Men who participated in a moderate amount of physical activity, particularly walking and bicycling, had a lower risk of future heart failure compared to those with lower and higher levels of physical activity, according to a study published Aug. 12 in JACC: Heart Failure. The study also found that recent active behavior is more important that past physical activity.

Researchers examined 33,012 men between 1998 and 2012 with an average age of 60 years at baseline. Participants completed a questionnaire about their level of activity at work, home, walking or bicycling, and exercise over the previous year and at age 30. Overall, men who had the lowest and highest levels of physical activity had a higher risk of heart failure, 47 percent and 51 percent respectively, than men with a median level. Walking or bicycling for 20 minutes per day was associated with a 21 percent lower risk of heart failure and accounted for the largest difference in heart failure free survival. Of the men diagnosed with heart failure during the course of study, those who had engaged in at least 20 minutes per day in walking or bicycling were approximately eight months older compared to heart failure cases who had engaged in less than 20 minutes per day of walking or bicycling.

The researchers found that certain types of physical activity, such as walking and bicycling or exercising more than one hour per week were associated with reduced risk of heart failure. Work occupation, household work, and physical inactivity were not significantly associated with heart failure development. They also found that men who were active at 30 years old but were inactive at the time of study enrollment did not have a decreased risk of heart failure.

“Because participants in the study cohort had also provided information about their physical activity at age 30, as well as at the time of enrollment around age 60, we were able to examine the long-term impacts of physical activity on heart failure,” said Andrea Bellavia, MSc, of the Karolinska Institutet in Stockholm and one of the study authors. “We found that recent activity may be more important for heart failure protection than past physical activity levels. The first incidence of heart failure in men was also later for those who actively walked or bicycled 20 minutes each day.”

Although the study suggests both low and high levels of physical activity could increase the risk of heart failure in men, the study authors cautioned that the link between physical activity and cardiovascular disease is not fully understood. Heavy physical activity, such as intense long distance running or manual labor may put stress on the body, which in turn has adverse effects on the heart.

“The U-shaped relationship between exercise levels and the likelihood of subsequent heart failure is a unique finding and will stimulate further research in the important field of prevention,” said Christopher O’Connor, MD, FACC, editor-in-chief of JACC: Heart Failure.

Additionally, in an accompanying editorial, Steven J. Keteyian, PhD, and Clinton A. Brawner, PhD, of the Division of Cardiovascular Medicine at Henry Ford Hospital in Detroit, wrote, “We are reminded that we still know relatively little about how variations in physical activity and exercise ‘dose’ might impact disease onset.” They add that the paradoxical nature of the findings that risk of heart failure development actually increases for those reporting high levels of physical activity leads them to ask, “How much exercise it too much?” However, they also said they believe the study findings reinforce the “message that a moderate level of total physical activity is an important behavioral strategy” in both the treatment and prevention of heart failure.

Keywords: Exercise, Heart Failure, Male

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