title: Dose-response relationship of total and leisure time physical activity to risk of heart failure: a prospective cohort study.
abstract: BACKGROUND
  The nature of the association between levels of physical activity and risk of heart failure is little known. We investigated nonlinear associations of total and leisure time physical activity with risk of heart failure.
  
  
  RESULTS
  In 1997, 39 805 persons without heart failure completed a questionnaire of lifestyle factors and medical history. We used Cox regression models to investigate total (adjusting for education and previous myocardial infarction) and direct (multivariable-adjusted) effects of self-reported total and leisure time physical activity on risk of heart failure of any cause and heart failure of nonischemic origin. Heart failure diagnoses were obtained until December 31, 2010. Higher leisure time physical activity was associated with lower risk of heart failure of any cause; hazard ratio of the total effect of leisure time physical activity was for fifth versus first quintile 0.54; 95% confidence interval was 0.44 to 0.66. The direct effect was similar. High total daily physical activity level was associated with lower risk of heart failure, although the effect was less pronounced than for leisure time physical activity (total effect hazard ratio, 0.81; 95% confidence interval, 0.69-0.95; fifth versus first quintile). A similar direct effect observed.
  
  
  CONCLUSIONS
  Leisure time physical activity was inversely related to risk of developing heart failure in a dose-response fashion. This was reflected in a similar but less pronounced association of total physical activity with risk of heart failure. Only part of the effects appeared to be mediated by traditional risk factors.
authors.affiliation: From the Department of Medical Sciences (K.A., C.H., J.S.) and Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory (E.I.), Uppsala University Hospital, Uppsala, Sweden; Department of Medical Epidemiology and Biostatistics (D.M., H.-O.A., O.N., W.Y., R.B.) and Unit of Clinical Epidemiology (Y.T.L.), Karolinska Institutet, Solna, Sweden; Department of Statistics, University of Milano-Bicocca, Milan, Italy (R.B.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.-O.A.). kasper.andersen@medsci.uu.se.
authors.forename: Kasper
authors.initials: K
authors.lastname: Andersen
authors.affiliation: From the Department of Medical Sciences (K.A., C.H., J.S.) and Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory (E.I.), Uppsala University Hospital, Uppsala, Sweden; Department of Medical Epidemiology and Biostatistics (D.M., H.-O.A., O.N., W.Y., R.B.) and Unit of Clinical Epidemiology (Y.T.L.), Karolinska Institutet, Solna, Sweden; Department of Statistics, University of Milano-Bicocca, Milan, Italy (R.B.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.-O.A.).
authors.forename: Daniela
authors.initials: D
authors.lastname: Mariosa
authors.affiliation: From the Department of Medical Sciences (K.A., C.H., J.S.) and Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory (E.I.), Uppsala University Hospital, Uppsala, Sweden; Department of Medical Epidemiology and Biostatistics (D.M., H.-O.A., O.N., W.Y., R.B.) and Unit of Clinical Epidemiology (Y.T.L.), Karolinska Institutet, Solna, Sweden; Department of Statistics, University of Milano-Bicocca, Milan, Italy (R.B.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.-O.A.).
authors.forename: Hans-Olov
authors.initials: HO
authors.lastname: Adami
authors.affiliation: From the Department of Medical Sciences (K.A., C.H., J.S.) and Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory (E.I.), Uppsala University Hospital, Uppsala, Sweden; Department of Medical Epidemiology and Biostatistics (D.M., H.-O.A., O.N., W.Y., R.B.) and Unit of Clinical Epidemiology (Y.T.L.), Karolinska Institutet, Solna, Sweden; Department of Statistics, University of Milano-Bicocca, Milan, Italy (R.B.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.-O.A.).
authors.forename: Claes
authors.initials: C
authors.lastname: Held
authors.affiliation: From the Department of Medical Sciences (K.A., C.H., J.S.) and Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory (E.I.), Uppsala University Hospital, Uppsala, Sweden; Department of Medical Epidemiology and Biostatistics (D.M., H.-O.A., O.N., W.Y., R.B.) and Unit of Clinical Epidemiology (Y.T.L.), Karolinska Institutet, Solna, Sweden; Department of Statistics, University of Milano-Bicocca, Milan, Italy (R.B.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.-O.A.).
authors.forename: Erik
authors.initials: E
authors.lastname: Ingelsson
authors.affiliation: From the Department of Medical Sciences (K.A., C.H., J.S.) and Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory (E.I.), Uppsala University Hospital, Uppsala, Sweden; Department of Medical Epidemiology and Biostatistics (D.M., H.-O.A., O.N., W.Y., R.B.) and Unit of Clinical Epidemiology (Y.T.L.), Karolinska Institutet, Solna, Sweden; Department of Statistics, University of Milano-Bicocca, Milan, Italy (R.B.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.-O.A.).
authors.forename: Ylva Trolle
authors.initials: YT
authors.lastname: Lagerros
authors.affiliation: From the Department of Medical Sciences (K.A., C.H., J.S.) and Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory (E.I.), Uppsala University Hospital, Uppsala, Sweden; Department of Medical Epidemiology and Biostatistics (D.M., H.-O.A., O.N., W.Y., R.B.) and Unit of Clinical Epidemiology (Y.T.L.), Karolinska Institutet, Solna, Sweden; Department of Statistics, University of Milano-Bicocca, Milan, Italy (R.B.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.-O.A.).
authors.forename: Olof
authors.initials: O
authors.lastname: Nyrén
authors.affiliation: From the Department of Medical Sciences (K.A., C.H., J.S.) and Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory (E.I.), Uppsala University Hospital, Uppsala, Sweden; Department of Medical Epidemiology and Biostatistics (D.M., H.-O.A., O.N., W.Y., R.B.) and Unit of Clinical Epidemiology (Y.T.L.), Karolinska Institutet, Solna, Sweden; Department of Statistics, University of Milano-Bicocca, Milan, Italy (R.B.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.-O.A.).
authors.forename: Weimin
authors.initials: W
authors.lastname: Ye
authors.affiliation: From the Department of Medical Sciences (K.A., C.H., J.S.) and Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory (E.I.), Uppsala University Hospital, Uppsala, Sweden; Department of Medical Epidemiology and Biostatistics (D.M., H.-O.A., O.N., W.Y., R.B.) and Unit of Clinical Epidemiology (Y.T.L.), Karolinska Institutet, Solna, Sweden; Department of Statistics, University of Milano-Bicocca, Milan, Italy (R.B.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.-O.A.).
authors.forename: Rino
authors.initials: R
authors.lastname: Bellocco
authors.affiliation: From the Department of Medical Sciences (K.A., C.H., J.S.) and Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory (E.I.), Uppsala University Hospital, Uppsala, Sweden; Department of Medical Epidemiology and Biostatistics (D.M., H.-O.A., O.N., W.Y., R.B.) and Unit of Clinical Epidemiology (Y.T.L.), Karolinska Institutet, Solna, Sweden; Department of Statistics, University of Milano-Bicocca, Milan, Italy (R.B.); and Department of Epidemiology, Harvard School of Public Health, Boston, MA (H.-O.A.).
authors.forename: Johan
authors.initials: J
authors.lastname: Sundström
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D015444:Exercise / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D015994:Incidence; D007899:Leisure Activities; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D057566:Self Report; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
keywords: cohort studies; epidemiology; exercise; heart failure; primary prevention