Physicians' Academy for Cardiovascular Education

Increase of physical activity over time associated with lower HF risk

Six-Year Changes in Physical Activity and the Risk of Incident Heart Failure: The Atherosclerosis Risk in Communities (ARIC) Study

Literature - Florido R, Kwak L, Lazo M, et al. - Circulation 2018; published online ahead of print


There are data showing that increases in physical activity (PA) over time are associated with lower risks of coronary heart disease (CHD) and total mortality, and that exercise training programs are beneficial for HF patients, but it is not known whether exercise training has an impact on HF prevention [1].

In this analysis of the prospective, community-based Atherosclerosis Risk in Communities (ARIC) study [2], the association between 6-year changes in PA and HF risk was evaluated. Moreover, it was assessed whether the association between PA change and HF risk differs across age, race and gender subgroups.

For this analysis, 11,351 participants without CHD or HF at baseline were included, and their PA was assessed using a modified interviewer-administered Baecke Questionnaire [3] at 2 visits, which were separated by approximately 6 years. PA was converted into a metabolic equivalent of task (MET) using the Compendium of Physical Activities, and classified into moderate (3-6 METS), and vigorous (>6 METS) exercise. A continuous variable of MET*min/week was generated using duration of PA per week and number of months per year. Based on the current American Heart Association (AHA) recommendations [4] PA levels were subsequently categorized as:

The primary outcome was incident HF defined as the first hospitalization or death related to HF.

Main results


In a community-based population without baseline CVD, increasing PA over 6 years was associated with reduced HF risk over the next two decades, while decreasing activity over time was associated with greater HF risk. The lowest HF risk was seen among those with persistently recommended PA, but increasing from poor to recommended activity levels over 6 years was associated with a significantly decreased HF risk. These findings suggest that initiating and augmenting PA in middle age may be helpful for HF prevention.


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