Fast Walking Pace Shown to Benefit Patients With Heart Failure

The risks of developing heart failure (HF), HF with preserved ejection fraction (HFpEF), and HF with reduced ejection fraction (HFrEF) were all reduced among a group of postmenopausal women able to walk at a faster pace.

Results were published online today in Journal of the American Geriatrics Society, with the authors explaining that they took up their study because the impact of specific types of physical activity on risk of HF requires more investigation and clearer guidance.

The risk was highlighted in connection with the women (N = 25,183)—aged 50 to 79 years (mean [SD] age, 62.6 [7.2] years) with hospitalization for incident HF events from 2010 through March 31, 2018, and enrolled in the Women’s Health Initiative between 1993 and 1998—and their 3 self-reported walking paces:

• Casual: less than 2 mph (17.1% Hispanic, 38.1% Black, 41.7% White, 3.1% Other)
• Average: 2 to 3 mph (12.5% Hispanic, 24.7% Black, 60.4% White, 2.4% Other)
• Fast: more than 3 mph (12.0% Hispanic, 26.0% Black, 59.7% White, 2.3% Other)

None had HF, cancer, or the inability to walk at least 1 block at study entry. A questionnaire collected data on various physical activities in which they participated, with walking assessed separately. For the study, HFrEF was defined as having an ejection fraction of less than 45% and HFpEF, at least 45%.

After almost 17 years of follow-up, there were 1455 cases of newly diagnosed and adjudicated acute decompensated HF requiring hospitalization (811, HFpEF; 429, HFrEF; 215, unknown ejection fraction). Within these cases, a faster walking pace indicated a lessened overall risk for developing HF:

• Average vs casual pace: 27% (HR, 0.73; 95% CI, 0.65-0.83)
• Fast vs casual pace: 34% (HR, 0.66; 95% CI, 0.56-0.78)

Also seen were potential links between walking pace and development of HFpEF and HFrEF:

• HFpEF:
  • Average vs casual pace: 27% (HR, 0.73; 95% CI, 0.62-0.86)
  • Fast vs casual pace: 37% (HR, 0.63; 95% CI, 0.50-0.80)
• HFrEF:
  • Average vs casual pace: 28% (HR, 0.72; 95% CI, 0.57-0.91)
  • Fast vs casual pace: 26% (HR, 0.74; 95% CI, 0.54-0.99)

Similar risks for developing HF were further seen when comparing outcomes among those walking at a fast pace for less than 1 hour each week and those walking at a casual or average pace for 1 to 2 hours and more than 2 hours each week. Lower risks for overall HF and HFpEF were seen among participants able to walk at a fast pace, and the lowest risks among fast walkers walking more than 2 hours each week.

“From a geriatrician viewpoint, slow walking pace may help to identify those at higher risk of HF who may benefit from targeted interventions,” the authors wrote. “From a preventive viewpoint, if our finding is proven to be causal by randomized trials, there will be an opportunity for those who do not have enough time or motivation to walk as long as the guidelines recommend to still reduce their HF risk by increasing their walking pace when capable of doing so.”

The authors project the incidence of HF to increase by 46% between 2012 and 2030, or 8 million new cases. And with the condition most prevalent among older adults, especially women older than 80 years, more data are needed on optimal lifestyle preventions, particularly among those with HFpEF, they emphasized.

To make inroads in this area, they highlight the importance of conducting randomized, controlled physical activity intervention trials, with a primary goal of HF intervention—and to confirm the safety of the present findings between fast and slow walkers—or hypothetical interventions “on large longitudinal observational data by using modern causal inference methods.”

Reference

Miremad M-M, Lin X, Rasla S, et al. The association of walking pace and incident heart failure and subtypes among postmenopausal women. J Am Geriatr Soc. Published online January 20, 2022. doi:10.1111/jgs.17657