Association between device-measured physical activity and incident heart failure: a prospective cohort study of 94 739 UK Biobank participants

Background: Studies of objectively measured physical activity (PA) have investigated acute cardiovascular outcomes but not heart failure (HF), an emerging chronic condition. This study aimed to investigate the dose-relationship between device-measured PA and HF by intensity of PA. Methods: This was a prospective cohort study of 94,739 UK Biobank participants who had device-measured PA measured in 2013-2015 and were free from myocardial infarction and heart failure. PA was measured using a wrist-worn accelerometer and time spent on light- (LPA), moderate- (MPA), and vigorous-intensity PA (VPA) were extracted. Incident HF was ascertained from linked hospital and death records. Cox proportional hazard models with cubic penalised splines were used to study the associations, adjusted for sociodemographic and lifestyle factors. Competing risk was handled using cause-specific hazard ratios (HRs). Results: The overall incidence of HF was 98.5 per 10,000 person-years over a median 6.1 years of follow-up. Compared with participants who undertook no MVPA, those who performed 150-300 minutes of MPA/week (HR 0.37, 95% CI 0.34-0.41) and 75-150 minutes of VPA/week (HR 0.34, 95% CI 0.25-0.46) were at lower HF risk. The association between VPA and HF was reverse J-shaped with a potentially lower risk reduction above 150 minutes/week. Conclusions: Device-measured PA, especially MPA, was associated with lower risk of HF. Current VPA recommendations should be encouraged but not increased. In contrast, increasing MPA may be beneficial even among those meeting current recommendations