title: Association of Physical Activity or Fitness With Incident Heart Failure: A Systematic Review and Meta-Analysis.
abstract: 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.
  
  
  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.
authors.affiliation: From the Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (J.B.E.-T.); Cardiology Division, Stony Brook University, Stony Brook, NY (J.B.); Cardiology Division, Northwestern Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.). jechouf@emory.edu.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Echouffo-Tcheugui
authors.affiliation: From the Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (J.B.E.-T.); Cardiology Division, Stony Brook University, Stony Brook, NY (J.B.); Cardiology Division, Northwestern Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.).
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.affiliation: From the Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (J.B.E.-T.); Cardiology Division, Stony Brook University, Stony Brook, NY (J.B.); Cardiology Division, Northwestern Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.).
authors.forename: Clyde W
authors.initials: CW
authors.lastname: Yancy
authors.affiliation: From the Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (J.B.E.-T.); Cardiology Division, Stony Brook University, Stony Brook, NY (J.B.); Cardiology Division, Northwestern Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.).
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
mesh_terms: D015992:Body Mass Index; D005081:Exercise Therapy / Q000379:methods*; D006333:Heart Failure / Q000453:epidemiology / Q000503:physiopathology / Q000534:rehabilitation; D006801:Humans; D015994:Incidence; D009043:Motor Activity / Q000502:physiology*; D010809:Physical Fitness / Q000502:physiology*
keywords: epidemiology; exercise; heart failure; motor activity; physical fitness