Exercise Capacity and the Obesity Paradox in Heart Failure

The FIT (Henry Ford Exercise Testing) Project

Paul A. McAuley, Steven J. Keteyian, Clinton A. Brawner, Zeina A. Dardari, Mahmoud Al Rifai, Jonathan K. Ehrman, Mouaz H. Al-Mallah, Seamus Whelton, Michael Blaha

Research output: Contribution to journalArticle

Abstract

Objectives: To assess the influence of exercise capacity and body mass index (BMI) on 10-year mortality in patients with heart failure (HF) and to synthesize these results with those of previous studies. Patients and Methods: This large biracial sample included 774 men and women (mean age, 60±13 years; 372 [48%] black) with a baseline diagnosis of HF from the Henry Ford Exercise Testing (FIT) Project. All patients completed a symptom-limited maximal treadmill stress test from January 1, 1991, through May 31, 2009. Patients were grouped by World Health Organization BMI categories for Kaplan-Meier survival analyses and stratified by exercise capacity (<4 and ≥4 metabolic equivalents [METs] of task). Associations of BMI and exercise capacity with all-cause mortality were assessed using multivariable-adjusted Cox proportional hazards models. Results: During a mean follow-up of 10.1±4.6 years, 380 patients (49%) died. Kaplan-Meier survival plots revealed a significant positive association between BMI category and survival for exercise capacity less than 4 METs (log-rank, P=.05), but not greater than or equal to 4 METs (P=.76). In the multivariable-adjusted models, exercise capacity (per 1 MET) was inversely associated, but BMI was not associated, with all-cause mortality (hazard ratio, 0.89; 95% CI, 0.85-0.94; P<.001 and hazard ratio, 0.99; 95% CI, 0.97-1.01; P=.16, respectively). Conclusion: Maximal exercise capacity modified the relationship between BMI and long-term survival in patients with HF, upholding the presence of an exercise capacity-obesity paradox dichotomy as observed over the short-term in previous studies.

Original languageEnglish (US)
Pages (from-to)701-708
Number of pages8
JournalMayo Clinic Proceedings
Volume93
Issue number6
DOIs
StatePublished - Jun 1 2018

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Heart Failure
Obesity
Metabolic Equivalent
Exercise
Body Mass Index
Exercise Test
Survival
Mortality
Kaplan-Meier Estimate
Survival Analysis
Proportional Hazards Models

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Exercise Capacity and the Obesity Paradox in Heart Failure : The FIT (Henry Ford Exercise Testing) Project. / McAuley, Paul A.; Keteyian, Steven J.; Brawner, Clinton A.; Dardari, Zeina A.; Al Rifai, Mahmoud; Ehrman, Jonathan K.; Al-Mallah, Mouaz H.; Whelton, Seamus; Blaha, Michael.

In: Mayo Clinic Proceedings, Vol. 93, No. 6, 01.06.2018, p. 701-708.

Research output: Contribution to journalArticle

McAuley, PA, Keteyian, SJ, Brawner, CA, Dardari, ZA, Al Rifai, M, Ehrman, JK, Al-Mallah, MH, Whelton, S & Blaha, M 2018, 'Exercise Capacity and the Obesity Paradox in Heart Failure: The FIT (Henry Ford Exercise Testing) Project', Mayo Clinic Proceedings, vol. 93, no. 6, pp. 701-708. https://doi.org/10.1016/j.mayocp.2018.01.026
McAuley, Paul A. ; Keteyian, Steven J. ; Brawner, Clinton A. ; Dardari, Zeina A. ; Al Rifai, Mahmoud ; Ehrman, Jonathan K. ; Al-Mallah, Mouaz H. ; Whelton, Seamus ; Blaha, Michael. / Exercise Capacity and the Obesity Paradox in Heart Failure : The FIT (Henry Ford Exercise Testing) Project. In: Mayo Clinic Proceedings. 2018 ; Vol. 93, No. 6. pp. 701-708.
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AU - Dardari, Zeina A.

AU - Al Rifai, Mahmoud

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AU - Al-Mallah, Mouaz H.

AU - Whelton, Seamus

AU - Blaha, Michael

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