Physical activity and the risk of heart failure: a systematic review and dose-response meta-analysis of prospective studies.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of prospective observational cohort studies.
PubMed 33331992 · doi:10.1007/s10654-020-00693-6
What was done
Authors conducted a systematic review and dose-response meta-analysis of prospective observational studies searching PubMed and Embase up to January 14, 2020. They used random-effects models to evaluate associations between total physical activity, specific activity domains (leisure-time, vigorous, walking and bicycling combined, and occupational), and cardiorespiratory fitness with the risk of incident heart failure across 29 prospective studies (36 publications).
What was found
High versus low comparison summary relative risks (RRs) for heart failure risk were: - Total physical activity: RR 0.77 (95% CI 0.70–0.85, I2 = 49%, n = 7) - Leisure-time activity: RR 0.74 (95% CI 0.68–0.81, I2 = 88.1%, n = 16) - Vigorous activity: RR 0.66 (95% CI 0.59–0.74, I2 = 0%, n = 2) - Walking and bicycling combined: RR 0.81 (95% CI 0.69–0.94, I2 = 86%, n = 3) - Occupational activity: RR 0.90 (95% CI 0.86–0.95, I2 = 0%, n = 3) - Cardiorespiratory fitness: RR 0.31 (95% CI 0.19–0.49, I2 = 96%, n = 6) In dose-response analyses, heart failure RR was 0.89 (95% CI 0.83–0.95, I2 = 67%, n = 4) per 20 MET-hours/day of total activity and 0.71 (95% CI 0.65–0.78, I2 = 85%, n = 11) per 20 MET-hours/week of leisure-time activity, with dose-response curve flattening observed at 15–20 MET-hours/week for leisure-time activity.
Why it matters
This review establishes dose-response relationships between specific physical activity domains and reduced risk of heart failure, identifying a plateau in protective benefits for leisure-time activity at 15–20 MET-hours per week.
Limits
The included evidence is entirely observational, precluding causal inference. High between-study heterogeneity was present in several analyses, particularly for cardiorespiratory fitness (I2 = 96%) and leisure-time activity (I2 = 88.1%). Several sub-analyses (vigorous activity, occupational activity, and walking/bicycling) relied on very small numbers of studies (2 to 3 studies each). Total participant counts and adjustment factors are not specified in the abstract.
Cited by
- supports The nadir where maximal cardiovascular benefit is achieved for heart failure outcomes is about 5 to 10 hours of exercise per week.