Adults experience steep declines in moderate to vigorous-intensity physical activity (MVPA) before developing cardiovascular disease, with exercise reduction persisting after diagnosis, according to a cohort and nested case-control study published July 23 in JAMA Cardiology.

Yariv Gerber, PhD, et al., analyzed data from 3,068 CARDIA participants, a prospective study initiated in 1985-1986 with up to 10 physical activity assessments through 2020-2022. The participants were about 25 years old at baseline, 57% were women and 45% self-identified as Black.

At baseline, the mean MVPA was 423 exercise units (EU), with 300 EU approximating 150 minutes/week of MVPA.

Results showed overall that MVPA decreased between young adulthood and middle age before stabilizing thereafter. Specifically, Black men had a more sustained decline, whereas Black women had the lowest MVPA across adulthood.

In a nested case-control analysis of 236 incident cardiovascular disease cases, each participant was matched to controls without cardiovascular disease by age, sex and race. Participants who developed cardiovascular disease (defined as coronary heart disease, stroke or heart failure) began reducing MVPA approximately 12 years before cardiovascular disease, with declines accelerating two years before. Notably, after established cardiovascular disease, participants continued to be less active vs. controls.

Further findings revealed that, by disease type, heart failure was associated with the steepest decline, which leveled off a few years before diagnosis. Overall, those with cardiovascular disease were more likely than controls to have low MVPA levels after diagnosis (odds ratio [OR], 1.78), with the greatest risk seen in Black women (OR, 4.52), followed by White women (OR, 2.86) and Black men (OR, 1.72).

Gerber and colleagues advise sustaining lifelong physical activity, which "is vital for maintaining function and preventing disability and chronic cardiovascular or metabolic diseases." They write that "these findings reinforce the importance of preventing age-related declines and promoting post-[cardiovascular disease] recovery – especially among women."