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Sedentary behavior and health outcomes in patients with heart failure: a systematic review and meta-analysis

Abstract

A better understanding of the association between sedentary behavior and heart failure is essential for the development of interventions to improve patients’ outcomes. Therefore, a systematic review was conducted to determine the association between sedentary behavior and all-cause mortality, health-related quality of life, and depression in heart failure patients. We searched Web of Science, PubMed, Embase, and Cochrane Library and articles in references on 7 May 2021. The search results were limited to articles on heart failure patients over the age of 18, observational studies investigating the association between sedentary behavior and heart failure, and studies reporting one or more outcomes of interest. Two reviewers independently screened the literature and extracted data. Strengthening the Reporting of Observational Studies in Epidemiology was used to assess the quality of articles. Nine observational studies were included, of which, four were of high quality. Four cohort studies indicated that sedentary behavior was significantly associated with increased all-cause mortality (hazard ratio: 1.97; 95% confidence interval: 1.60 to 2.44; I2 = 38.9%). In addition, subgroup analysis based on geographical regions was conducted (hazard ratio: 1.82; 95% confidence interval: 1.46 to 2.29; I2 = 0%). Sedentary behavior was associated with worse health-related quality of life in patients with heart failure, and the regression coefficients ranged from 0.004 to 0.033 (95% confidence interval: 0.0004 to 0.055). Although sedentary behavior was associated with increased all-cause mortality and worse quality of life in patients with heart failure, further studies are needed to determine whether this association is causal.

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References

  1. Ambrosy AP, Fonarow GC, Butler J et al (2014) The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries. J Am Coll Cardiol 63:1123–1133

    PubMed  Article  Google Scholar 

  2. Keihani D, Kargarfard M, Mokhtari M (2014) Cardiac effects of exercise rehabilitation on quality of life depression and anxiety in patients with heart failure patients. J Fund Ment Health 17:13–19

    Google Scholar 

  3. Go AS, Mozaffarian D, Roger VL et al (2013) Heart disease and stroke statistics 2014 update: a report from the American Heart Association. Circulation 129:e28–e292

    PubMed  PubMed Central  Google Scholar 

  4. Fabbri M, Murad MH, Wennberg AM et al (2020) Health literacy and outcomes among patients with heart failure a systematic review and meta-analysis. Heart Failure 8:451–460

    PubMed  Google Scholar 

  5. Hegde SM, Claggett B, Shah AM et al (2017) Physical activity and prognosis in the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist). Circulation 136:982–992

    PubMed  PubMed Central  Article  Google Scholar 

  6. Lee H, Boo S, Yu J et al (2017) Physical functioning physical activity exercise self-efficacy and quality of life among individuals with chronic heart failure in Korea: A crosssectional descriptive study. J Nurs Res 25:131–139

    PubMed  Article  Google Scholar 

  7. Waring T, Gross K, Soucier R et al (2017) Measured physical activity and 30-day rehospitalization in heart failure patients. J Cardiopulm Rehabil Prev 37:124–129

    PubMed  Article  Google Scholar 

  8. Pescatello LS, Arena R, Reiebe D et al (2014) ACSM’s guidelines for exercise testing and prescription. Wolters Kluwer/Lippincott Williams Wilkins, Philadelphia

    Google Scholar 

  9. Yancy CW, Jessup M, Bozkurt B et al (2013) ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 62:147–239

    Article  Google Scholar 

  10. Dontje ML, van der Wal MHL, Stolk RP, Brugemann J et al (2014) Daily physical activity in stable heart failure patients. J Cardiovasc Nurs 29:218–226

    PubMed  Article  Google Scholar 

  11. Chen M-F, Ke S-R, Liu C-L et al (2020) Associated factors and impacts of sedentary behaviour in patients with heart failure: a longitudinal study. Eur J Cardiovasc Nurs 19:601–618

