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

Abstract

Background—The nature of the association between levels of physical activity and risk of heart failure is little known. We investigated non-linear associations of total and leisure-time physical activity with risk of heart failure.

Methods and Results—In 1997, 39,805 persons without heart failure completed a questionnaire of lifestyle factors and medical history. We used Cox regression models to investigate total (adjusting for education and previous myocardial infarction) and direct (multivariable-adjusted) effects of self-reported total and leisure-time physical activity on risk of heart failure of any cause and heart failure of non-ischemic origin. Heart-failure diagnoses were obtained until December 31, 2010. Higher leisure-time physical activity was associated with lower risk of heart failure of any cause; hazard ratio (HR) of the total effect of leisure time physical activity was for fifth vs. first quintile 0.54; 95% confidence interval (CI) 0.44-0.66. The direct effect was similar. 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). A similar direct effect observed.

Conclusions—Leisure-time physical activity was inversely related to risk of developing heart failure in a dose-response fashion. This was reflected in a similar but less pronounced association of total physical activity with risk of heart failure. Only part of the effects appeared to be mediated by traditional risk factors.