In observational studies, more physical activity was associated with less HFpEF among women and showed a stronger association with reduced mortality than in men.

The heart failure with preserved ejection fraction (HFpEF) epidemic in older women is a critical target for prevention, as therapeutic options are limited. In a prospective cohort study, researchers examined the association between accelerometer-measured physical activity and incident heart failure in 5951 women aged 63 to 99 years. Increases in moderate to vigorous physical activity, number of steps per day and light physical activity, as well as decreased sedentary time, were each associated with decreased overall heart failure and HFpEF. Interestingly, these parameters were not associated with heart failure with reduced ejection fraction.

In another prospective study in 412,413 US adults (55% women; mean age, 44 years), survey data on leisure-time physical activity showed a stronger association between exercise and mortality in women than in men. For example, an 18% lower risk of all-cause mortality associated with about 300 minutes of walking per week in men was achieved at 140 minutes of walking per week in women. An increase to about 300 minutes of walking per week in women was associated with even lower all-cause mortality risk, down 24%. Cardiovascular death showed a similar association, and there was no difference between aerobic and resistive training.

Comment: These prospective observational studies suggest that we might be able to empower women to prevent HFpEF incidence and cardiovascular and all-cause mortality at clinic visits. Setting a daily goal of walking of more than 3000 steps (estimated 30 minutes) and decreasing sedentary time to less than 10 hours total seems attainable, potentially aided by a feedback mechanism from popular smart phones and smart watches that include accelerometers. While the optimal amount and type of exercise for each individual requires further study, I plan to share these results with patients when encouraging them to exercise more.

Vlad G. Zaha, MD, PhD, FAHA, FACC, Associate Professor of Medicine/Cardiology, Biomedical Engineering and Cancer Biology; Section Chief, Cardio-Oncology; Program Director, Cardio-Oncology Fellowship; Director, Cardio-Oncology Program, Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, USA.

LaMonte MJ, et al. Accelerometer-measured physical activity, sedentary time, and heart failure risk in women aged 63 to 99 years. JAMA Cardiol 2024; 9: 336-345.

Ji H, et al. Sex differences in association of physical activity with all-cause and cardiovascular mortality. J Am Coll Cardiol 2024; 83: 783-793.

This summary is taken from the following Journal Watch title: Cardiology.