Strategies Needed to Address Physical Activity Before, After CVD Events

Black women had the lowest scores for moderate-to-vigorous-intensity physical activity leading up to and after cardiovascular disease events, a new study published in JAMA Cardiology found.1

Researchers measured physical activity trajectories before and after CVD events like coronary heart disease, stroke, and heart failure. | Image Credit: LIGHTFIELDSTUDIOS - stock.adobe.com

Moderate-to-vigorous-intensity physical activity (MVPA) is essential to decrease poor health outcomes and, more specifically, primary and secondary prevention of cardiovascular disease (CVD). The World Health Organization recommends 150 minutes of MVPA a week for adults aged 18 and older, which levels out to about 30 minutes a day, 5 days a week. However, researchers believe that it still may not be enough to combat the remaining sedentary behaviors that command the majority of day-to-day life for many individuals.2

The study tracked how MVPA fluctuated over time as age progressed, comparing scores of Black and White men and women, respectively, and their association with CVD events such as coronary heart disease (CHD), stroke, and heart failure.1 The study analyzed MVPA in 3068 participants with a baseline age of 25.2 years for more than 35 years, with measurements before and after a CVD event—if applicable—from the Coronary Artery Risk Development in Young Adults (CARDIA; NCT00005130) study data. Of the 3068 participants, 56.8% (n = 1734) were female, 17.2% (n = 529) were Black men, 27.2% (n = 834) were Black women, 25.9% (n = 796) were White men, and 29.6% (n = 909) were White women.

The MVPA scores were calculated based on respondents’ physical activity history questionnaire and measured by exercise units (EU), with a score of 300 EU equating to 150 minutes of MVPA a week, consistent with physical activity recommendations. Cardiovascular events were tracked through annual contact with participants with a median interquartile range (IQR) follow-up of 34.0 years.

Out of all participants, 332 experienced non-fatal CVD events during follow-up, and of those, 236 had post-event MVPA data and were included in the case cohort. The control was then selected based on their absence of risk in relation to the case cohort and matched at a 1:1 ratio by age, sex, and race.

Average Sedentary Behavior Trends Associated With CVD Events

Average MVPA scores amongst Black and White men and women showed that Black men had the highest MVPA at baseline amongst all participants but had a persistent decline throughout their lives and were exceeded by White men and women’s MVPA during midlife (40 to 50 years old). Black women had the lowest MVPA scores starting at an early age and plateaued in their late 40s and early 50s. White men and women showed a decline in MVPA in their early years; however, both made a notable recovery after their mid-30s.

However, the gap between the case and control cohorts, although relatively similar at baseline age, widened pre-CVD event and grew larger post-CVD, superseding the former.

The study also included a nested case-control sample, 59.7% (n = 282) of whom were male and 63.6% (n = 300) of whom were Black, with a baseline age of approximately 26 years. The median age (IQR) at which CVD events occurred in the nested case-control was 49 years, and pre-CVD event, the mean MVPA was 383 EU.

The MVPA scores were also categorized by CVD type (CHD, stroke, and heart failure). MVPA showed a decline leading up to all CVD events and remained low post-CVD; however, CHD had a higher MVPA throughout follow-ups. Additionally, participants with heart failure showed the steepest decline in MVPA, which leveled off 2 to 3 years before the diagnosis and/or CVD event.

Potential covariate influences of MVPA and CVD risk

“Race and sex differences observed here align with CARDIA fitness findings, which identified steeper fitness declines among those with early adulthood risk factors (e.g., smoking, obesity, poor self-rated health),” the study authors wrote.

Present covariates showed that Black women had the highest body mass index, which is associated with sedentary behaviors like prolonged sitting and leisure entertainment like watching TV.2 Furthermore, 24.8% (n = 760) of participants reported smoking, and amongst them, Black men had the highest rate. On the contrary, White women had the lowest blood pressure and a more favorable lipid profile.

The limitations include that standard with self-reported data, like the MVPA survey, in addition to unavailable data on CVD severity, cardiac rehabilitation, and other potential influences.

“Lifelong PA is vital for maintaining function and preventing disability and chronic cardiovascular or metabolic diseases,” the study authors wrote. “This study contributes novel insights...illustrating how MVPA behavior evolves and how...CVD can alter these trajectories.”

References

1. Gerber Y, Pettee Gabriel K, Jacobs DR, et al. Trajectories of physical activity before and after cardiovascular disease events in CARDIA participants. JAMA Cardiol. Published online July 23, 2025. doi:10.1001/jamacardio.2025.2282

2. Huang Z, Liu Y, Zhou Y. Sedentary behaviors and health outcomes among young adults: a systematic review of longitudinal studies. Healthcare (Basel). 2022;10(8):1480. doi:10.3390/healthcare10081480