Wearable device-measured moderate to vigorous physical activity and risk of degenerative aortic valve stenosis

Abstract

Background and aims: Physical activity has proven effective in preventing atherosclerotic cardiovascular disease, but its role in preventing degenerative valvular heart disease (VHD) remains uncertain. This study aimed to explore the dose-response association between moderate to vigorous physical activity (MVPA) volume and the risk of degenerative VHD among middle-aged adults.

Methods: A full week of accelerometer-derived MVPA data from 87 248 UK Biobank participants (median age 63.3, female: 56.9%) between 2013 and 2015 were used for primary analysis. Questionnaire-derived MVPA data from 361 681 UK Biobank participants (median age 57.7, female: 52.7%) between 2006 and 2010 were used for secondary analysis. The primary outcome was the diagnosis of incident degenerative VHD, including aortic valve stenosis (AS), aortic valve regurgitation (AR), and mitral valve regurgitation (MR). The secondary outcome was VHD-related intervention or mortality.

Results: In the accelerometer-derived MVPA cohort, 555 incident AS, 201 incident AR, and 655 incident MR occurred during a median follow-up of 8.11 years. Increased MVPA volume showed a steady decline in AS risk and subsequent AS-related intervention or mortality risk, levelling off beyond approximately 300 min/week. In contrast, its association with AR or MR incidence was less apparent. The adjusted rates of AS incidence (95% confidence interval) across MVPA quartiles (Q1-Q4) were 11.60 (10.20, 13.20), 7.82 (6.63, 9.23), 5.74 (4.67, 7.08), and 5.91 (4.73, 7.39) per 10 000 person-years. The corresponding adjusted rates of AS-related intervention or mortality were 4.37 (3.52, 5.43), 2.81 (2.13, 3.71), 1.93 (1.36, 2.75), and 2.14 (1.50, 3.06) per 10 000 person-years, respectively. Aortic valve stenosis risk reduction was also observed with questionnaire-based MVPA data [adjusted absolute difference Q4 vs. Q1: AS incidence, -1.41 (-.67, -2.14) per 10 000 person-years; AS-related intervention or mortality, -.38 (-.04, -.88) per 10 000 person-years]. The beneficial association remained consistent in high-risk populations for AS, including patients with hypertension, obesity, dyslipidaemia, and chronic kidney disease.

Conclusions: Higher MVPA volume was associated with a lower risk of developing AS and subsequent AS-related intervention or mortality. Future research needs to validate these findings in diverse populations with longer durations and repeated periods of activity monitoring.

Keywords: Aortic regurgitation; Aortic stenosis; Aortic valve replacement; Exercise; Mitral regurgitation.

Structured Graphical Abstract

Moderate to vigorous physical activity volume and degenerative valvular heart disease risk. CI, confidence interval; HR, hazard ratio; MVPA, moderate to vigorous physical activity; VHD, valvular heart disease.

Figure 1

Flowchart of the study. The Venn diagram illustrates the number of individuals who completed either the accelerometer-based physical activity assessment, the questionnaire-based physical activity assessment, or both. AS, aortic valve stenosis; AR, aortic valve regurgitation; MR, mitral valve regurgitation

Figure 2

Dose–response relationship between moderate to vigorous physical activity volume and risk of aortic valve stenosis and related events. Upper panel: Absolute risk of aortic valve stenosis and related events across deciles of moderate to vigorous physical activity volume groups. The adjusted incidence rate, reported as per 10 000 person-years, was estimated using Poisson regression models with time since MVPA measurement as the timescale. Adjustments were made for age, sex, ethnicity, Townsend deprivation index, education, smoking status, alcohol intake, diet quality, sleep duration, and discretionary screen time. Lower panel: Relative risk of aortic valve stenosis and related events. The adjusted hazard ratio was estimated using Cox proportional hazard models with age as the timescale. Adjustments were made for sex, ethnicity, Townsend deprivation index, education, smoking status, alcohol intake, diet quality, sleep duration, and discretionary screen time. The solid line represents the adjusted hazard ratio, with the ribbon indicating the 95% confidence interval. The grey area denotes the proportion of the population (units: 30 min/week). MVPA, moderate to vigorous physical activity.

Figure 3

Adjusted hazard ratio for aortic valve stenosis and related events by quartiles of moderate to vigorous physical activity volume. The adjusted hazard ratio was estimated using Cox proportional hazard models, with age as the timescale. Adjustments were made for sex, ethnicity, Townsend index of deprivation, education, smoking status, alcohol intake, diet score, sleep duration, and discretionary screen time. AS, aortic valve stenosis; CI, confidence interval; MVPA: moderate to vigorous physical activity.

Figure 4

Adjusted survival curves for the risk of aortic valve stenosis and related events across quartiles of moderate to vigorous physical activity volume. Adjusted survival curves were estimated using Cox proportional hazard models, with age as the timescale. Adjustments were made for sex, ethnicity, Townsend index of deprivation, education, smoking status, alcohol intake, diet score, sleep duration, and discretionary screen time. MVPA, moderate to vigorous physical activity.

Figure 5

The 5-year absolute risk of aortic valve stenosis and related events. The 5-year absolute risk of aortic valve stenosis and related events in the primary cohort was estimated using Fine and Gray competing risks regression models. Cells containing ‘<’ indicate an insufficient number of participants for cumulative incidence estimation. AS, aortic valve stenosis; MVPA, moderate to vigorous physical activity.

Figure 6

Dose–response relationship between moderate to vigorous physical activity volume and risk of aortic valve regurgitation and mitral valve regurgitation. Upper panel: Absolute risk of aortic valve regurgitation and mitral valve regurgitation across deciles of moderate to vigorous physical activity volume groups. The adjusted incidence rate, reported as per 10 000 person-years, was estimated using Poisson regression models with time since MVPA measurement as the timescale. Adjustments were made for age, sex, ethnicity, Townsend deprivation index, education, smoking status, alcohol intake, diet quality, sleep duration, and discretionary screen time. Lower panel: Relative risk of aortic valve regurgitation and mitral valve regurgitation. The adjusted hazard ratio was estimated using Cox proportional hazard models, with age as the timescale. Adjustments were made for sex, ethnicity, Townsend deprivation index, education, smoking status, alcohol intake, diet quality, sleep duration, and discretionary screen time. The solid line represents the adjusted hazard ratio, with the ribbon indicating the 95% confidence interval. The grey area denotes the proportion of the population (units: 30 min/week). MVPA, moderate to vigorous physical activity.