Six-Year Changes in Physical Activity and the Risk of Incident Heart Failure: ARIC Study

Abstract

Background: Higher physical activity (PA) is associated with lower heart failure (HF) risk; however, the effect of changes in PA on HF risk is unknown.

Methods: We evaluated 11 351 ARIC study (Atherosclerosis Risk in Communities) participants (mean age 60 years) who attended visit 3 (1993-1995) and did not have a history of cardiovascular disease. Exercise PA was assessed using a modified Baecke questionnaire and categorized according to American Heart Association guidelines as recommended, intermediate, or poor. We used Cox regression models to characterize the association of 6-year changes in PA between the first (1987-1989) and third ARIC visits and HF risk.

Results: During a median of 19 years of follow-up, 1750 HF events occurred. Compared with those with poor activity at both visits, the lowest HF risk was seen for those with persistently recommended activity (hazard ratio, 0.69; 95% confidence interval, 0.60-0.80). However, those whose PA increased from poor to recommended also had reduced HF risk (hazard ratio, 0.77; 95% confidence interval 0.63-0.93). Among participants with poor baseline activity, each 1 SD higher PA at 6 years (512.5 METS*minutes/week, corresponding to ≈30 minutes of brisk walking 4 times per week) was associated with significantly lower future HF risk (hazard ratio, 0.89, 95% confidence interval, 0.82-0.96).

Conclusions: Although maintaining recommended activity levels is associated with the lowest HF risk, initiating and increasing PA, even in late middle age, are also linked to lower HF risk. Augmenting PA may be an important component of strategies to prevent HF.

Keywords: exercise; heart failure; lifestyle; prevention.

© 2018 American Heart Association, Inc.

Figures

Figure 1

Distribution of PA Levels at Visit 1 and Visit 3. Proportion of participants within cross categories of PA at Visits 1 and 3. For example, 20.3% of participants had poor PA at Visit 1 as well as poor PA at Visit 3. Conversely, 25.5% of participants had recommended PA at both time points.

Figure 2

Kaplan Meier Estimates of HF-Free Survival Among Participants with Stable High, Stable Low, Decreased, and Increased PA Levels Between Visits 1 and 3. Kaplan Meier estimates of HF-free survival among participants with stable PA category at Visits 1 and 3 that was below (stable low), or equal to or above (stable high) the average median levels of PA at both Visits; those who decreased their PA category from Visit 1 to Visit 3 (from recommended to intermediate or poor activity, or from intermediate to poor activity); and those who increased their PA category from Visit 1 to Visit 3 (from poor to intermediate or recommended activity, or from intermediate to recommended activity). p from log rank test comparing those who increased PA category to persons with stable PA below the median = 0.049. p from log rank test comparing those who decreased PA category to persons with stable PA above the median = 0.002.

Figure 3

Continuous association of increasing levels of PA over a six-year period (from Visit 1 to Visit 3), among participants with no (zero) PA at Visit 1 and incident HF in a restricted cubic spline model. *Adjusted for age, race*center, sex, smoking status, and alcohol use. Shaded area represents 95% CI.