Physical activity may lower the risk of myocardial damage in middle-aged and older adults and reduce the levels of myocardial damage in people who are obese, according to a study published April 24 in JACC: Heart Failure.

Roberta Florido, MD, and colleagues examined 9,427 patients aged 45-64 years without cardiovascular disease and a body mass index of more than 18.5 kg/m². Physical activity was measured through a questionnaire and categorized according to current guidelines as “recommended” (at least 75 minutes per week of vigorous intensity or at least 150 minutes per week of a combination of moderate to vigorous intensity), “intermediate” (1-74 minutes per week of vigorous intensity or 1-149 minutes of a combination of moderate to vigorous intensity), or “poor” (no moderate to vigorous exercise). To measure myocardial damage, researchers assessed levels of high sensitivity troponin T (hs-cTnT).

Results showed that elevated hs-cTnT was observed in 7.2 percent of the total study population. Participants who performed poor and intermediate levels of physical activity were 39 percent and 34 percent more likely to have myocardial damage than persons who engaged in recommended levels of physical activity.

The researchers subsequently looked at the combined associations of physical activity and obesity with hs-cTnT. Participants with obesity who performed poor levels of exercise had the highest likelihood of having elevated hs-cTnT. Subjects with obesity who performed recommended levels of physical activity had a weaker association with elevated hs-cTnT, and after adjustment for traditional cardiac risk factors, this was association was no longer statistically significant. These results suggest physical activity may lessen the association of obesity and myocardial damage. The authors also found a significant interaction between physical activity and obesity on elevated hs-cTnT, which indicates that the protective association of physical activity and myocardial damage may be stronger among individuals with obesity, a group at particularly high risk for future heart failure. 

In an accompanying editorial comment, Tariq Ahmad, MD, MPH, FACC, and Jeffrey M. Testani, MD, MTR, encourage cardiologists to promote healthy habits rather than simply treating heart failure after it has developed. “What if we started to view heart failure as a failure, of not only of the heart to keep up with the metabolic demands of the body, but also the community of cardiologists to promote the behaviors that lead to its development?” they ask. “This will surely encourage a shift beyond the reactionary approaches used in contemporary clinical practice and force us into interactions with the multitude of stakeholders that play a role in improving the cardiovascular health of our communities.”

Keywords: Body Mass Index, Exercise, Habits, Heart, Heart Failure, Middle Aged, Myocardium, Obesity, Research Personnel, Risk Factors, Troponin T

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