unclassified PA and professional athletes were associated with a higher risk of ALS, while sport-related activity showed no association with ALS. Our findings clarified the relation between different types of PA and ALS and provided some practicable advice for the lifestyle of high-risk populations.

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Data availability

All data analyzed during this study are included in supplementary materials.



Amyotrophic lateral sclerosis


Motor neuron disease


Physical activity


Meta-analysis of Observational Studies in Epidemiology


Preferred Reporting Item for Systematic Review and Meta-analysis (2020) guideline


Odds ratio


Hazard ratio


Confidence intervals


Standardized mortality rate


Standardized incidence rate


Newcastle–Ottawa Scale


Compendium of Physical Activities


Metabolic equivalents


Vigorous physical activity


Standard error


Body mass index


Mendelian randomization


Superoxide dismutase 1


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We would like to thank all authors of the original research studies included in the meta-analysis.


This work was supported by the National Key Research and Development Program of China (Grant No. 2021YFC2501203 and 2021YFC2501205), the Sichuan Science and Technology Program (Grant No. 2022ZDZX0023 and 2020YJ0457).

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Authors and Affiliations



XZ, CL and HS conceived and designed the study. XZ and SW selected studies, collected data and quality assessment. JH and CL cross-checked the data and quality assessment. XZ, SW and JH contributed to the statistical analysis. XZ wrote the first manuscript draft. XZ, SW, JL, TY, YX, QJ revised the manuscript.

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Correspondence to Chunyu Li or Huifang Shang.

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Zheng, X., Wang, S., Huang, J. et al. Physical activity as risk factor in amyotrophic lateral sclerosis: a systematic review and meta-analysis. J Neurol (2023).

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  • Amyotrophic lateral sclerosis
  • Physical activity
  • Risk factor