Moderate-to-vigorous Intensity Physical Activity and Incident Left-sided Degenerative Valvular Heart Disease
Authors: Li Ziang , Cheng Sijing , Guo Bo , Ding Lu , Liang Yu , Shen Yinghan , Li Jinyue , Hu Yiqing , Long Tianxin , Guo Xinli , Ge Junbo , Gao Runlin , Pibarot Philippe , Zhang Bin , Xu Haiyan , Clavel Marie-Annick , Wu Yongjian 
Published: August 2023

Background

Despite the escalating incidence of degenerative valvular heart disease (VHD), recommended preventive interventions are conspicuously absent. Physical activity has proven effective in preventing atherosclerotic cardiovascular disease, but its role in preventing VHD remains uncertain. This study aimed to explore the association between moderate-to-vigorous intensity physical activity (MVPA) and incident left-sided degenerative VHD in middle-aged adults from the UK biobank.

Methods

Data from wrist-worn accelerometer and self-reported questionnaires were utilized to assess the impact of MVPA volume on the incidence of aortic valve stenosis (AS), aortic valve regurgitation (AR), and mitral valve regurgitation (MR). Incident VHD were ascertained from hospital admissions and death reports. Cox proportional hazards regression models were employed to calculate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for sociodemographic characteristics, lifestyle risk factors, and comorbidities.

Results

In the accelerometer-derived MVPA cohort (n=90,865; median age 63; 43% male; median follow-up 8.1 years), the age- and sex-adjusted incidence rates per 1000 person-years were 0.70 for AS, 0.29 for AR, and 0.84 for MR. In the questionnaire-based MVPA cohort (n=397,335; median age 57; 47% male; median follow-up 13.8 years), the corresponding rates were 0.76 for AS, 0.29 for AR, and 0.76 for MR. The accelerometer-measured MVPA volume showed a curvilinear relationship with reduced risk of AS, plateauing above 300 min/week. Participants engaging in 150-299 minutes of MVPA per week, meeting the guideline recommendation, had the most significant reduction in AS risk compared to those with no MVPA [adjusted HR, 0.53 (95% CI, 0.37-0.76)]. Similar results were found in the questionnaire-based MVPA cohort, with 150-299 minutes of MVPA showing a relatively smaller reduction in HR [adjusted HR, 0.82 (95% CI, 0.73-0.91)]. The association remained consistent across subgroups at high risk for AS. However, there was no significant inverse association of MVPA with risk of AR or MR.

Conclusion

Adhering to the recommended MVPA duration (150-299 min/week) was associated with the lowest risk of developing AS. Encouraging the utilization of wearable devices to monitor activity levels enhances AS risk reduction. Nonetheless, MVPA’s efficacy in preventing valvular regurgitation is limited, revealing distinctive pathological mechanisms in valvular stenotic and regurgitation lesions.

Clinical Perspective

What Is New?

Engaging in 150-299 minutes of moderate-to-vigorous intensity physical activity per week can reduce the risk of aortic valve stenosis by nearly 50% in middle-aged individuals.

Using wearable devices to measure activity levels may improve the risk stratification of aortic valve stenosis compared to assessments based on questionnaires.

No significant association is observed between moderate-to-vigorous intensity physical activity and risks of aortic valve regurgitation and mitral valve regurgitation.

What Are the Clinical Implications?

Objective activity monitoring through wearable devices shows promise as an effective nonpharmaceutical intervention to alleviate the healthcare burdens associated with aortic valve stenosis.

Encouraging middle-aged individuals at higher risk for aortic valve stenosis to engage in moderate volume (150-299 minutes per week) and moderate intensity physical activity (e.g., walking at a speed of 2.5 miles per hour) is recommended.

Engaging in physical activity beyond the recommended volume and intensity does not yield additional benefits nor pose additional risks for aortic valve stenosis.