Article, see p 982

Physical inactivity and low fitness are important, modifiable risk factors for the development of heart failure (HF).^1–4 Recent studies have demonstrated strong, dose-dependent inverse associations among physical activity, fitness, and risk of incident HF.⁵ Physical activity has been shown to have a stronger and more graded association with risk of HF with preserved ejection fraction (HFpEF) than HF with reduced ejection fraction.⁶ However, the prognostic role of physical activity among patients with established HFpEF is less well established. This finding is particularly relevant given the near-universal presence of exercise intolerance among patients with HFpEF.

In this issue of Circulation, Hegde et al⁷ have addressed this knowledge gap by evaluating the association between physical activity levels and risk of adverse clinical outcomes among 1751 patients with HFpEF in the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist). The authors observed several important findings. First, only 11% of the study participants engaged in guideline-recommended physical activity levels at baseline. Second, compared with individuals with ideal physical activity, those with poor and intermediate self-reported physical activity had a higher risk of HF hospitalization and mortality within …

文章，请参见第982页

缺乏运动和低健身是导致心力衰竭（HF）的重要且可更改的危险因素。^{1 - 4}最近的研究表明体力活动，健身和事件HF的风险的强烈的剂量依赖性负相关。⁵与射血分数降低的HF相比，体育活动与射血分数保留（HFpEF）的HF风险具有更强，更分级的关联。⁶然而，在已建立的HFpEF患者中，体育锻炼对预后的作用尚不明确。鉴于HFpEF患者中运动不耐症的普遍性近乎普遍，因此这一发现特别相关。

在这一期《循环》杂志中，Hegde等[ ^7]通过评估TOPCAT试验中1751名HFpEF患者的体育活动水平与不良临床结局风险之间的关联来解决这一知识鸿沟（用醛固酮拮抗剂治疗心功能失常） ）。作者观察到一些重要发现。首先，只有11％的研究参与者在基线时从事指南建议的身体活动水平。其次，与具有理想体育活动的个人相比，自我报告体育活动较差和中等的人在下列情况下HF住院和死亡的风险更高：