Exercise and Heart Failure in Postmenopausal Women

Study Questions:

Among postmenopausal women, what is the role of physical activity in preventing heart failure (HF)?


Women enrolled in the WHI (Women’s Health Initiative) study between ages 50-79 years who were free of HF and able to walk ≥1 block were followed for a mean 14-year follow-up. Self-reported recreational activity and cases of heart failure with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF) were analyzed.


Increasing levels of total physical activity were associated with lower risks for overall HF (controlled for age, race, education, income, smoking, alcohol, hormone therapy, and hysterectomy status). Compared to women reporting no physical activity, inverse associations were observed across incremental tertiles of physical activity for risk of overall HF (hazard ratio [HR]: Tertile 1 = 0.89; Tertile 2 = 0.74; Tertile 3 = 0.65; trend p < 0.001), HFpEF (HR, 0.93, 0.70, 0.68; p < 0.001), and HFrEF (HR, 0.81, 0.59, 0.68; p = 0.01). Walking was the most common form of physical activity and was inversely associated with HF (overall HF: 1.00, 0.98, 0.93, 0.72; p < 0.001; HFpEF: 1.00, 0.98, 0.87, 0.67; p < 0.001; HFrEF: 1.00, 0.75, 0.78, 0.67; p = 0.01). Physical activity was also associated with lower risk of HF among subgroups, defined by age, body mass index, diabetes, hypertension, physical function, and coronary heart disease.


Higher levels of physical activity, such as walking, are associated with reduced HF risk among older women.


These findings strongly support the importance of physical activity in the prevention of HF among older women, thus building upon a breadth of research demonstrating the benefits of exercise for overall cardiovascular health. Physical activity has several cardiometabolic effects and is also associated with lower risks of obesity, hypertension, and diabetes. The benefits of exercise extend well-beyond the cardiovascular effects, as outlined by the recent Physical Activity Guidelines (see Piercy KL, et al., The Physical Activity Guidelines for Americans. JAMA 2018;320:2020-8). Interestingly, this study suggests that total volume of movement, such as walking, can have benefit for preventing both HFpEF and HFrEF. The challenge for physicians is to find an effective way to encourage our patients to become more active. Physical activity programs within the community and at the population level could be beneficial.

Clinical Topics: Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Chronic Heart Failure, Exercise, Hypertension, Smoking

Keywords: Body Mass Index, Coronary Disease, Diabetes Mellitus, Exercise, Heart Failure, Heart Failure, Diastolic, Heart Failure, Systolic, Hypertension, Hysterectomy, Obesity, Postmenopause, Primary Prevention, Risk, Smoking, Stroke Volume, Walking, Women

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