Exercise Capacity, Heart Failure Risk, and Mortality in Older Adults: The Health ABC Study

Am J Prev Med. 2017 Feb;52(2):144-153. doi: 10.1016/j.amepre.2016.08.041. Epub 2016 Nov 14.

Abstract

Introduction: Data on the association between exercise capacity and risk for heart failure (HF) in older adults are limited.

Methods: This study examined the association of exercise capacity, and its change over time, with 10-year mortality and incident HF in 2,935 participants of the Health, Aging, and Body Composition Study without HF at baseline (age, 73.6 [SD=2.9] years; 52.1% women; 41.4% black; 58.6% white). This cohort was initiated in 1997-1998 and exercise capacity was evaluated with a long-distance corridor walk test (LDCW) at baseline and Year 4. Outcomes were collected in 2007-2008 and initial analysis performed in 2014.

Results: Ten-year incident HF for completers (n=2,245); non-completers (n=331); and those excluded from LDCW for safety reasons (n=359) was 11.4%, 19.2%, and 23.0%, respectively. The corresponding 10-year mortality was 27.9%, 41.1%, and 42.4%. In models accounting for competing mortality, the adjusted subhazard ratio for HF was 1.37 (95% CI=1.00, 1.88; p=0.049) in non-completers and 1.41 (95% CI=1.06, 1.89; p=0.020) in those excluded versus completers. Non-completers (adjusted hazard ratio, 1.49; 95% CI=1.21, 1.84; p<0.001) and those excluded (hazard ratio, 1.27; 95% CI=1.04, 1.55; p=0.016) had elevated mortality. In adjusted models, LDCW performance variables were associated mainly with mortality. Only 20-meter walking speed and resting heart rate retained prognostic value for HF. Longitudinal changes in LDCW did not predict subsequent incident HF or mortality.

Conclusions: Completing an LDCW is strongly associated with lower 10-year mortality and HF risk in older adults. Therefore, walking capacity may serve as an early risk marker.

MeSH terms

  • Aged
  • Aging / physiology*
  • Female
  • Follow-Up Studies
  • Heart Failure / epidemiology*
  • Humans
  • Incidence
  • Male
  • Prevalence
  • Prognosis
  • Proportional Hazards Models
  • Sex Factors
  • Walk Test / statistics & numerical data
  • Walking / physiology*
  • Walking / statistics & numerical data
  • Walking Speed / physiology*