March 12, 2014Open Access
Speed and Duration of Walking and Other Leisure Time Physical Activity and the Risk of Heart Failure: A Prospective Cohort Study from the Copenhagen City Heart Study
Key Result
High walking speed was associated with a significantly reduced risk of heart failure (HR 0.30) compared to low walking speed, whereas duration of walking showed no consistent association.
Study Design
Type
Cohort (n=18,209)
Multicenter
No
Structured PICO
Does higher speed and duration of walking and leisure-time physical activity reduce the risk of hospitalization or death from heart failure in adults free of previous MI, stroke or HF?
P
Population
18,209 adults aged 20-80 years, free of previous myocardial infarction, stroke, or heart failure, followed for over 30 years to assess the risk of developing heart failure.
E
Exposure
Self-assessed leisure-time physical activity (light and moderate/high levels) and walking (speed and duration).
C
Comparator
Lowest activity level.
O
Outcome
Subsequent hospitalization or death from HF.composite
Walking speed, rather than duration, is strongly associated with a reduced risk of developing heart failure in adults without prior cardiovascular disease.
Main Result
Hazard Ratio: 0.3 (95% CI 0.21–0.44)
p-value: p=<0.001
Limitations
- Information on physical activity and duration of walking was self-reported.
- Hospital discharge diagnosis of heart failure has low sensitivity, potentially missing milder cases treated outside the hospital.
- Observational design precludes inferring causality.
Abstract
AIM: Physical activity (PA) confers some protection against development of heart failure (HF) but little is known of the role of intensity and duration of exercise. METHODS AND RESULTS: In a prospective cohort study of men and women free of previous MI, stroke or HF with one or more examinations in 1976-2003, we studied the association between updated self-assessed leisure-time PA, speed and duration of walking and subsequent hospitalization or death from HF. Light and moderate/high level of leisure-time PA and brisk walking were associated with reduced risk of HF in both genders whereas no consistent association with duration of walking was seen. In 18,209 subjects age 20-80 with 1580 cases of HF, using the lowest activity level as reference, the confounder-adjusted hazard ratios (HR) for light and moderate/high leisure-time physical activity were 0.75 (0.66-0.86) and 0.80 (0.69-0.93), respectively. In 9,937 subjects with information on walking available and 542 cases of HF, moderate and high walking speed were associated with adjusted HRs of 0.53 (0.43-0.66) and 0.30 (0.21-0.44), respectively, and daily walking of ½-1 hrs, 1-2 and >2 hrs with HR of 0.80 (0.61-1.06), 0.82 (0.62-1.06), and 0.96 (0.73-1.27), respectively. Results were similar for both genders and remained robust after exclusion of HF related to coronary heart disease and after a series of sensitivity analyses. CONCLUSIONS: Speed rather than duration of walking was associated with reduced risk of HF. Walking is the most wide-spread PA and public health measures to curb the increase in HF may benefit from this information.