Article Impact Level: HIGH Data Quality: STRONG Summary of Cardiology. https://doi.org/10.1001/jamacardio.2025.2282 Dr. Yariv Gerber et al.
Points
- Physical activity generally decreases from young adulthood to middle age and then plateaus, with significant differences observed across demographic groups.
- Adults who develop cardiovascular disease experience a steeper decline in physical activity starting about twelve years before the event, which accelerates two years prior.
- After a cardiovascular disease event, patients remain at low activity levels, and the gap between them and their healthy peers persists long-term.
- Black women consistently have the lowest physical activity levels throughout adulthood and face the highest risk of inactivity following a cardiovascular disease diagnosis.
- Maintaining physical activity throughout the lifespan is essential for reducing cardiovascular risk and promoting recovery, particularly for high-risk groups that require targeted support.
Summary
This prospective cohort and nested case-control study utilized data from the Coronary Artery Risk Development in Young Adults (CARDIA) study to analyze trajectories of moderate to vigorous–intensity physical activity (MVPA). The cohort analysis included 3,068 participants (56.8% female; 54.2% Black) with a mean baseline age of 25.2 years, followed for a median of 34.0 years. MVPA was self-reported using a validated questionnaire and measured in exercise units (EU), with <300 EU defined as low activity. The primary outcome was incident cardiovascular disease (CVD), including coronary heart disease, stroke, and heart failure, with 236 incident cases identified for the nested case-control analysis, each matched 1:1 with controls.
General MVPA levels declined steadily from young adulthood into midlife before stabilizing. Significant demographic variations were observed, with Black women consistently reporting the lowest MVPA levels throughout adulthood. The nested case-control analysis revealed that individuals who developed CVD began to show declining MVPA levels approximately 12 years before the event, with an accelerated decline in the two years immediately preceding diagnosis. The pre-event decline was steepest among participants who later developed heart failure. Post-event, the MVPA gap between cases and controls persisted across all types of CVD.
After adjusting for pre-CVD MVPA, cases had significantly higher odds of exhibiting low MVPA post-event compared to controls (OR, 1.78; 95% CI, 1.26-2.50). This risk was most pronounced among Black women, who had over a four-fold increased odds of low post-CVD activity (OR, 4.52; 95% CI, 2.29-8.89). In contrast, White men showed no significant increased risk. These findings underscore a critical link between long-term activity patterns and CVD risk, highlighting the need for interventions to promote and sustain physical activity across the life course, particularly for high-risk demographic groups.
Link to the article: https://jamanetwork.com/journals/jamacardiology/article-abstract/2836452
References Gerber, Y., Pettee Gabriel, K., Jacobs, D. R., Brown, N. I., Reis, J. P., Shearer, J. J., Lewis, C. E., Carnethon, M. R., Sidney, S., & Roger, V. L. (2025). Trajectories of physical activity before and after cardiovascular disease events in cardia participants. JAMA Cardiology. https://doi.org/10.1001/jamacardio.2025.2282
