Relationship Between Physical Activity, Sedentary Time, and Heart Failure Risk in Older Women
abstract
This abstract is available on the publisher's site.
Access this abstract nowIMPORTANCE
Heart failure (HF) prevention is paramount to public health in the 21st century.
OBJECTIVE
To examine incident HF and its subtypes with preserved ejection fraction (HFpEF) and reduced EF (HFrEF) according to accelerometer-measured physical activity (PA) and sedentary time.
DESIGN, SETTING, AND PARTICIPANTS
This was a prospective cohort study, the Objective Physical Activity and Cardiovascular Health (OPACH) in Older Women study, conducted from March 2012 to April 2014. Included in the analysis were women aged 63 to 99 years without known HF, who completed hip-worn triaxial accelerometry for 7 consecutive days. Follow-up for incident HF occurred through February 2022. Data were analyzed from March to December 2023.
EXPOSURE
Daily PA (total, light, moderate to vigorous PA [MVPA], steps) and sedentary (total, mean bout duration) behavior.
MAIN OUTCOMES AND MEASURES
Adjudicated incident HF, HFpEF, and HFrEF.
RESULTS
A total of 5951 women (mean [SD] age, 78.6 [6.8] years) without known HF were included in this analysis. Women self-identified with the following race and ethnicity categories: 2004 non-Hispanic Black (33.7%), 1022 Hispanic (17.2%), and 2925 non-Hispanic White (49.2%). There were 407 HF cases (257 HFpEF; 110 HFrEF) identified through a mean (SD) of 7.5 (2.6) years (range, 0.01-9.9 years) of follow-up. Fully adjusted hazard ratios (HRs) for overall HF, HFpEF, and HFrEF associated with a 1-SD increment were 0.85 (95% CI, 0.75-0.95), 0.78 (95% CI, 0.67-0.91), and 1.02 (95% CI, 0.81-1.28) for minutes per day total PA; 0.74 (95% CI, 0.63-0.88), 0.71 (95% CI, 0.57-0.88), and 0.83 (95% CI, 0.62-1.12) for steps per day; and 1.17 (95% CI, 1.04-1.33), 1.29 (95% CI, 1.10-1.51), and 0.94 (95% CI, 0.75-1.18) for minutes per day total sedentary. Cubic spline curves for overall HF and HFpEF were significant inverse for total PA and steps per day and positive for total sedentary. Light PA and MVPA were inversely associated with overall HF (HR per 1 SD: 0.88; 95% CI, 0.78-0.98 and 0.84; 95% CI, 0.73-0.97) and HFpEF (0.80; 95% CI, 0.70-0.93 and 0.85; 95% CI, 0.72-1.01) but not HFrEF. Associations did not meaningfully differ when stratified by age, race and ethnicity, body mass index, physical function, or comorbidity score. Results for sedentary bout duration were inconsistent.
CONCLUSIONS AND RELEVANCE
Higher accelerometer-measured PA (MVPA, light PA, steps per day) was associated with lower risk (and greater total sedentary time with higher risk) of overall HF and HFpEF in a racially and ethnically diverse cohort of older women. Increasing PA and reducing sedentary time for primary HFpEF prevention may have relevant implications for cardiovascular resilience and healthy aging in later life.
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Additional Info
Disclosure statements are available on the authors' profiles:
Accelerometer-Measured Physical Activity, Sedentary Time, and Heart Failure Risk in Women Aged 63 to 99 Years
JAMA Cardiol 2024 Apr 01;9(4)336-345, MJ LaMonte, AZ LaCroix, S Nguyen, KR Evenson, C Di, ML Stefanick, ET Hyde, B Anuskiewicz, CB EatonFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Heart failure with preserved but not reduced ejection fraction is prevented by physical activity
Heart failure (HF) with preserved ejection fraction (HFpEF) is an increasing clinical problem among older patients, especially among women. The Objective Physical Activity and Cardiovascular Health study performed in-home interviews and measured physical activity (PA) using accelerometers in 5951 woman aged 63 to 99 years at baseline. The incidence of HF was then determined over a mean follow-up period of 7.5 years. There were 407 incident cases of HF, 367 of which were adjudicated as HFpEF (257, or 63%) or as HF with reduced ejection fraction (HFrEF). The incidence of HF decreased by 26% with each 3600 steps per day, due entirely to a 29% decrease in HFpEF . HFrEF incidence was unrelated to PA.
There are several important clinical lessons from this report:
Patients have much difficulty eating less and exercising more. But only 2000 steps (about a mile) decreased the incidence of HFpEF. This is not a lot of activity to ask of our older female patients, but it could contribute to reducing the incidence of HFpEF in this vulnerable patient group.