When it comes to brain health, stroke may not be on your radar—but maybe it should be. The condition, which happens when a blood vessel in the brain bursts or is blocked, is the second most common cause of death worldwide. Still, it is “preventable, treatable, and beatable,” says Kara Sands, MD, a neurologist and stroke medical director at the Mayo Clinic. There are things you can do to reduce your risk. But a recent study published in the Journal of the American Heart Association provides more evidence that movement and brain health are connected. Researchers examined stroke risk factors and found a common leisure activity can cause your brain major issues—and you might be doing it right now.

Movement and brain health

Keeping your brain healthy starts by moving your body. The relationship between exercise and stroke has been studied quite a bit, with research showing that physical activity effectively reduces the risk of stroke in both women and men. But the Journal of the American Heart Association study added a new element into the mix: leisurely sedentary time. The study compared sedentary time, physical activity, and stroke events for 143,180 healthy people with no prior history of stroke, diabetes, or cancer.

“It’s not just about how many miles you run, if you go to the gym, or take a Pilates class. You should be aware of how much sedentary time you have throughout the day, whether it be sitting at a desk for work or school or binge-watching TV.” — Kara Sands, MD

The study results showed that only one group was at a significantly higher risk of stroke—four times higher, to be exact. The group with the highest risk of stroke had the lowest physical activity levels, and they were also the stillest, reporting eight or more hours of sedentary time per day. The most surprising characteristic of the study group at the highest risk was their age. They were all younger than 60-years-old. Dr. Sands hopes these results get more young people to pay attention to stroke risks. “One in ten strokes occur in a young adult,” she says. “The study defined young as less than 60, but typically we are talking about ages 18 to 50.”

Sit less, move more may be straightforward advice for some, but it isn’t that simple for people with disabilities, a population the sedentary study didn’t consider. “There are physical disabilities, and there are also mental, emotional, and psychological disabilities,” says Dr. Sands. “It’s all about understanding strengths and weaknesses and identifying what we can empower people to do, whether that be water aerobics, bodyweight exercises, or just focusing on the mind-body connection.” She says it ultimately comes down to support and “how we can reach out to people, so they have access to resources.”

Ultimately, Dr. Sands says everyone should look in the mirror and be honest with themselves about how much time they’re spending sitting or lying on the couch each day. The study group did a lot of sitting without exercising, but “it’s not just about how many miles you run, if you go to the gym, or take a Pilates class,” Dr. Sands says. “You should be aware of how much sedentary time you have throughout the day, whether it be sitting at a desk for work or school or binge-watching TV.”

The risks of sitting too much

It’s not just stroke risk that gives reason to reevaluate your sitting time. According to the American Diabetes Association, prolonged sitting increases your risk for issues associated with metabolic syndrome, including high blood sugar, high blood pressure, high cholesterol, and excess belly fat. And a 2018 study published in the American Journal of Epidemiology showed a link between long periods of sitting and a higher risk for all causes of death.

So, why is sitting so bad for you? Harvard Health says researchers don’t yet know the exact reason. But one explanation is that while you sit, your large muscles relax, and relaxed muscles don’t take in as much glucose from your blood. The extra glucose in your system creates a domino effect of negative consequences in your body, starting with damaging the blood vessels that supply blood to all your vital organs.

But Dr. Sands says the focus of brain health shouldn’t be on only how much we move. “It’s multifactorial,” she says. “You have to look at all the risk factors together to get the whole picture.” The American Stroke Association divides risk factors into controllable and uncontrollable. The uncontrollable risk factors, like family history, age (risk increases as you get older), and gender (risk is higher for women), are obviously out of your hands. So, as you think about your brain health, Dr. Sands recommends you focus on the controllable risk factors, such as smoking, lifestyle, diet, and physical activity.

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