title: Dose-Response Relationship Between Physical Activity and Risk of Heart Failure: A Meta-Analysis.
abstract: BACKGROUND
  Prior studies have reported an inverse association between physical activity (PA) and risk of heart failure (HF). However, a comprehensive assessment of the quantitative dose-response association between PA and HF risk has not been reported previously.
  
  
  RESULTS
  Prospective cohort studies with participants >18 years of age that reported association of baseline PA levels and incident HF were included. Categorical dose-response relationships between PA and HF risk were assessed with random-effects models. Generalized least-squares regression models were used to assess the quantitative relationship between PA (metabolic equivalent [MET]-min/wk) and HF risk across studies reporting quantitative PA estimates. Twelve prospective cohort studies with 20 203 HF events among 370 460 participants (53.5% women; median follow-up, 13 years) were included. The highest levels of PA were associated with significantly reduced risk of HF (pooled hazard ratio for highest versus lowest PA, 0.70; 95% confidence interval, 0.67-0.73). Compared with participants reporting no leisure-time PA, those who engaged in guideline-recommended minimum levels of PA (500 MET-min/wk; 2008 US federal guidelines) had modest reductions in HF risk (pooled hazard ratio, 0.90; 95% confidence interval, 0.87-0.92). In contrast, a substantial risk reduction was observed among individuals who engaged in PA at twice (hazard ratio for 1000 MET-min/wk, 0.81; 95% confidence interval, 0.77-0.86) and 4 times (hazard ratio for 2000 MET-min/wk, 0.65; 95% confidence interval, 0.58-0.73) the minimum guideline-recommended levels.
  
  
  CONCLUSIONS
  There is an inverse dose-response relationship between PA and HF risk. Doses of PA in excess of the guideline-recommended minimum PA levels may be required for more substantial reductions in HF risk.
authors.affiliation: From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.).
authors.forename: Ambarish
authors.initials: A
authors.lastname: Pandey
authors.affiliation: From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.).
authors.forename: Sushil
authors.initials: S
authors.lastname: Garg
authors.affiliation: From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.).
authors.forename: Monica
authors.initials: M
authors.lastname: Khunger
authors.affiliation: From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.).
authors.forename: Douglas
authors.initials: D
authors.lastname: Darden
authors.affiliation: From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.).
authors.forename: Colby
authors.initials: C
authors.lastname: Ayers
authors.affiliation: From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.).
authors.forename: Dharam J
authors.initials: DJ
authors.lastname: Kumbhani
authors.affiliation: From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.).
authors.forename: Helen G
authors.initials: HG
authors.lastname: Mayo
authors.affiliation: From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.).
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
authors.affiliation: From Division of Cardiology (A.P., C.A., D.J.K., J.A.d.L., J.D.B.), Department of Internal Medicine (D.D.), and Department of Clinical Sciences (C.A., J.D.B.), University of Texas Southwestern Medical Center, Dallas; Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis (S.G.); Department of Internal Medicine, Cleveland Clinic, OH (M.K.); and University of Texas Southwestern Medical Center Library, Dallas (H.G.M.). jarett.berry@utsouthwestern.edu.
authors.forename: Jarett D
authors.initials: JD
authors.lastname: Berry
mesh_terms: D015331:Cohort Studies; D015444:Exercise / Q000502:physiology; D006333:Heart Failure / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D009043:Motor Activity / Q000502:physiology*; D011446:Prospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior
keywords: exercise; heart failure; meta-analysis; prevention and control