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More Physical Activity Linked to Reduced HF Risk in Older Women


Increased daily step count was linked to reduced risks of overall heart failure (HF) and HF with preserved or reduced ejection fraction.

Older women who engage in more physical activity have a lower risk of developing heart failure (HF), according to a new study published in JAMA Cardiology.

Women hula hooping | Image credit: Rawpixel.com – stock.adobe.com

Women hula hooping | Image credit: Rawpixel.com – stock.adobe.com

This finding is based on accelerometer-measured physical activity (PA) and sedentary time among 5951 women aged between 63 and 99 years without known HF. The researchers of the Objective Physical Activity and Cardiovascular Health in Older Women study, which was conducted from March 2012 to April 2014, measured PA and resting time by having the women wear hip-worn triaxial accelerometers for 7 days straight. Follow-up for incident HF continued until February 2022.

The mean (SD) age among the cohort was 78.6 (6.8) years, with 49.2% of women being non-Hispanic White, 33.7% being non-Hispanic Black, and 17.2% being Hispanic. Across a mean follow-up of 7.5 (2.6) years, the researchers identified 407 cases of HF, including 257 cases of HF with preserved ejection fraction (HFpEF) and 110 of HF with reduced EF (HFrEF).

These women were sedentary for a significant portion of their day, with a mean (SD) of 10.3 (1.7) hours per day seated, and a median (IQR) number of daily steps of only 3133 (2303-4547) steps. Additionally, of the mean (SD) 5.7 (1.5) hours spent doing physical activity each day, most of this activity was light intensity (85% or 4.8 hours).

The researchers also found that, for every 1-SD increase in minutes of daily physical activity, overall HF risk decreased by 15%, risk of HFpEF decreased by 22%, and risk of HFrEF remained relatively unchanged with a slight increase of 2%. Additionally, every 1-SD increase in daily steps, overall HF risk decreased by 26%, HFpEF risk decreased by 29%, and HFrEF risk decreased by 17%. Meanwhile, for every 1-SD increase in daily sedentary time, overall HF risk increased by 17%, HFpEF risk increased by 29%, and HFrEF risk actually decreased by 6%.

Cubic spline curves revealed significant inverse relationships between overall HF and HFpEF with total physical activity and steps per day, while they showed a positive association with total sedentary behavior. Light physical activity and moderate to vigorous physical activity were both inversely linked with overall HF and HFpEF, indicating lower risk with higher levels of these activities. However, no such association was observed for HFrEF. These associations remained consistent across different groups based on age, race and ethnicity, body mass index, physical function, and comorbidity score. However, the results regarding sedentary bout duration were not consistently reliable.

According to the researchers, it was unclear why there was no inverse association between physical activity and incident HFrEF. Interestingly, mean sedentary bout duration was inversely associated with HFrEF, but the small number of cases in the lowest quartile may have influenced this unexpected finding, according to the researchers. Meanwhile, positive associations for sedentary bout duration were consistent with HFpEF and overall HF.

Higher levels of physical activity were found to be associated with younger age, non-Hispanic White race, higher education, alcohol intake, better self-rated health, higher physical functioning, lower rates of smoking and obesity, and favorable cardiometabolic factors. Meanwhile, factors positively associated with incident HF included older age, assistive walking device use, fair or poor self-rated health, obesity, depression, diabetes, hypertension, coronary heart disease, stroke, atrial fibrillation, higher systolic blood pressure, and higher C-reactive protein level. In contrast, non-Hispanic Black and Hispanic women, alcohol use, better physical function, and higher HDL cholesterol level were inversely associated with HF incidence.

“An association for sedentary bout duration with HF was not clear and requires further investigation,” the researchers said. “Encouraging older adults to sit less and be more active in usual daily activities could be an important part of primary HFpEF prevention, where clinical treatment options are presently limited and population burden is growing.”


LaMonte MJ, LaCroix AZ, Nguyen S, et al. Accelerometer-measured physical activity, sedentary time, and heart failure risk in women aged 63 to 99 years. JAMA Cardiol. Published online February 21, 2024. doi:10.1001/jamacardio.2023.5692

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