Exercise and Heart Failure Risk: How to Get Active
He may have heart failure, but Rev. Adam Leeper also has a great sense of humor. An enthusiastic participant in U.S. Masters Swimming, a nonprofit organization of members age 18 or older, he recalls swimming a memorable race in early 2016. In the lane next to him was another competitor, age 22, headed to the next Olympic Trials.
"I trained for the 1984 Olympics, but my big problem was that I wasn't fast enough," says Leeper, 53, of Chambersburg, Pennsylvania, with a self-deprecating chuckle. "My goal in that 2016 race was just to not have my defibrillator go off!" He spoke to HealthCentral during a telephone interview.
Diagnosed with heart failure — also called congestive heart failure — in 2010 at the age of 45, along with other challenging chronic conditions, he says he had symptoms for approximately 12 years, most notably impinging shortness of breath. The disease occurs when the heart can't pump enough blood to the body, or pump forcefully enough, depriving the body of oxygen.
At the time of diagnosis, he was no slouch, vigorously pursuing triathlons, which require swimming, cycling, and running. "My performance just continued to decline," he says.
Now he manages his symptoms with positivity and commitment. "It's hard to breathe when I lie flat or bend over to tie my shoes," says the pastor, a staff chaplain at a major local retirement community where he ministers in palliative care and hospice.
Rev. Leeper has cardiomyopathy that contributes to his heart failure. His heart's left ventricle contains weakened tissue and therefore can't pump blood well. "We don't know what caused it, and maybe it's congenital, or maybe I had an infection. My arteries are clear and I never had a heart attack."
He's doing better than expected, he said. He thinks it's partly because he gets plenty of exercise with swimming three mornings a week for an hour, spinning, and walking a lot. "I try to do something every day," he says.
Definitely on the right health track
In the wide world of medicine, there is probably no greater way to improve overall health with lifestyle choices than with exercise. The studies about exercise benefits could fill a small room — and we'll add to that compendium here.
Yet why is it that we Americans resist movement so much? Unlike Rev. Leeper, nearly 80 percent of us do not meet recommendations for aerobic activity and muscle strengthening. Nearly 45 percent of adults aren't active enough to achieve health benefits. Approximately 5 to 6 million of us have heart failure.
An observational study from Johns Hopkins Medicine, published in the journal Circulation, reports that increasing physical activity to recommended levels over as few as six years in middle age is associated with a significantly decreased risk of heart failure.
"Heart failure is a major public health challenge with a high rate of mortality and a lot of morbidity," said the study's senior author, Chiadi Ndumele, M.D., M.H.S., the Robert E. Meyerhoff Assistant Professor of Medicine at the Johns Hopkins University School of Medicine, in a telephone interview with HealthCentral.
His team analyzed data from more than 11,000 participants who were part of The Atherosclerosis Risk in Communities Study, which began in 1987 – 1989. They were ages 50 to 70, with a mean age of 63, and were monitored an average of 19 years for cardiovascular disease.
"We wanted to evaluate how changes in physical activity over time — both increases and decreases — relate to heart failure risk, since this question is relevant to a large portion of the population," says Dr. Ndumele. "We looked at physical activity levels at two points in time over six years."
Here are key points: Findings suggest that consistently participating in the recommended 150 minutes of moderate to vigorous activity each week, such as brisk walking or biking, in middle age may be enough to reduce heart failure risk by 31 percent, he says. Going from no exercise to recommended activity levels over six years in middle age may reduce heart failure risk by 23 percent.
Those people who consistently met recommended levels of activity, 75 minutes per week of vigorous activity, or 150 minutes per week of moderate-intensity activity, had the lowest heart failure risk, he says.
Results say 'Get active'
"It's important to note that substantial reduction in risk for those who went from poor levels of activity to recommended levels over a six-year period," he says. "Conversely, those who decreased physical activity levels over time had some increase in heart failure risk."
The takeaway: It's definitely not too late to start physical activity at any point in your life. That's a very important clinical finding, Dr. Ndumele says.
"Knowledge is power for many people who may not realize, especially after many years of a certain lifestyle, that they have the power to effect a change in their health status with a change in behavior," he says. Of course, easier said than done for many people when it comes to actually getting active and staying active.
"The lack of participation may be because people's time is limited, with many distracting priorities," Dr. Ndumele says. "We want them to schedule time that prioritizes themselves and makes time for their personal health."
Don't make physical activity such a big deal. "You don't have to suit up and wear fancy gym clothes to be physically active," he says. "Take the stairs instead of the elevator and walk longer distances briskly, even during your lunch break. Do it with a partner or friend for accountability, and make sure to do something you enjoy to help sustain your activity. Finally, remember that what you like to do now can change over time.'"
It's also up to you
Rev. Leeper says it's so important to "listen to your doctor." His happens to be Dr. Ndumele. "Don't just think pills will 'take care of it.' You have to take action."
He admits his strong faith has helped him accept what's transpired and he's committed "to making the best of it." He also follows the low-fat, plant-strong Engine 2 Diet and initially lost 25 pounds in two months.
"My blood work looks good, but if I don't get enough exercise or follow the diet, I don't do as well — my energy levels decrease, and my body takes on more fluid," says Rev. Leeper. Both are symptoms of heart failure that also brings on swelling, weight gain, and shortness of breath.
He and Dr. Nduleme are hopeful he will live and thrive for decades, and he's determined to do everything he can to do just that — including continuing his high levels of physical activity.
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