Marlene Busko

March 09, 2016

PHOENIX, AZ — In a study of close to 40,000 postmenopausal women, those who walked briskly were less likely to develop heart failure within the next 2 decades, after adjustment for relevant variables[1]. Leisure-time exercise was also beneficial, but walking pace trumped that, in this analysis from the Women's Health Study.

Walking pace remained associated with a lower risk of heart failure after correction for physical activity, but the reverse was not true.

"If you take two women who are exercising the same amount in their leisure time, and one is walking faster, one slower, the one walking faster would have more benefit," Dr Luc Djousse (Brigham and Women's Hospital and Harvard university, Boston, MA) told told heartwire from Medscape, at a moderated poster session at the recent American Heart Association (AHA) Epidemiology and Prevention and Lifestyle and Cardiometabolic Health (EPI|Lifestyle) 2016 Scientific Sessions .

The findings would be similar in men, he speculated. Thus, physicians should advise patients that "the best way to reap the benefits is to walk in a brisk manner," rather than strolling.

Session moderator Dr Erin Michos (Johns Hopkins School of Medicine, Baltimore, MD) wanted to know if these self-reported physical-activity levels correspond to fitness (or metabolic equivalents [METs]) determined by a treadmill test. "Is walking pace a surrogate for fitness?" she asked. Djousse replied that walking 3 or more miles per hour (the fastest pace) would correspond to brisk walking on a treadmill. A pace of about 2 miles per hour would correspond to strolling.

"We are already struggling to get [patients] to walk; how do we get them to walk faster?" another physician asked. Djousse replied that if, for example, a patient walks the dog or takes a certain route, a clinician could suggest that over time, they try to cover the same route in fewer minutes. Using a phone app or a Fitbit might help patients up their walking pace, he added.

Walking Pace, Physical Activity, and Risk of HF

Little is known about how physical activity or walking speed affect the risk of heart failure in women, Djousse said. To investigate this, the researchers analyzed data from 39,635 women with a mean age of 55 in the Women's Health Study who had replied to questionnaires asking them about leisure-time physical activity, including how fast and how long they usually walked.

Close to one in five women (18%) reported that they did not walk regularly, whereas 32% said that they walked briskly.

The women were grouped into five physical-activity levels: <3.75 in MET-hours/week (12,355 women), 3.75–7.4 MET-hours/week (5877), 7.5–14.9 MET-hours/week (7752), 15–22.4 MET-hours/week (5396), and >22 MET-hours/week (8255).

They were also grouped into walking-pace levels: 0 miles/hour, <2 miles/hour, 2–2.9 miles/hour, and >3 miles/hour.

Compared with the most active women, the least active women were more likely to have diabetes (3.5% vs 1.5%) or hypertension (30% vs 21%), to smoke (19% vs 9%), and to have a higher mean BMI (28 vs 25), and they were less likely to take hormone-replacement therapy (39% vs 44%) or drink alcohol (35% vs 49%).

During a median follow-up of 17 years, 635 women developed heart failure.

Physical activity was inversely related to the risk of heart failure after adjustment for age, smoking, alcohol, aspirin, hormone-replacement therapy, hypertension, and atrial fibrillation. However, the relationship was lessened, after an added adjustment for walking pace.

For example, compared with the least active women, the most active women had a 23% lower risk of developing heart failure (HR 0.67; 95% CI 0.53–0.84). After an added adjustment for walking pace, they only had a 15% lower risk of developing heart failure (HR 0.85; 95% CI 0.61–1.10).

Walking pace was also inversely related to the risk of heart failure. However, in this case, the relationship persisted after an added adjustment for physical activity.

Compared with the women who did not walk in their leisure time, the women who walked the most briskly had a 48% lower risk of developing heart failure (HR 0.52; 95% CI 0.41–0.66) and a 41% lower risk of this outcome (HR 0.59; 95% CI 0.45–0.78) before and after adjustment for physical activity.

The authors have no relevant financial relationships.


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