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Moderate Physical Activity Tied to Lower Heart Failure Risk

Performing 150 to 300 minutes of moderate physical activity, or 75 to 150 minutes of vigorous activity, weekly is associated with a lower risk of heart failure (HF), independently of clinical, sociodemographic, and lifestyle factors, a UK Biobank study suggests.

Adults who logged 150 to 300 minutes of objectively measured moderate physical activity (PA) in a week, measured using wrist accelerometers, had a 63% lower HF risk, and those doing 75 to 150 minutes of vigorous PA had a 66% lower risk.

The findings, published online August 29 in Circulation, are consistent with previous studies and mirror the latest US and World Health Organization PA recommendations for adults of all ages.

More Is Better — to a Point

“Our study is the largest conducted to date using wrist accelerometers to measure PA,” Carlos Celis-Morales, PhD, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK, told | Medscape Cardiology. “Current evidence is mainly based on self-reported questionnaires, which are prone to recall bias and therefore could obscure the true link between PA and risk of HF.”

The team analyzed data from 94,739 UK Biobank participants (mean age about 55 years; about 40% men) who had not been diagnosed with HF or had a previous myocardial infarction.

PA was measured 24/7 for 1 week with an Axivity AX3 wrist-worn triaxial accelerometer. Minutes per week of light-intensity, moderate-intensity, and vigorous-intensity PA were defined as the time spent in 30- to 125-mg, >125- to 400-mg, and >400-mg intensity activity, respectively.

Over a median 6.1 years of follow-up after the 1-week PA measurement, the overall HF incidence was 98.5 per 10,000 person-years.

After adjustment for age, sex, ethnicity, education, smoking, deprivation index, body mass index (BMI), waist–hip circumference, and intake of fruits/vegetables, red meat, processed meat, oily fish, and alcohol, those who engaged in 150 to 300 min/wk of moderate-intensity PA (hazard ratio, 0.37) and 75 to 150 min/wk of vigorous-intensity PA (HR, 0.34) were at lower HF risk compared with those who did no moderate-to-vigorous PA.

Participants who undertook more PA were generally younger; more likely to be female, White, and university graduates; less likely to smoke; and ate more fruit and vegetables and less red and processed meat. They also had lower BMIs and were less likely to have high blood pressure, type 2 diabetes, or take statins.

The lowest HF risk was achieved at 600 min/wk of moderate PA and plateaued thereafter.

Furthermore, the association between vigorous-intensity PA and HF was reverse J-shaped, with a potentially lower risk reduction beyond 150 min/wk.

The authors conclude, “Current vigorous-intensity PA recommendations should be encouraged but not increased. In contrast, increasing moderate-intensity PA may be beneficial even among those meeting current recommendations.”

Celis-Morales added, “Although the recommendations are very clear, poor PA levels in the population are related more to how individuals can fit PA into their busy routines than understanding the amount of PA needed. Applying behavioral-change techniques to promote and maintain PA levels routinely would be very important.”

Physicians on Board?

“We need to improve physician training and knowledge around PA prescription,” Celis-Morales noted. “As far as we know, exercise prescription has not been a key component in their medical training. Incentives could be a way to tackle reluctance among physicians, even if they (have to) be context-dependent.”

Charles German, MD, an assistant professor of medicine in the cardiology section at the University of Chicago, Illinois, who was not involved in the study, also underscored the need for physician knowledge and action in a comment to | Medscape Cardiology.

“Physicians would greatly benefit from more education on the benefits of PA, which would translate to better counseling and patient care,” said German, who serves on the American Heart Association Lifestyle and Cardiometabolic Health Council Committee. “They absolutely need to take it upon themselves to educate and promote PA among their patients by any means necessary.”

“While it is known that moderate-to-vigorous physical activity is associated with reductions in cardiovascular disease, so is light-intensity PA,” he added. “Physicians should not discount the fact that even light-intensity PA can translate to reductions in the risk of heart failure and other diseases.”

The study was supported in part by the University of Glasgow Reinvigorating Research Fund. No relevant disclosures were reported.

Circulation. Published online August 29, 2022. Full text

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