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Dose-Response Relationship Between Physical Activity and Risk of Heart Failure: A Meta-Analysis.
Circulation 2015; 132(19):1786-94Circ

Abstract

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 with random-effects models. Generalized least-squares regression models were used to assess the quantitative relationship between PA (metabolic equivalent [MET]-min/wk) 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 for highest versus lowest PA, 0.70; 95% confidence interval, 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/wk; 2008 US federal guidelines) had modest reductions in HF risk (pooled hazard ratio, 0.90; 95% confidence interval, 0.87-0.92). In contrast, a substantial risk reduction was observed among individuals who engaged in PA at twice (hazard ratio for 1000 MET-min/wk, 0.81; 95% confidence interval, 0.77-0.86) and 4 times (hazard ratio for 2000 MET-min/wk, 0.65; 95% confidence interval, 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.

Authors+Show Affiliations

From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.).From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.).From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.).From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.).From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.).From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.).From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.).From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.).From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.). jarett.berry@utsouthwestern.edu.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26438781

Citation

Pandey, Ambarish, et al. "Dose-Response Relationship Between Physical Activity and Risk of Heart Failure: a Meta-Analysis." Circulation, vol. 132, no. 19, 2015, pp. 1786-94.
Pandey A, Garg S, Khunger M, et al. Dose-Response Relationship Between Physical Activity and Risk of Heart Failure: A Meta-Analysis. Circulation. 2015;132(19):1786-94.
Pandey, A., Garg, S., Khunger, M., Darden, D., Ayers, C., Kumbhani, D. J., ... Berry, J. D. (2015). Dose-Response Relationship Between Physical Activity and Risk of Heart Failure: A Meta-Analysis. Circulation, 132(19), pp. 1786-94. doi:10.1161/CIRCULATIONAHA.115.015853.
Pandey A, et al. Dose-Response Relationship Between Physical Activity and Risk of Heart Failure: a Meta-Analysis. Circulation. 2015 Nov 10;132(19):1786-94. PubMed PMID: 26438781.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dose-Response Relationship Between Physical Activity and Risk of Heart Failure: A Meta-Analysis. AU - Pandey,Ambarish, AU - Garg,Sushil, AU - Khunger,Monica, AU - Darden,Douglas, AU - Ayers,Colby, AU - Kumbhani,Dharam J, AU - Mayo,Helen G, AU - de Lemos,James A, AU - Berry,Jarett D, Y1 - 2015/10/05/ PY - 2015/02/03/received PY - 2015/08/03/accepted PY - 2015/10/7/entrez PY - 2015/10/7/pubmed PY - 2016/2/24/medline KW - exercise KW - heart failure KW - meta-analysis KW - prevention and control SP - 1786 EP - 94 JF - Circulation JO - Circulation VL - 132 IS - 19 N2 - 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 with random-effects models. Generalized least-squares regression models were used to assess the quantitative relationship between PA (metabolic equivalent [MET]-min/wk) 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 for highest versus lowest PA, 0.70; 95% confidence interval, 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/wk; 2008 US federal guidelines) had modest reductions in HF risk (pooled hazard ratio, 0.90; 95% confidence interval, 0.87-0.92). In contrast, a substantial risk reduction was observed among individuals who engaged in PA at twice (hazard ratio for 1000 MET-min/wk, 0.81; 95% confidence interval, 0.77-0.86) and 4 times (hazard ratio for 2000 MET-min/wk, 0.65; 95% confidence interval, 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. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/26438781/Dose_Response_Relationship_Between_Physical_Activity_and_Risk_of_Heart_Failure:_A_Meta_Analysis_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.115.015853?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -