Six-year changes in physical activity and the risk of incident heart failure ARIC study

Roberta Florido, Lucia Kwak, Mariana Lazo, Vijay Nambi, Haitham M. Ahmed, Sheila M. Hegde, Gary Gerstenblith, Roger S. Blumenthal, Christie M. Ballantyne, Elizabeth Selvin, Aaron R. Folsom, Josef Coresh, Chiadi E. Ndumele

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42 Scopus citations


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 11351 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.

Original languageEnglish (US)
Pages (from-to)2142-2151
Number of pages10
Issue number20
StatePublished - 2018

Bibliographical note

Funding Information:
The ARIC study is conducted as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN2 68201100006C, HHSN268201100007C, HHSN268201100008C, HHSN26820 1100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201 100012C). The authors thank the staff and participants of the ARIC study for their important contributions. The views expressed here are those of the authors and do not necessarily reflect those of the Department of Veterans Affairs.

Funding Information:
This work was supported by the Robert E. Meyerhoff Professorship, a Robert Wood Johnson Amos Medical Faculty Development Award, a Johns Hopkins University Catalyst Award, and a National Institutes of Health/National Heart, Lung, and Blood Institute grant K23HL12247 (to Dr Ndumele); and a National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases grant K24DK106414 (to Dr Selvin).

Publisher Copyright:
© 2018 American Heart Association, Inc.


  • Exercise
  • Heart failure
  • Lifestyle
  • Prevention


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