Current guidelines from the American Heart Association (AHA) and other groups for adults recommend a minimum of at least 150 minutes of moderate-intensity aerobic physical activity (PA) per week. Despite this recommendation, some studies have suggested that even more PA can better protect patients from adverse cardiac events.

Prior studies have shown that there appears to be an inverse association between PA and risk of heart failure (HF). “The role of PA in coronary heart disease has been studied comprehensively, but few analyses have focused exclusively on the quantitative relationship between the amount—or specific dose—of regular PA and the risk of HF,” says Ambarish Pandey, MD.

In a study published in Circulation, Dr. Pandey and colleagues pooled data from 12 studies from United States and Europe. The analysis collectively included 370,460 patients with varying levels of PA at baseline and 20,203 HF events over an average of follow-up about of 15 years. PA was measured by self-reported levels of activity using standard questionnaires. According to the research team, this approach provided an opportunity to assess the dose-response relationship between PA and HF risk in the general population.


More Is Better

“Our findings suggest a dose-dependent inverse association between PA levels and risk for HF such that  patients who had the highest levels of PA had a significantly lower risk of developing HF than those with the lowest levels of PA,” says Dr. Pandey. This relationship was consistent across all age, sex, race, and geographic location based subgroups studied.

Participants who engaged in guideline recommended minimum levels of PA—150 minutes of moderate intensity PA per week—had modest reductions in HF risk when compared with those reporting no leisure time PA. “A substantial risk reduction was observed among patients who engaged in PA at twice and four times the minimum guideline recommended levels,” Dr. Pandey says. “Doubling or quadrupling the minimum federally recommended levels of PA lowered the risk of developing HF by 20% and 35%, respectively.”


Examining Implications

Dr. Pandey says that to significantly lower risks of HF, patients may need substantially more PA than what is currently recommended. “In the general population, there has been tremendous success in reducing risks of coronary heart disease over the last 30 years,” he says. “However, during this same time, HF rates have not declined to the same extent. Findings from our study suggest that higher levels of PA may help combat the growing burden of HF.”

In light of the study data, Dr. Pandey says it is important for future PA guidelines to consider these recent findings when issuing updated recommendations. “It’s possible that with more research on this topic, we can potentially provide stronger data to support better recommendations regarding the value of higher amounts of PA for the prevention of HF,” he says.


Pandey A, Garg S, Khunger M, et al. Dose response relationship between physical activity and risk of heart failure: a meta-analysis. Circulation. 2015;132:1786-1794. Available at:

Patel K, Sui X, Zhang Y, et al. Prevention of heart failure in older adults may require higher levels of physical activity than needed for other cardiovascular events. Int J Cardiol. 2013;168:1905-1909.

Young DR, Reynolds K, Sidell M, et al. Effects of physical activity and sedentary time on the risk of heart failure. Circ Heart Fail. 2014;7:21-27.

Andersen K, Mariosa D, Adami HO, et al. Dose-response relationship of total and leisure time physical activity to risk of heart failure: a prospective cohort study. Circ Heart Fail. 2014;7:701-708.