    Google Scholar 

  12. Sedentary BRN (2012) Letter to the editor: standardized use of the terms sedentary and sedentary behaviours. Appl Physiol Nutr Metab 37:540–542

    Article  Google Scholar 

  13. Owen N, Bauman A, Brown W (2009) Too much sitting: a novel and important predictor of chronic disease risk? Br J Sports Med 43:81–83

    CAS  PubMed  Article  Google Scholar 

  14. Ford ES, Caspersen CJ (2012) Sedentary behaviour and cardiovascular disease: a review of prospective studies. Int J Epidemiol 41:1338–1353

    PubMed  Article  Google Scholar 

  15. Booth FW, Krupa DJ (2001) Sedentary death syndrome is what researchers now call America’s second largest threat to public health. Medical Pharmacology and Physiology publications (MU)

  16. Proper KI, Singh AS, van Mechelen W, Chinapaw MJ (2011) Sedentary behaviors and health outcomes among adults: a systematic review of prospective studies. Am J Prev Med 40:174–182

    PubMed  Article  Google Scholar 

  17. Thorp AA, Owen N, Neuhaus M et al (2011) Sedentary behaviors and subsequent health outcomes in adults a systematic review of longitudinal studies 1996–2011. Am J Prev Med 41:207–215

    PubMed  Article  Google Scholar 

  18. Young DR, Hivert MF, Alhassan S et al (2016) Sedentary behavior and cardiovascular morbidity and mortality: a science advisory from the American Heart Association. Circulation 134:262–279

    Article  Google Scholar 

  19. Loprinzi PD, Crush EA (2018) Source and size of social support network on sedentary behavior among older adults. Am J Health Promot 32:28–31

    PubMed  Article  Google Scholar 

  20. Edwards MK, Loprinzi PD (2016) Sedentary behavior health-related quality of life among congestive heart failure patients. Int J Cardiology 220:520–523

    Article  Google Scholar 

  21. Borland M, Rosenkvist A, Cider A (2014) A group-based exercise programme did not improve physical activity in patients with chronic heart failure and comorbidity: a randomized controlled trial. J Rehabil Med 46:461–467

    PubMed  Article  Google Scholar 

  22. Lavie CJ, Ozemek C, Carbone S et al (2019) Sedentary behavior exercise and cardiovascular health. Circ Res 124:799–815

    CAS  PubMed  Article  Google Scholar 

  23. Doukky R, Mangla A, Ibrahim Z et al (2016) Impact of physical inactivity on mortality in patients with heart failure. Am J Cardiol 117(7):1135–1143

    PubMed  PubMed Central  Article  Google Scholar 

  24. Schmidt C, Santos M, Bohn L et al (2020) Comparison of questionnaire and accelerometerbased assessments of physical activity in patients with heart failure with preserved ejection fraction: clinical and prognostic implications. Scand Cardiovasc J 54:77–83

    PubMed  Article  Google Scholar 

  25. Barbaresko J, Rienks J, Nothlings U (2018) Lifestyle indices and cardiovascular disease risk: a meta-analysis. Am J Prev Med 55:555–564

    PubMed  Article  Google Scholar 

  26. Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151:264–269

    PubMed  Article  Google Scholar 

  27. Park LG, Dracup K, Whooley MA et al (2017) Symptom diary use and improved survival for heart failure patients. Circ Heart Fail 10:e003874

  28. Park LG, Dracup K, Whooley MA et al (2019) Sedentary lifestyle associated with mortality in rural patients with heart failure. Eur J Cardiovasc Nurs 18(4):318–324

    PubMed  Article  Google Scholar 

  29. Oerkild B, Frederiksen M, Hansen JF et al (2011) Self-reported physical inactivity predicts survival after hospitalization for heart disease. Eur J Prev Cardiol 18:475–480

    Article  Google Scholar 

  30. Zahid I, Baig MA, Gilani JA et al (2018) Frequency and predictors of depression in congestive heart failure. Indian Heart J 70(3):199–203

