Physical Activity Linked to Reduced Risk of Heart Failure

A meta-analysis found evidence that different kinds of physical activity can help reduce risk of heart failure for the general population.

Different types of physical activity, including leisure-time activity, occupational activity, walking, and bicycling, were shown to reduce the risk of heart failure, according to a study published in the European Journal of Epidemiology. This helps to support the recommendation to increase physical activity among the general population.

The results build on well-established evidence that physical activity can help reduce risks of developing cardiovascular disease by adding information of how it can also reduce heart failure risk.

Although previous studies have focused on establishing whether or not physical activity can reduce heart failure risk, results have differed on whether an association exists. Additionally, little research has been done to investigate how specific types and intensities of physical activity affect heart failure. The researchers also said that updating the evidence regarding various physical activities could be used by physicians for heart failure risk assessments.

In the present review, studies published onto the PubMed and Embase databases up until January 14, 2020, were analyzed. Studies included in the analysis had to be prospective cohort, case-cohort, or nested case-control studies that investigated the link between physical activity or cardiorespiratory fitness and heart failure in the general population.

The researchers identified 20,208 records and included 29 prospective studies representing 36 publications; 27 studies from 34 publications were used in the meta-analysis. Twenty-one of these studies addressed different domains of physical activity and 6 had investigated cardiorespiratory fitness, for approximately 73,000 cases and 1.9 million participants. Eleven studies were from the United States, 1 was from Canada, 8 came from Europe, and 1 was an international study. The United States and Europe each had 3 studies that included information on cardiorespiratory fitness and heart failure.

The investigators calculated the summary relative risks (RR) using random effects models. The summary RR for high vs low physical activity was 0.77 (95% CI, 0.70-0.85; I2 = 48.7%; P = .07). The overall RR ranged from 0.74 (95% CI, 0.68-0.81; I2 = 88.1%; P < .0001) for leisure-time activity to 0.66 (95% CI, 0.59-0.74; I2 = 0%; P = .63) for more aggressive activity.

For walking and bicycling combined, the overall RR was 0.81 (95% CI, 0.69-0.94; I2 = 86%; P = .001). Walking and walking speed were not observed to have a significant association with heart failure, with the researchers noting that studies in this area were limited.

Occupational activity had an overall RR of 0.90 (95% CI, 0.86-0.95; I2 = 0%; P = .46), and cardiorespiratory fitness had a summary RR of 0.31 (95% CI, 0.19-0.49; I2 = 96%; P < .0001).

The summary RR in the dose-response analysis per 20 metabolic equivalent hours per day of total physical activity was 0.89 (95% CI, 0.83-0.95; I2 = 67%; P = .03). For leisure-time activity, the summary RR was 0.71 (95% CI, 0.65-0.78; I2 = 85%; P < .0001).

Studies that adjusted for body mass index, diabetes, and hypertension did not show a significant difference in their results, the investigators said, suggesting that the association between physical activity and heart failure is independent of a person’s weight.

The researchers noted that their results may be influenced by confounding factors; however, a subgroup analysis defined by adjustments in various situational and health-related factors revealed that the association between physical activity and heart failure persisted. Additionally, the investigators said that some of the included studies may have had a publication bias.

Future studies should investigate the association of different forms of physical activity and subtypes of heart failure, the investigators concluded, and report the results in a way that could be useful in a dose-response meta-analysis.


Aune D, Schlesinger S, Leitzmann MF, et al Physical activity and the risk of heart failure: a systematic review and dose–response meta‐analysis of prospective studies. Eur J Epidemiol. Published online December 17, 2020. doi:10.1007/s10654-020-00693-6