Dose Response Relationship Between Physical Activity and Risk of Heart Failure: A Meta-Analysis
Background—Prior studies have reported an inverse association between physical activity (PA) and risk of heart failure (HF). However, a comprehensive assessment of the quantitative dose-response association between PA and HF risk has not been reported previously.
Methods and Results—Prospective cohort studies with participants >18 years of age that reported association of baseline PA levels and incident HF were included. Categorical dose response relationships between PA and HF risk were assessed using random effects models. Generalized least squares regression models were used to assess the quantitative relationship between PA (MET-min/week) and HF risk across studies reporting quantitative PA estimates. Twelve prospective cohort studies with 20,203 HF events among 370,460 participants (53.5% women; median follow-up: 13 years) were included. The highest levels of PA were associated with significantly reduced risk of HF [Pooled Hazard Ratio (HR)Highest vs. lowest PA: 0.70 (0.67-0.73)]. Compared with participants reporting no leisure time PA, those who engaged in guideline recommended minimum levels of PA (500 MET-min/week, 2008 US Federal Guidelines) had modest reductions in HF risk [RR: 0.90 (0.87 - 0.92)]. In contrast, a substantial risk reduction was observed among individuals who engaged in PA at twice [HR for 1000 MET-min/week: 0.81(0.77 - 0.86)] and four times [HR for 2000 MET-min/week: 0.65 (0.58 - 0.73)] the minimum guideline recommended levels.
Conclusions—There is an inverse, dose-response relationship between PA and HF risk. Doses of PA in excess of the guideline recommended minimum PA levels may be required for more substantial reductions in HF risk.
- Received February 3, 2015.
- Revision received July 22, 2015.
- Accepted August 3, 2015.