Association of Physical Activity or Fitness With Incident Heart Failure: A Systematic Review and Meta-Analysis
Open accessAbstract
Background—: Previous studies have shown that high levels of physical activity are associated with lower risk of risk factors for heart failure (HF), such as coronary heart disease, hypertension, and diabetes mellitus. However, the effects of physical activity or fitness on the incidence of HF remain unclear. Methods and Results—: MEDLINE and EMBASE were systematically searched until November 30, 2014. Prospective cohort studies reporting measures of the association of physical activity (n=10) or fitness (n=2) with incident HF were included. Extracted effect estimates from the eligible studies were pooled using a random-effects model meta-analysis, with heterogeneity assessed with the I 2 statistic. Ten cohort studies on physical activity eligible for meta-analysis included a total of 282 889 participants followed for 7 to 30 years. For the physical activity studies, maximum versus minimal amount of physical activity groups were used for analyses; with a total number of participants (n=165 695). The pooled relative risk (95% confidence interval [CI]) for HF among those with a regular exercise pattern was 0.72 (95% CI, 0.67–0.79). Findings were similar for men (0.71 [95% CI, 0.61–0.83]) and women (0.72 [95% CI, 0.67–0.77]) and by type of exercise. There was no evidence of publication bias ( P value for Egger test=0.34). The pooled associated effect of physical fitness on incident HF was 0.79 (95% CI, 0.75–0.83) for each unit increase in metabolic equivalent of oxygen consumption. Conclusions—: Published literature support a significant association between increased physical activity or fitness and decreased incidence of HF.
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The amount of daily physical activity, leisure time physical activity and physical fitness level are negatively correlated with mortality due to cerebrovascular disease and cancer, as well as all-cause mortality.
“The amount of daily physical activity, leisure time physical activity and physical fitness level have been found to be negatively correlated with morality due to cerebrovascular disease and cancer, as well as all-cause mortality in studies conducted worldwide596–606) and cohort studies in Japan577).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [597]
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Wicks, J., Oldridge, N., & Franklin, B. A. (2025) · Journal of Cardiopulmonary Rehabilitation and Prevention · doi:10.1097/hcr.0000000000000926 · Cited by 4 · see citing works
Lind, L., Zethelius, B., & Byberg, L. (2022) · PLoS ONE · doi:10.1371/journal.pone.0269402 · Cited by 4 · see citing works
“A number of meta-analyses have presented summaries of findings from these original studies and uniformly shown that a high PA is associated with a reduced risk of myocardial infarction/coronary heart disease [1, 2], stroke [1] and heart failure [3, 4].”
BackgroundWu, Y., Cheng, Q., Song, H., Gong, X., Wang, S., Xu, K., Qin, L., Cheng, J., & He, F. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1554130 · Cited by 3 · see citing works
Gunnes, M., Aksetøy, I. A., Follestad, T., Indredavik, B., & Askim, T. (2021) · PLoS ONE · doi:10.1371/journal.pone.0255308 · Cited by 3 · see citing works
Screening for Atherosclerotic Cardiovascular Disease in Asymptomatic Individuals
Michos, E. D., Blaha, M. J., Martin, S. S., & Blumenthal, R. S. (2017) · Elsevier eBooks · doi:10.1016/b978-0-323-42880-4.00029-7 · Cited by 3 · see citing works
Heart Failure Prevention for All
Butler, J., & Khan, M. S. (2020) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2020.08.020 · Cited by 3 · see citing works
Self-citationPhysical Activity/Exercise and Cardiovascular Disease
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Interaction between body mass index and physical fitness in primary heart failure prevention
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Heart Failure Prevention: Special Considerations for Women
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Physical Activity and Cardiorespiratory Fitness in Heart Failure
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Skeletal muscle, exercise and activity in pulmonary hypertension
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Physical activity for prevention of cardiovascular diseases: two sides of the same medal
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Physical Activity in the Mediterranean Region
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“Regular exercise substantially lowers the risk of developing HF and improves survival, symptoms, and exercise capacity in patients with established HF, while a sedentary lifestyle increases both HF incidence and mortality [114, 115].”
- Authors
- Echouffo-Tcheugui, J. B., Butler, J., Yancy, C. W., & Fonarow, G. C.
- Affiliations
- Northwestern University (US)
- Venue
- Circulation: Heart Failure
- Published
- 2015-09
- Volume
- 8
- Issue
- 5
- Pages
- 853-861
- ISSN
- 1941-3289 (ISSN-L)
- 1941-3297
- OpenAlex
- W2152856382
- Cited by
- 64
- References
- 33
- Citations by year
- 2026: 2 · 2025: 6 · 2023: 8 · 2022: 5 · 2021: 3 · 2020: 10 · 2019: 7 · 2018: 7 · 2017: 11 · 2016: 5
- FWCI
- 5.65
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation Heart Failure (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Keywords
- physical activity, physical fitness, heart failure, incident heart failure, cardiovascular risk factors, coronary artery disease, hypertension, diabetes mellitus
- MeSH terms
- Exercise Therapy, Heart Failure, Humans, Motor Activity, Physical Fitness, Body Mass Index, Incidence
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