Introducing Physical Activity Improves Heart Failure Survival Rate

A sedentary lifestyle is prevalent among patients with heart failure (HF) and is associated with poor prognosis and survival, possibly owing to the displacement of health-enhancing behaviours, such as physical activity (PA). However, there is limited evidence examining the displacement effects of reducing duration of sedentary time (ST) on clinical outcomes in patients with HF.

The current study examined the theoretical effects of relocating ST with PA on all-cause and cardiovascular disease (CVD)-specific mortality risks in patients with HF.

We analysed 265 patients with HF who participated in the National Health and Nutrition Examination Survey from 2003 to 2006. Cox proportional hazards regression model was fitted to estimate mortality risks based on objectively measured ST well as time spent in light-intensity PA (LPA) and moderate- and vigorous-intensity PA (MVPA). The theoretical changes in the hazard ratio (HR) by replacing ST with LPA or MVPA were examined using isotemporal substitutional modeling. On average, patients with HF spent 70% of waking hours per day in ST (9.01 hours), followed by LPA (29%; 3.75 hours) and MVPA (1%; 0.13 hours). Ten-minute substitution of ST with LPA was associated with significantly lower all-cause and CVD-specific mortality risks (hazard ratio [HR]=0.93 for both). The mortality risks progressively decreased as more ST was relocated to LPA. The relocation effects of ST with MVPA were not statistically significant, possibly because of limited MVPA accrued in this clinical population.

The current study provides empirical evidence about the potential health benefits of replacing a modest amount of ST with LPA among patients with HF.

Survey Data and Participants

The National Health and Nutrition Examination Survey (NHANES) conducted between 2003 and 2004 and 2005 and 2006 cycles were used. The NHANES is a cross-sectional survey on various health-related variables through household interviews, laboratory, and physical examinations among the sample selected by a complex, multistage probability sampling method to produce a nationally representative sample of the US population. The NHANES protocol was approved by the Research Ethics Review Board at the


Descriptive characteristics of the study population estimated from a sample of 265 patients with HF in the NHANES 2003 to 2006, representing 2.57% of the US population (weighted N = 4,222,716), are presented in Table 1. The mean age of patients with HF was 67 years, with an average of 9.70 years since they were first diagnosed with HF. A majority (80%) of patients were overweight or had obesity, and 91.23% of patients had at least 1 chronic medical condition.

On average, patients wore


The current study examined the theoretical effects of substituting ST with LPA and MVPA on the risks of mortality among patients with HF, using an isotemporal substitution modeling approach. The results highlight that replacing ST with as little as 10 minutes per day of LPA was associated with a significantly reduced all-cause and CVD-specific mortality risk. Although we found a favorable trend in reduction in mortality risks when ST was substituted with MVPA, such associations were not


Using a nationally representative sample of US adults, our study demonstrated that patients with HF spend the majority of their waking time in ST, which likely increases the risk of adverse health outcomes. However, even a modest amount of time relocated from sedentary to LPA would have a significant health benefit for patients with HF. Future interventions focusing on behavioral change from sedentary to active phase is recommended to mitigate the health risks and maximize the health benefits

Potential Competing Interests

The authors report no competing interests

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