    Article  Google Scholar 

  31. Bendassolli IMF, Oliveira AG, Costa EC et al (2019) Sedentary behavior is associated with physical activity functional capacity and a history of stroke in patients with heart failure a cross-sectional study. Motriz:Revista de Educação Física 24(3):e001418

  32. Haedtke C, Smith M, Vanburen J et al (2017) The relationships among pain depression and physical activity in patients with heart failure. J Cardiovasc Nurs 32(5):21–25

    Article  Google Scholar 

  33. von Elm E, Altman DG, Egger M et al (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Prev Med 45:247–251

    Article  Google Scholar 

  34. Falck RS, Davis JC, Liu-Ambrose T (2017) What is the association between sedentary behaviour and cognitive function A systematic review. Br J Sports Med 51(10):800–811

    PubMed  Article  Google Scholar 

  35. Schnohr P, Lange P, Scharling H et al (2006) Long term physical activity in leisure time and mortality from coronary heart disease stroke respiratory diseases and cancer: The Copenhagen City Heart Study. Eur J Cardiovasc Prev Rehabil 13:173–179

    PubMed  Article  Google Scholar 

  36. Clark BK, Winkler E, Healy GN et al (2013) Adults’ past-day recall of sedentary time: reliability validity and responsiveness. Med Sci Sports Exerc 45:1198–1207

    PubMed  Article  Google Scholar 

  37. Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16:606–613

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  38. Carvalho V, Guimarães G, Carrara D, Bacal F, Bochi EA (2009) Validação da Versão em Português do Minnesota Living with Heart Failure Questionnaire. Arq Bras Cardiol 93:39–44

    PubMed  Article  Google Scholar 

  39. Middel B, Bouma J, de Jongste M et al (2001) Psychometric properties of the Minnesota Living with Heart Failure Questionnaire (MLHF-Q). Clin Rehabil 15:489–500

    CAS  PubMed  Article  Google Scholar 

  40. IPAQ (2005) Guidelines for data processing and analysis of the international physical activity questionnaire. https://www.academia.edu/5346814/Guidelines_for_Data_Processing_and_Analysis_of_the_International_Physical_Activity_Questionnaire_IPAQ_Short_and_Long_Forms_Contents. Accessed 26 Nov 2014

  41. Furlanetto LM, Mendlowicz MV, Romildo Bueno J (2005) The validity of the Beck Depression Inventory-Short Form as a screening and diagnostic instrument for moderate and severe depression in medical inpatients. J Affect Disord 86:87–91

    PubMed  Article  Google Scholar 

  42. Beck AT, Steer RA, Ball R, Ranieri W (1996) Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. J Pers Assess 67:588–597

    CAS  PubMed  Article  Google Scholar 

  43. Craig CL, Marshall AL, Sjostrom M et al (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35:1381–1395

    PubMed  Article  Google Scholar 

  44. Loprinzi PD (2015) Joint associations of objectively-measured sedentary behavior and physical activity with health-related quality of life. Prev Med Rep 2:959–961

    PubMed  PubMed Central  Article  Google Scholar 

  45. Weston AT, Petosa R, Pate RR (1997) Validation of an instrument for measurement of physical activity in youth. Med Sci Sports Exerc 29(1):138–143

    CAS  PubMed  Article  Google Scholar 

  46. Hagstromer M, Ainsworth BE, Oja P et al (2010) Comparison of a subjective and an objective measure of physical activity in a population sample. J Phys Act Health 7:541–550

    PubMed  Article  Google Scholar 

  47. Dworkin RH, Turk DC, Wyrwich KW et al (2008) Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain 9:105–121

    PubMed  Article  Google Scholar 

  48. Young DR, Reynolds K, Sidell M et al (2014) Effects of physical activity and sedentary time on the risk of heart failure. Circ Heart Fail 7:21–27

