Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Changes in Physical Activity & Risk of HF

Circulation; ePub 2018 Jan 31; Florido, et al

Even in late middle age, initiating and increasing physical activity (PA) can lower heart failure (HF) risk, a recent study found. 11,351 patients (mean age 60 years) from the Atherosclerosis Risk in Communities (ARIC) study who attended Visit 3 (1993-1995) and did not have a history of cardiovascular disease (CVD) were evaluated. Cox regression models were used to characterize the association of 6-year changes in PA between the first (1987-1989) and third ARIC visits and HF risk. Researchers found:

  • There were 1,750 HF events during a median of 19 years of follow-up.
  • The lowest HF risk was seen for those with persistently recommended activity (HR, 0.69), compared to those with poor activity at both visits.
  • However, those whose PA increased from poor to recommended also had reduced HF risk (HR, 0.77).
  • Among those with poor baseline activity, each 1-SD higher PA at 6 years was associated with significantly lower future HF risk (HR, 0.89).


Florido R, Kwak L, Lazo M, et al. Six-year changes in physical activity and the risk of incident heart failure: The Atherosclerosis Risk in Communities (ARIC) study. [Published online ahead of print January 31, 2018]. Circulation. doi:10.1161/CIRCULATIONAHA.117.030226.


The beauty of this study is that it addresses the important question that people who are around 60 years old often wonder about: “Is the horse is out of the barn?” Many people feel if they have not started an exercise regimen by the time they are 50 to 65 years of age, there is not reason to start at that point. This trial shows that nothing could be further from the truth. With a mean age of 60 and a full 19 years of follow-up, those who stayed in good shape had a 40% lower risk of developing heart failure. What was remarkable though was that those who were not in good shape at the beginning of the study and worked hard to get into shape reduced their chances of developing heart failure by almost 25%. That’s impressive and offered good rationale for devoting time to behavioral counseling in the office devoted to helping patients increase physical activity as a part of their approach to a happy and healthy life. — Neil Skolnik, MD