A team of researchers from multiple institutions reports that adults who go on to develop cardiovascular disease exhibit a decrease in physical activity levels approximately 12 years before the event, with this reduced activity persisting even afterward.
Physical activity is key for both preventing and managing cardiovascular disease. Many adults do not meet recommended physical activity guidelines, and there are significant demographic variations among those who maintain consistent activity throughout life.
The study, "Trajectories of Physical Activity Before and After Cardiovascular Disease Events in CARDIA Participants," published in JAMA Cardiology, utilized complementary longitudinal and nested case-control analyses to examine patterns of moderate to vigorous-intensity physical activity across adulthood, both before and after cardiovascular disease events.
JAMA CardiologyScientists from the Coronary Artery Risk Development in Young Adults (CARDIA) study, involving researchers from institutions such as the US National Heart, Lung, and Blood Institute, the University of Alabama at Birmingham, the University of Minnesota, Northwestern University, Kaiser Permanente Northern California, and Tel Aviv University, analyzed data from 3,068 CARDIA participants. This prospective study began in 1985-1986 and included up to 10 physical activity assessments through 2020-2022.
The cohort analysis focused on long-term trajectories across adulthood, while nested case-control analysis looked at activity patterns around cardiovascular events. Participants were tracked across four US cities with a median follow-up of 34 years.
Physical activity was measured using exercise units (EUs), where 300 EUs approximate 150 minutes per week of moderate to vigorous-intensity physical activity, aligning with standard recommendations.
Participants self-reported their activities via a validated questionnaire covering eight types of vigorous-intensity and five types of moderate-intensity exercises over the preceding 12 months. Cardiovascular events included coronary heart disease, stroke, and heart failure, and were tracked through August 2020, with verification by medical records and physician adjudication.
Across all participants, physical activity gradually decreased from young adulthood to middle age before stabilizing in later years. Black men exhibited a more persistent decline, while Black women reported the lowest overall activity levels throughout their lives.
White men initially declined but then stabilized with a slight recovery, whereas white women showed lower initial activity than men yet had significant recovery beginning around midlife.
A nested case-control analysis of 236 incident cardiovascular disease cases (1:1 match to controls) revealed notable patterns. Physical activity levels in those who later developed cardiovascular disease began declining around 12 years before diagnosis, accelerating within two years of the event.
Participants who went on to develop heart failure showed the steepest pre-event decline compared to those who experienced coronary heart disease or stroke.
After diagnosis, all three groups maintained similarly low physical activity levels (less than 300 EUs), with no significant post-event differences between them. Adjusting for pre-disease activity levels, cases were more likely than controls to have lower activity following their cardiovascular event.
Black women were at the highest risk of maintaining low post-cardiovascular disease activity, while white men showed no increased risk (odds ratio: 0.92).
The researchers conclude that physical activity typically decreases from early adulthood to midlife before stabilizing, with significant demographic differences. The study supports a link between declining physical activity and cardiovascular disease outcomes.
In conclusion, maintaining regular physical activity throughout life, especially among vulnerable groups such as Black women, may reduce cardiovascular risk and improve recovery.