Heart failure does not develop overnight. Rather, it is a disease that can progress over several decades; long before symptoms are apparent to the individual or their physician. During later, clinical stages of heart failure, it can be very difficult for the individual to be physically active at any level. While clinical heart failure is most often diagnosed in older adults (aged ≥ 65 years), the percentage of middle-aged adults with heart failure is growing in parallel with the growing number of adults living with obesity, high blood pressure, and/or diabetes. Thus, to reduce the burden of heart failure, strategies focused on preventing or managing these conditions with optimal timing during adulthood are needed.
This was the motivation for our paper published in the April 2026 issue of Medicine and Science in Sports and Exercise; to ask a simple but critical question: How does everyday movement in midlife, including how much time we sit or are physically active, reduce blood-based markers of heart failure progression that predict future heart failure risk?
To address this question, we drew upon the unique strengths of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a large-scale prospective cohort study of over 5,000 Black and White men and women that were recruited and enrolled at one of four U.S. clinical centers in 1985-86 when they were 18-30 years old. CARDIA was originally designed to investigate the development of cardiovascular risk factors and disease, but over 35+ years of repeated follow-up has evolved to also become a premier study of aging. In 2005-06, when participants were aged 38–50 years, a wearable device protocol was implemented, much earlier than other large epidemiological studies. This protocol was repeated in CARDIA 10- and 15- years later, which together represent the midlife period. In this paper, over 2,400 CARDIA participants contributed data, including accelerometry and two blood-based markers of heart failure progression, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (troponin). Together, these markers provide important information about heart stretch and strain, with higher levels indicating further disease progression.
The most important takeaway from this study was that higher levels of moderate or vigorous intensity physical activity (MVPA; an effort that is like a brisk walk or more intense activity) were related to lower levels of troponin. Importantly, this relationship held even after accounting for heart failure risk factors such as obesity, high blood pressure, and diabetes. The results were less clear with NT-proBNP. Overall, MVPA was not associated with this heart failure marker; however, when examining associations by groups representing sex and racial identity, MVPA appeared important for NT-proBNP levels in White men.
Surprisingly, there was no evidence to support the role of sedentary or light intensity physical activity (requires an effort like casual walking or light housework) behaviors with either heart failure biomarker. While other studies have found that even light intensity physical activities are beneficial to health, it may not be of sufficient intensity to influence these specific heart failure markers during midlife.
As the percentage of adults living with heart failure continues to rise, it is increasingly important to understand the role that modifiable behaviors, like physical activity, can play in prevention. Midlife is a critical period when the risk of heart disease increases, but it’s also a time when people may have greater opportunity and motivation to engage in physical activity. Our findings contribute new evidence that even small amounts of MVPA can lower an important marker of future heart failure. With ongoing follow-up of clinical outcomes, like heart failure, CARDIA is well-positioned to add to what we know regarding the importance of physical activity across the adult life course.
Kelley Pettee Gabriel, PhD, MS, FACSM, FAHA, is a professor of epidemiology and associate dean for research at the University of Alabama at Birmingham (UAB) School of Public Health with undergraduate and graduate training in exercise science, clinical exercise physiology, and epidemiology. Dr. Gabriel currently serves as a multiple principal investigator for the CARDIA Birmingham Field Center and actively collaborates with several large observational studies, as a PI or co-investigator, to examine the timing of physical activity and physical fitness on subsequent risk of disability and disease using a life-course framework.
Bjoern Hornikel, PhD, MA, MSPH, OLY, is a staff scientist at the University of Alabama at Birmingham (UAB) School of Public Health. He has training in exercise physiology and biostatistics and serves as the analyst for the CARDIA Birmingham Field Center. His research focuses on cardiorespiratory fitness assessment in cohort studies, physical activity measurement, and cardiovascular health.
Together, Drs. Gabriel and Hornikel serve as leaders of the UAB Scoring and Classifying Outcomes for Research in Exercise and Sleep (SCORES) Research Group, which provides comprehensive support to researchers throughout the life-cycle of a research study by providing services relevant to report- and device-based assessment of physical activity and sleep.
