Dose-Response Relations of Total and Leisure-Time Physical Activity to Risk of Heart Failure: A Prospective Cohort Study

Study Questions:

Is increased physical activity associated with a reduced risk for heart failure?


Data from the Swedish National March Cohort were used for the present analysis. This cohort was formed in 1997 by the Swedish Cancer Society and included residents from 3,600 Swedish cities and villages. Participants completed a 32-page questionnaire, which included items on physical activity, diet, medical history, and lifestyle factors. A total of 43,880 participants completed the questionnaire. Those with a history of heart failure or with missing information were excluded. The exposure of interest was leisure time physical activity. Heart failure outcome was assessed through linkage of participants with hospital discharge diagnoses. Follow-up was conducted from October 1997 to December 2010.


A total of 39,805 participants were included in the present analysis, of which 1,545 (3.9%) experienced an index hospitalization for heart failure during the follow-up period. Median leisure time physical activity was 2.6 METs/day. Higher levels of leisure-time physical activity were associated with lower risk of heart failure (of any cause). Those in the fifth quintile of leisure time physical activity compared to those in the first quintile had a hazard ratio (HR) of 0.54 (95% confidence interval [CI], 0.44-0.66) for heart failure. High total daily physical activity level was associated with lower risk of heart failure, although the effect was less pronounced than for leisure-time physical activity (total effect HR, 0.81; 95% CI, 0.69-0.95; fifth vs. first quintile).


The investigators concluded that leisure-time physical activity appears to be inversely associated with risk for heart failure, in a dose-response fashion.


These data support the benefits of regular physical activity for reducing risk of cardiovascular disease outcomes, including heart failure. In particular, leisure time physical activity is recommended based on these data. Understanding the mechanisms for this benefit is warranted.

Clinical Topics: Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Diet, Exercise

Keywords: Neoplasms, Life Style, Exercise, Heart Failure, Leisure Activities, Diet, Questionnaires

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