A multi-institution team of investigators report that adults who later develop cardiovascular disease show declining physical activity levels beginning roughly 12 years before their event, with the gap versus their healthy peers persisting long afterward.
Physical activity serves as an essential countermeasure for both preventing and managing cardiovascular disease. Many adults do not meet recommended levels of moderate to vigorous-intensity physical activity, with substantial demographic differences in who stays active throughout life.
In the study, “Trajectories of Physical Activity Before and After Cardiovascular Disease Events in CARDIA Participants,” published in JAMA Cardiology, researchers designed complementary longitudinal and nested case-control analyses to evaluate moderate to vigorous-intensity physical activity trajectories across adulthood, pre- and post-cardiovascular disease changes, alongside demographic variations.
Scientists from the Coronary Artery Risk Development in Young Adults (CARDIA) study, which included researchers from the US National Heart, Lung, and Blood Institute, the University of Alabama at Birmingham, the University of Minnesota, Northwestern University, Kaiser Permanente Northern California, and Tel Aviv University, analyzed data from 3,068 participants in CARDIA, a prospective study initiated in 1985–1986 with up to 10 physical activity assessments through 2020–2022.
Cohort analysis examined long-term trajectories across adulthood, while a nested case-control analysis assessed activity patterns around cardiovascular events. Participants were followed in four US cities with a median follow-up of 34.0 years.
Researchers measured moderate to vigorous-intensity physical activity using exercise units, where 300 EU approximates 150 minutes per week of activity consistent with guidelines.
Participants self-reported activity using a validated questionnaire covering eight vigorous-intensity and five moderate-intensity activity types over the past 12 months. Cardiovascular events included coronary heart disease, stroke, and heart failure, tracked through August 2020 and verified using medical records with trained physician adjudication.
Physical activity decreased steadily from young adulthood into middle age, then stabilized in later years across the full cohort. Black men had a more sustained decline, while Black women consistently reported the lowest activity throughout adulthood.
White men showed initial decline followed by stabilization and slight recovery, while white women began with lower activity than men but showed notable recovery beginning in midlife.
Analysis of 236 incident cardiovascular disease cases matched 1:1 to control participants revealed striking patterns around heart events. Activity levels in case participants began declining approximately 12 years before cardiovascular disease diagnosis, with accelerated declines within two years of the event.
Trajectories analyzed by cardiovascular disease type showed the steepest pre‑event decline in participants who later developed heart failure, whereas those who experienced coronary heart disease or stroke declined more gradually.
After diagnosis, all three groups remained at similarly low physical‑activity levels (<300 exercise units), and the post‑event trajectory differences between disease types were not statistically significant (P = 0.90).
Adjusting for pre-cardiovascular disease activity levels, cases were more likely than controls to exhibit low activity post-cardiovascular disease (odds ratio, 1.78; 95% CI, 1.26–2.50).
Black women faced the highest risk of low post-cardiovascular disease activity (odds ratio, 4.52; 95% CI, 2.29–8.89), while white men showed no significant increased risk (odds ratio, 0.92).
Researchers conclude that physical activity declines from early adulthood to midlife then stabilizes, with notable demographic differences. Cases experienced steep declines before cardiovascular disease events, supporting a link between physical activity and disease outcomes.
Authors conclude that sustaining physical activity across the lifespan, especially for groups such as Black women, may help reduce cardiovascular risk and improve recovery.
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