Relationship between physical activity, body mass index, and risk of heart failure
Open accessAbstract
Background Lower leisure-time physical activity (LTPA) and higher body mass index (BMI) are independently associated with risk of heart failure (HF). However, it is unclear if this relationship is consistent for both heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF).Objectives This study sought to quantify dose-response associations between LTPA, BMI, and the risk of different HF subtypes.Methods Individual-level data from 3 cohort studies (WHI [Women's Health Initiative], MESA [Multi-Ethnic Study of Atherosclerosis], and CHS [Cardiovascular Health Study]) were pooled and participants were stratified into guideline-recommended categories of LTPA and BMI. Associations between LTPA, BMI, and risk of overall HF, HFpEF (ejection fraction ≥45%), and HFrEF (ejection fraction <45%) were assessed by using multivariable adjusted Cox models and restricted cubic splines.Results The study included 51,451 participants with 3,180 HF events (1,252 HFpEF, 914 HFrEF, and 1,014 unclassified HF). In the adjusted analysis, there was a dose-dependent association between higher LTPA levels, lower BMI, and overall HF risk. Among HF subtypes, LTPA in any dose range was not associated with HFrEF risk. In contrast, lower levels of LTPA (<500 MET-min/week) were not associated with HFpEF risk, and dose-dependent associations with lower HFpEF risk were observed at higher levels. Compared with no LTPA, higher than twice the guideline-recommended minimum LTPA levels (>1,000 MET-min/week) were associated with an 19% lower risk of HFpEF (hazard ratio: 0.81; 95% confidence interval: 0.68 to 0.97). The dose-response relationship for BMI with HFpEF risk was also more consistent than with HFrEF risk, such that increasing BMI above the normal range (≥25 kg/m 2) was associated with a greater increase in risk of HFpEF than HFrEF.Conclusions Our study findings show strong, dose-dependent associations between LTPA levels, BMI, and risk of overall HF. Among HF subtypes, higher LTPA levels and lower BMI were more consistently associated with lower risk of HFpEF compared with HFrEF.
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The associations between physical activity and cardiorespiratory fitness and heart failure risk are stronger and more dose-dependent for heart failure with preserved ejection fraction than for heart failure with reduced ejection fraction.
“Furthermore, the associations between PA and CRF and HF risk are stronger and more dose-dependent for HF with preserved ejection fraction (HFpEF) than for HF with reduced ejection fraction (HFrEF) [ 114 , 116 ].”
From Physical activity, cardiorespiratory fitness, and cardiovascular health: A clinical practice statement of the American Society for Preventive Cardiology Part II: Physical activity, cardiorespiratory fitness, minimum and goal intensities for exercise training, prescriptive methods, and special patient populations (2022) · cites this paper as [116]
The Results section reports a dose-dependent inverse association between leisure-time physical activity and HFpEF risk, but no significant association with HFrEF risk. The paper does not report a corresponding comparison of cardiorespiratory fitness and risk of the two heart-failure subtypes, so the CRF part of the claim is unsupported. (LLM, conf=0.87)
Experimental — accuracy not yet measuredObesity is a major risk factor for the development and progression of heart failure with preserved ejection fraction.
“Obesity is a major risk factor for heart failure (HF) with preserved ejection fraction (HFpEF). 1,2”
From Semaglutide versus placebo in people with obesity-related heart failure with preserved ejection fraction: a pooled analysis of the STEP-HFpEF and STEP-HFpEF DM randomised trials (2024) · cites this paper as [2]
The Results report a significant, dose-dependent association between BMI and the risk of developing HFpEF; participants with class I obesity had a 56% higher risk than those of normal weight. The paper addresses incident HFpEF, not whether obesity contributes to progression after HFpEF develops. (LLM, conf=0.86)
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Self-citation
- Authors
- Pandey, A., LaMonte, M., Klein, L., Ayers, C., Psaty, B. M., Eaton, C. B., Allen, N. B., de Lemos, J. A., Carnethon, M., Greenland, P., & Berry, J. D.
- Affiliations
- The University of Texas Southwestern Medical Center (US)
- University at Buffalo, State University of New York (US)
- University of California, San Francisco (US)
- University of Washington (US)
- Brown University (US)
- Northwestern University (US)
- Corresponding author
- Berry, Jarett D.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2017-03
- Volume
- 69
- Issue
- 9
- Pages
- 1129-1142
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC5848099
- OpenAlex
- W2592392911
- Cited by
- 398
- References
- 64
- Citations by year
- 2026: 45 · 2025: 75 · 2024: 60 · 2023: 48 · 2022: 37 · 2021: 38 · 2020: 36 · 2019: 24 · 2018: 21 · 2017: 13
- FWCI
- 19.90
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- American Heart Association (N01-HC-95167, N01HC95169, UL1-TR-001079, UL1 TR000040, N01-HC 95168, N01HC95165, N01HC95166, N01-HC-95159, HHSN268201500003I)
- National Institutes of Health (n01hc95164-17-0-1, n01hc085082-026, n01hc085081-021, n01hc085079-024, n01hc095159-004, n01hc085083-027, n01hc085080-026, n01hc95161-24-0-1, HHSN268201100004C, n01hc085086-022, n01hc95162-31-0-1, n01hc095167-003, n01hc95160-18-0-1, n01hc095165-005, HHSN268201100001C, n01hc095166-004, HHSN268201100002C, UL1TR001079, n01hc95163-22-0-1, n01hc55222-0-0-0, n01hc095168-003, UL1TR001412, n01hc095169-004, UL1TR000040, HHSN268201100003C)
- National Institute on Aging (HHSN-271-2011-00004C,, R01AG023629)
- National Heart, Lung, and Blood Institute (N01 HC085086, N01 HC-95159, N01-HC095169, N01 HC-95168, N01-HC-095165, N01 HC95167, N01 HC085079, N01 HC095163, HHSN2682011-00001I, N01 HC085083, HHSN2682011-00002I, N01 HC95165, N01 HC085080, HHSN 268200800007C, U01HL130114, UL1-TR-, N01-HC-095159, N01-HC, N01 HC095168, N01-HC-095162, HHSN2682011‐00004I, HC-95168, N01-HC-095161, HHSN268201500003C, HHSN26820150 0003I, HHSN268201200036C, HHSN268201100046C, N01 HC095167, N01HC085082, U01HL080295, N01-HC-095160, N01 HC055222, N01 HC095166, N01 HC095164, N01‐HC‐95166, HHSN2682011-00003I, N01 HC085081, HC95159, N01 HC95169)
- National Center for Research Resources (N01-HC-95166, N01-HC-95168, N01 HC 95169, N01-HC-95159, N01 HC 95165, N01-HC-95167)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- heart failure, heart failure with preserved ejection fraction, heart failure with reduced ejection fraction, leisure-time physical activity, body mass index, obesity, dose-response relationship, cardiovascular risk factors, Women's Health Initiative, Multi-Ethnic Study of Atherosclerosis, Cardiovascular Health Study
- MeSH terms
- Aged, Female, Heart Failure, Humans, Male, Middle Aged, Risk Factors, Stroke Volume, Cohort Studies, Exercise, Body Mass Index, Proportional Hazards Models
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