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Dose–Response Relationship of Total and Leisure Time Physical Activity to Risk of Heart Failure: a prospective cohort study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.ORCID iD: 0000-0002-6534-2613
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
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2014 (English)In: Circulation Heart Failure, ISSN 1941-3289, E-ISSN 1941-3297, Vol. 7, no 5, 16 p.701-708 p.Article in journal (Refereed) Published
Abstract [en]

Background—The nature of the association between levels of physical activity and risk of heart failure is little known. We investigated nonlinear 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 nonischemic 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 of the total effect of leisure time physical activity was for fifth versus first quintile 0.54; 95% confidence interval was 0.44 to 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 hazard ratio, 0.81; 95% confidence interval, 0.69–0.95; fifth versus 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.

Place, publisher, year, edition, pages
2014. Vol. 7, no 5, 16 p.701-708 p.
Keyword [en]
heart failure, physical exercise, cohort study, primary prevention, epidemiology
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology; Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-216862DOI: 10.1161/CIRCHEARTFAILURE.113.001010ISI: 000342490900003PubMedID: 25185250OAI: oai:DiVA.org:uu-216862DiVA: diva2:692765
Available from: 2014-02-01 Created: 2014-01-27 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Physical Activity and Cardiovascular Disease
Open this publication in new window or tab >>Physical Activity and Cardiovascular Disease
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim was to investigate associations of fitness and types and levels of physical activity with subsequent risk of cardiovascular disease.

Four large-scale longitudinal cohort studies were used. The exposures were different measures related to physical activity and the outcomes were obtained through linkage to the Swedish In-Patient Register. In a cohort of 466 elderly men without pre-existing cardiovascular disease, we found that skeletal muscle morphology was associated with risk of cardiovascular events. A high amount of type I (slow-twitch, oxidative) skeletal muscle fibres was associated with lower risk of cardiovascular events and high amount of type IIx was associated with higher risk of cardiovascular events. This association was only seen among physically active men. Among 39,805 participants in a fundraising event, higher levels of both total and leisure time physical activity were associated with lower risk of heart failure. The associations were strongest for leisure time physical activity. In a cohort of 53,755 participants in the 90 km skiing event Vasaloppet, a higher number of completed races was associated with higher risk of atrial fibrillation and a higher risk of bradyarrhythmias. Further, better relative performance was associated with a higher risk of bradyarrhythmias. Among 1,26 million Swedish 18-year-old men, exercise capacity and muscle strength were independently associated with lower risk of vascular disease. The associations were seen across a range of major vascular disease events (ischemic heart disease, heart failure, stroke and cardiovascular death). Further, high exercise capacity was associated with higher risk of atrial fibrillation and a U-shaped association with bradyarrhythmias was found. Higher muscle strength was associated with lower risk of bradyarrhythmias and lower risk of ventricular arrhythmias.

These findings suggest a higher rate of atrial fibrillation with higher levels of physical activity. The higher risk of atrial fibrillation does not appear to lead to a higher risk of stroke. In contrast, we found a strong inverse association of higher exercise capacity and muscle strength with vascular disease. Further, high exercise capacity and muscle strength are related to lower risk of cardiovascular death, including arrhythmia deaths. From a population perspective, the total impact of physical activity on cardiovascular disease is positive.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. 84 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 972
Keyword
Physical activity, epidemiology, cohort study, heart failure, cardiovascular disease, arrhythmias, atrial fibrillation, bradyarrhythmias, sudden cardiac death, heart failure, stroke, ischemic heart disease, cardiovascular death, maximal exercise capacity, muscle strength, skeletal muscle morphology
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology; Epidemiology
Identifiers
urn:nbn:se:uu:diva-217309 (URN)978-91-554-8871-0 (ISBN)
Public defence
2014-03-21, Enghoffsalen, Akademiska Sjukhuset, Ing 50, Uppsala, 13:15 (Swedish)
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Available from: 2014-02-27 Created: 2014-02-01 Last updated: 2014-04-29

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Andersen, KasperHeld, ClaesIngelsson, ErikSundström, Johan

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