    PubMed  Article  Google Scholar 

  49. Motl RW, McAuley E (2010) Physical activity disability and quality of life in older adults. Phys Med Rehabil Clin N Am 21:299–308

    PubMed  Article  Google Scholar 

  50. Boberska M, Szczuka Z, Kruk M et al (2018) Sedentary behaviors and health-related quality of life:a systematic review and meta-analysis. Health Psychol Rev 12:195–210

    PubMed  Article  Google Scholar 

  51. Rebar AL, Duncan MJ, Short C et al (2014) Differences in health-related quality of life between three clusters of physical activity sitting time depression anxiety and stress. BMC Public Health 14:1088

    PubMed  PubMed Central  Article  Google Scholar 

  52. Teychenne M, Ball K, Salmon J (2010) Sedentary behavior and depression among adults: a review. Int J Behav Med 17:246–254

    PubMed  Article  Google Scholar 

  53. Zhai L, Zhang Y, Zhang D (2015) Sedentary behaviour and the risk of depression: a meta-analysis. Br J Sports Med 49:705–709

    PubMed  Article  Google Scholar 

  54. Sui X, Brown WJ, Lavie CJ et al (2015) Associations between television watching and car riding behaviors and development of depressive symptoms: a prospective study. Mayo Clin Proc 90(2):184–193

    PubMed  Article  Google Scholar 

  55. Hallgren M, Owen N, Stubbs B et al (2018) Passive and mentally-active sedentary behaviors and incident major depressive disorder: a 13-year cohort study. J Affect Disord 241:579–585

    PubMed  Article  Google Scholar 

  56. Troiano RP (2009) Can there be a single best measure of reported physical activity? Am J Clin Nutr 89:736–737

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  57. Lee IM, Shiroma EJ (2014) Using accelerometers to measure physical activity in large-scale epidemiological studies: issues and challenges. Br J Sports Med 48:197–201

    PubMed  Article  Google Scholar 

  58. Atkinson G, Nevill AM (1998) Statistical methods for assessing measurement error (reliability) in variables relevant to sports medicine. Sports Med 26:217–238

    CAS  PubMed  Article  Google Scholar 

  59. Dupont WD, Plummer WD Jr (1990) Power and sample size calculations: a review and computer program. Control Clin Trials 11:116–128

    CAS  PubMed  Article  Google Scholar 

  60. Petersen C, Bauman A, Grønbæk M et al (2014) Total sitting time and risk of myocardial infarction coronary heart disease and all-cause mortality in a prospective cohort of Danish adults. Int J Behav Nutr Phys Act 11:1–13

    Article  Google Scholar 

  61. Snipelisky D, Kelly J, Levine JA et al (2017) Accelerometer-measured daily activity in heart failure with preserved ejection fraction: clinical correlates and association with standard heart failure severity indices. Circ Heart Fail 10:e003878

  62. Evenson KR, Butler EN, Rosamond WD (2014) Prevalence of physical activity and sedentary behavior among adults with cardiovascular disease in the United States. J Cardiopulm Rehabil Prev 34:406–419

    PubMed  PubMed Central  Article  Google Scholar 

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Contributions

Qiuge Zhao designed the study and wrote the manuscript; Cancan Chen provided help with drafting of tables and the study design. Jie Zhang and Yi Ye provided help with the study concept; Xiuzhen Fan designed the study and revised the manuscript. All the authors approved the final version of the manuscript.

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Correspondence to Xiuzhen Fan.

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The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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Zhao, Q., Chen, C., Zhang, J. et al. Sedentary behavior and health outcomes in patients with heart failure: a systematic review and meta-analysis. Heart Fail Rev 27, 1017–1028 (2022). https://doi.org/10.1007/s10741-021-10132-7

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  • DOI: https://doi.org/10.1007/s10741-021-10132-7

Keywords

  • Heart failure
  • Sedentary behavior
  • All-cause mortality
  • Health-related quality of life