Physical Activity and Heart Failure Risk in Men

Study Questions:

Is total physical activity, as well as different types of physical activity, associated with heart failure (HF) risk?


The study population consisted of 33,012 men from Cohort of Swedish Men (COSM), a population-based cohort established between 1997 and 1998. This cohort was followed from the beginning of 1998 until the end of 2012. The authors ascertained the first event of HF through linkage to the Swedish National Patient Register and Cause of Death Register. All were born between 1914 and 1948 and were asked to complete an extensive questionnaire regarding physical activity, diet, anthropometric traits, and other lifestyle factors. They analyzed the data using Cox proportional hazards regression and Laplace regression.


During a mean follow-up of 13 years, the study investigators ascertained a total of 3,609 first events of HF. The average age at study baseline was 60 ± 9 years. They found a U-shaped association between total physical activity and when HF risk was detected, with both extremely high (57 metabolic equivalent [MET] h/day) and extremely low (38 MET h/day) levels of total physical activity associated with an increased risk of HF. Compared with participants with the median total physical activity level (41 MET h/day), lower levels of total physical activity (beginning from 40 MET h/day) were progressively associated with higher HF risk, with up to 44% higher risk for participants with the lowest total physical activity (hazard ratio, 1.44; 95% confidence interval [CI], 1.24-1.68). When investigating different types of physical activity, they found that walking/bicycling at least 20 minutes/day was associated with 21% lower risk of HF (95% CI, 0.72-0.87); corresponding to a median age at HF 8 months later for those who had actively walked or biked daily. When looking at long-term physical activity of walking/bicycling, their results suggested a trend toward more recent active behavior being more related to HF protection than past physical activity levels. Exercising more than 1 hour/week was associated with HF risk reduction with a hazard ratio of 0.86 (95% CI, 0.79-0.94) in the multivariable-adjusted model. Work occupation, household work, and physical inactivity were not significantly associated with HF development.


The study investigators concluded that both low levels and high levels of total physical activity, in comparison with moderate levels, could increase HF risk in men, and that certain types of physical activity are associated with a protective effect on HF in men. When examining different types of physical activity, walking/bicycling at least 20 minutes per day was associated with the largest risk reduction of HF.


This is an important study that suggests the sweet-spot for reducing HF risk is moderate intensity of exercise (that is, too little or too much is too bad!). The findings of this study ‘correspond’ to other studies in the general population, which suggest that moderate intensity of exercise is the sweet-spot for longevity and also adds ‘life to one’s years.’ (O’Keefe JH, Lavie CJ. Run for your life, at a comfortable speed and not too far. Heart 2013;99:516-9).

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