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Physical Activity and Heart Failure Risk

Examining the dose response relationship

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An inverse, dose-response relationship exists between physical activity and heart failure (HF) risk, although doses of physical activity in excess of guideline recommended minimum physical activity levels may be required for more substantial reductions in HF risk, according to 12 prospective cohort studies with more than 20,000 HF events among 370,460 adult participants. Researchers found:

• Highest levels of physical activity were associated with significantly reduced risk of HF (HR, 0.70).

• Individuals who engaged in guideline recommended minimum levels of physical activity had modest reductions in HF risk (RR, 0.90) compared with those reporting no leisure time physical activity.

• A substantial risk reduction in HF risk was observed among individuals who engaged in physical activity at 2x (HR, 0.81) and 4x (HR, 0.65) the minimum guideline recommended levels.

Citation: Pandey A, Garg S, Khunger M, et al. Dose response relationship between physical activity and risk of heart failure: a meta-analysis. [Published online ahead of print October 5, 2015]. Circulation. doi: 10.1161/CIRCULATIONAHA.115.015853.

Commentary: As more data accumulates, it becomes ever clearer that exercise may be one or of the most important things we can prescribe for our patients. In a study of more than 3,000 healthy adults, exercise has been shown to decrease the development of hypertension, hypercholesterolemia and metabolic syndrome1. It has been shown to decrease the risk of future cardiovascular mortality in a study of over 2,000 men with diabetes, where the amount of exercise was inversely proportional to CV mortality2. In a study of more than 4,000 individuals, exercise appears to offset the cardiac risk of traditional risk factors, with CV mortality risk being lower for individuals with risk factors who exercise than for those without risk factors who do not exercise3. It is clear, with this study showing the benefits of exercise in patients with CHF, that exercise yields important benefits for both healthy individuals and those with significant illness. —Neil Skolnik, MD

1. Lee DC, Sui X, Church TS, Lavie CJ, Jackson AS, Blair SN. Changes in fitness and fatness on the development of cardiovascular disease risk factors hypertension, metabolic syndrome, and hypercholesterolemia. J Am Coll Cardiol. 2012;59(7):665-72.

2. Church TS, LaMonte MJ, Barlow CE, Blair SN. Cardiorespiratory fitness and body mass index as predictors of cardiovascular disease mortality among men with diabetes. Arch Intern Med. 2005;165:2114-2120.

3. Kokkinos P, Myers J, Faselis C, Doumas M, Kheirbek R, Nylen E. BMI–mortality paradox and fitness in African American and Caucasian men with type 2 diabetes. Diabetes Care 2012;35:1021–1027.

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